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Double eyelids for Asians: plastic surgeon Dr Woffles Wu demystifies the procedure

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Double eyelids, epicanthoplasty, facelifts, eye bag removals: these are just a few procedures in plastic surgeon Dr Woffles Wu’s surgical bag of tricks.

A craniofacial surgeon by training, Dr Wu’s name has become synonymous with plastic surgery in Singapore and the region. He pioneered several techniques, among them the famous Woffles Lift, a non-surgical face lifting procedure which involves injecting threads into the face through a needle with minimal downtime.

These days, as Dr Wu continues to work with his hands to create beauty for his patients, he has also written a memoir Life in Plastic and writes for a monthly column for the Straits Times on topics like living well. We had the pleasure of having a chat with Dr Wu on the inner workings of plastic surgery and what it means to get that coveted, double eyelid folds of every Asian girl’s dreams.

1. What is the most common reason for plastic surgery in Singapore, in your experience?

WW: There are different reasons for different age groups. You can divