The face and human interactions

Psychologist Albert Mehrabian described 3 components in face-to-face communications namely,  verbal, vocal and visual. Also known as the Mehrabian Rule, this rule states that 7% of communication involves words, 38% tone of voice and 55% body language. Usually the 3 components have to be congruent to support each other in communication. When words and body language fail to agree, one tends to believe the body language. 

People see, observe and judge others via their facial expressions. Facial expressions are therefore essential for daily life to enable effective communication.

Often times, people express concern that their facial features are communicating unintended signals.

 Often times, people express concern that their facial features are 

communicating unintended signals such as disapproval (frown lines), tiredness or disinterest (droopy eyelids), aging (forehead wrinkles and crow’s feet), worry (droopy angle of mouth, eyebrow  and frown lines).

Hyperactive corrugator muscles can send out unintended signals of worry or disapproval. 

Dental and skull deformity can also impair the ability to express oneself, with an observer potentially misinterpreting  one’s emotions or personality. For example, people with short chin, protruding incisors,  or gummy smiles may appear unintelligent. People with huge jaw  tend to appear more aggressive and a smile may appear more like a grimace. Those with flat cheek bones or saggy face often have down-turned angle of the mouth, thus looking angry or sad.

A small eye with single eyelid and wide inter-eye distance is sometimes misinterpreted as disinterest or tired

In other words, the face can malfunction as an organ of communication. As a great deal of human communication takes place without the need for words,  facial expression is immensely  significant in non-verbal communication. As aesthetic medical treatment is increasingly accessible, more people are seeking such services to improve their quality of life in terms of social interactions, carrier development and personal satisfaction.

Droopy brow and deep nose-lip fold with saggy mouth angle may appear as sad or angry.

DST 缝制无痕双眼皮

交叉式勾双眼皮（Double sutures and twisting method /DST) 手术法是最复杂的双眼皮手术 。

相对而言，传统的缝合法具有较高的损伤率和不清晰的皱折，其将随着时间的消逝而退化。

交叉式勾双眼皮（Double sutures and twisting method /DST)不仅可以解决这些不足，还可以保有缝合法的优势，如皱折几乎无痕、自然，并有潜在的可逆性、恢复迅速快（仅需要几天而非几周）。

在埋线法手术 中，折痕的生成是通过永久性地埋入无排斥反应的线（聚丙烯纺织纤维，用于心瓣膜手术），至眼睑的深度软组织。分析显示埋入线通常不会断裂，但埋入线可能切 穿上眼睑的软组织。

交叉式勾双眼皮(DST)矫正了这个问题，并让埋入线更结实，还降低了让埋入线切穿软组织的可能性。首先，把埋入线的一端固定在上眼睑 最结实的组织——睑板（其由坚固的软骨组成）；埋入线的另一端与临近的埋入线链接，正如两个连接在一条链上。在打结前，眼睑皮肤下方被捏入埋入线。这就形 成一个坚固且互锁的折皱，极为有效地防止了其切穿或断裂。


以下为部分完成的 交叉式勾双眼皮 例子：-

A History of Asian Double Eyelid Surgery

Is double eyelid surgery an attempt at Westernization of the Asian Eyelid?

Here is an abstract from PMC:

Asian Blepharoplasty

Marilyn Q. Nguyen, M.D., Patrick W. Hsu, M.D., and Tue A. Dinh, M.D.

Semin Plast Surg. 2009 August; 23(3): 185–197.
doi: 10.1055/s-0029-1224798

The “double eyelid” operation, or surgical creation of a supratarsal crease, is the most commonly performed aesthetic procedure in Asia. Whereas this procedure is considered by some to be an attempt at Westernization of the Asian eyelid, the first published description of the procedure was in the late 1800s, long before the existence of a strong Western presence in Asia.

Early publication in the Japanese medical literature favored the suture ligation method. In 1896, Mikamo described the “double eyelid” feature and how it was considered an indicator of beauty by writers and artists of that time period. Single eyelids that did not possess a distinct supratarsal crease were described as “monotonous and impassive.” He estimated the incidence of the single eyelid in Japanese women to be approximately 17 to 18% and thus concluded that the double eyelid was the physiologically normal appearance. Mikamo's technique was a modification of a surgical procedure used to correct entropion that was first described and used in the ophthalmology literature. He referenced Kamoto by saying that the procedure not only corrected entropion but also created a “clear double eyelid and a more attractive look.” In this first publication on Asian blepharoplasty, Mikamo described how three sutures were passed through the full thickness of the eyelid to include the tarsus. Each suture was placed approximately 3 mm apart, 6 to 8 mm superior to the lid margin, and removed after 4 to 6 days. He emphasized maintaining an appropriate distance between the lid margin and the suture line such that the double lid remained commensurate with those of Japanese women who had a naturally occurring crease. This again highlights the fact that the initial operation was not intended to Westernize the eyelid but to create an overall more expressive look.

After these initial case reports by Mikamo, little was published until the 1920s, when increased Western presence introduced new concepts of beauty and changed the Asian attitude toward aesthetic surgery. The suture ligation technique continued to be the only method and was described by several authors including Uchida. In Uchida's article, he described his results with 1523 eyelids in 396 males and 444 females. The crease was designed similarly to Mikamo's description; it was placed 7 to 8 mm from the ciliary margin, and the sutures were removed on postoperative day 4.

Maruo described the first external incision technique in 1929. His technique required an incision across the lid 7 mm from the ciliary margin. Closure of the incision included a trans-lid passage from the conjunctiva to the superior tarsal border of the anterior skin edge to the tarsal plate.

Over time, a greater Western influence was clearly seen and reflected in the procedures that followed. Hata described creating a higher crease at 10 mm in 1933, and in the 1940s to 1950s, multiple authors including Hayashi, Inoue, Sayoc, Mitsui, Fernandez, and Boo-Chai described techniques including excision of muscle and fat to create a deeper-set eye in addition to creating a double eyelid.

Today, the literature contains abundant material on both suture ligation and external incision techniques, as well as a new focus on procedures to eliminate the epicanthal fold. The surgeon should be aware of the broad range of surgical options in modifying the eyelid and tailor procedures according to each individual patient's preferences, which can vary widely even between different Asian populations. According to the 2006 cosmetic demographics published by the American Society of Plastic Surgeons, Asian Americans compose 6% of the cosmetic patient population with blepharoplasty ranking as the third most commonly requested surgical procedure behind rhinoplasty and breast augmentation. Although most patients desire the creation of a supratarsal crease, the expectation of the size, shape, and height of the crease can differ significantly between different subsets of the Asian population. All in all, most surgeons agree with the idea that the double eyelid procedure should create a lid that remains within the norms for the Asian face, rather than Westernize the eyelid altogether.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884917/

Why Do Men Find Women with Larger Eyes Attractive?

Zidbits, Science, June 2, 2011 - According to studies done, research has shown that men generally find larger eyes on women more attractive. This has lead to a growing trend (especially in Asia) for many women to use cosmetics and contact lenses with larger limbal rings to give the illusion of larger eyes. Some have even done this permanently through cosmetic surgery.

But why do men find larger eyes attractive?

There seems to be two separate reasons why larger eyes on a female are more attractive. The first is that larger eyes (along with fuller lips, bigger breasts and smaller chins) is a sign of higher levels of estrogen. Women that have higher levels of estrogen will be more successful and have an easier time conceiving than women with lower levels. This means that women with larger eyes will be seen as a better ‘mate’.

The second reason is that large eyes are a neotenous feature.

A neotenous feature is a characteristic of youth shared by babies and children that humans evolved to retain so they could attract quality mates with “protective and nurturing impulses” which would be more likely to help raise their offspring and raise reproductive success. Since human eyes do not grow in size during development as much as the rest of the body, the size of the eye relative to the face decreases as we grow. This means that babies have relatively large eyes compared to older children and adults. As a consequence, people who have large eyes are often perceived to be younger than they really are. Since perceived youth of a mate is also a sign of fertility, men tend to prefer women with neotenous features, like large eyes.

However, this isn’t saying that men want to mate with babies and small children – that would be incredibly maladaptive because they are not fecund. So, then, why do males usually prefer women who, in essence, look like babies?

It’s thanks to something that happens in evolution called Fisherian runaway selection. Fisherian selection suggests that, when one sex prefers mates with certain genetic traits, then, through the process of sexual selection, the other sex will come to possess the trait in increasingly exaggerated forms. 

The process is called “runaway” because over time, it would cause the development of greater preference and more pronounced traits, until the costs of producing the trait balance the reproductive benefit of possessing it. The peacock’s tail is an example of this. Its tail requires a great deal of energy to grow and maintain, it reduces the bird’s agility, and increases the animal’s visibility to predators. Yet it has evolved which indicates that peacocks with longer tails have some advantage.

This same process occurs with men’s preference for women with neotenous features.

Double Suture and Twist (DST) - The Durable Non-Cutting Double Eyelid Procedure for Asians

Double-eyelid procedure is the most popular cosmetic procedure in Asia. Whereas most surgeons in the United States perform cutting-type double eyelid surgery, Japanese women prefer non-incisional or suture methods.

Publications in the early Japanese medical literature favoured the suture method. The first description of this method, by Mikamo was published in 1896. Between 1896 and 1950, 11 articles relating to the suture methods were published in the Japanese medical literature.

The configuration of a double eyelid consists of four important parameters, namely, height, shape, continuity and permanence. As the suture method has been criticized for its high breakage rate and poorly define crease which fade over time, permanency is the major challenge the suture method is facing along its evolution.

In 2001, an improved non-cutting method to create double eyelids in Asian patients is reported. Dr Katsuhiro Kure, and Dr Akihiro Minami described an improved procedure that uses double sutures and twists (DST) to create double eyelids in Asian patients. Dr. Kure says the non-incisional procedure is “simple, durable, and virtually scar free.” The method uses only two sutures on each upper eyelid, with the durability explained by the areas of ties and the central twists that result in more secure and therefore longer-lasting results.

The average operative time ranged from 20 minutes (one side) to 60 minutes (bilateral). Most patients did not require sedation, and the surgeries were performed with only local anesthesia. Recovery time was short (3-7 days), and complications were minor and rare.

The published report for breakage or loss of fold is approximately one percent per year (ten year follow up). An extraordinarily low failure rate for this method has therefore been scientifically established, comparable to an incision method. There is a notion that the DST technique frequently fails or disappears over time. In many anecdotal comments, the most common source of misinformation has been in confusing the DST technique with traditional suture techniques that are unreliable. It is therefore important to verify that the technique used is DST before you decide to undergo such procedure.

The credential of the doctor is of course first and foremost. The registration of a doctor can be verified at the Malaysian Medical Council website.

This method is suitable for younger candidates with eyelids which do not have lots of loose skin or fat, or any obvious eyelid deformities.

Some examples of double eyelids created using DST:

The types of eyelids which are not suitable for this non-cutting technique:

Obvious ptosis (droopy eyelids)

Obvious asymmetrical eyelids

 Dermatochalasis (Eyelid with lots of sagging skin)

Thick eyelids with lots of fat

These cases require incisional blepharoplasty (Cutting double eyelid surgery), a procedure which requires a highly meticulous and precise work of a well-trained and talented oculoplastic surgeon as it involves highly accurate measurements, skin removal, cutting into deeper structures and the ability and experience to manage possible complications promptly. Such invasive procedure if carried out by unscrupulous cosmetic practitioner is at risk of suffering a permanent deformity due to excessive fat removal, ptosis (droopy eyelid) due to damage to the muscle and tendon which opens the upper eyelid (levator muscle and aponeurosis), lagophthalmos (lid retraction or unable to close the eyelid fully) due to excessive skin removal and worst of all, blindness due to retrobulbar haematoma (accumulation of blood behind the eyeball) resulting in compression and damage to the optic nerve.

A thorough assessment is therefore crucial before deciding on which kind of double eyelid procedure is suitable for an individual. Appropriate referral to a talented and experienced oculoplastic surgeon has to be made where DST is not suitable to ensure safety and best outcome for the individual.

Double Eyelid Surgery

Eyes with a lid crease between the eyelashes and the eyebrows  are described as having a ‘double eyelid’, whereas those without a crease have a ‘single eyelid’.

We all know that having double eyelids makes our eyes look bigger, wider and culturally perceived to be more alert, friendly, confident  and attractive. Having a double eyelid also allows easier application of cosmetics and no need to stick eyelid tapes anymore.

Studies have shown that about 50% of Asians do not have an upper eyelid crease, the other 50% have a least some form of crease. Therefore, it has been very popular among the Asians to opt for procedures that create double eyelids.

There have been various popular methods of creating double eyelids. The decision on which procedure is most suitable depends on the type and condition of one’s eyelids.

There are incisional (cutting) and non-incisional (non-cutting) methods. The incisional method involves plastic surgery through which some of the eyelid skin is excised. The patient will be required to return to the clinic and have the sutures removed. It may leave a prominent scar on the eyelid where the skin is removed. This is an excellent approach for those eyelids with too much loose skin around the eyes or lots of fat.

The non-incisional method is called the suture (stitching) method. In this method, no removal of skin using the knife is involved. Instead, sutures are passed through the eyelids via small punctures to create a fold by pulling the underbelly of the skin inwards when the eyes are opened. This method does not leave a prominent scar, no removal of sutures is required and recovery time is very short as no significant incision is made.

However, the traditional suture method is highly criticized for it’s short lifespan. Until recently, the advent of a new suture method known as the Double Suture and Twist (DST) technique, well-known for its longevity, addresses these disadvantages but maintaining the benefits of a suture method such as the quick recovery, scarlessness, naturalness of the crease and reversibility. This method is suitable for younger candidates with eyelids which do not have lots of loose skin or fat, or any obvious eyelid deformities.

Some examples of double eyelids created using the DST technique: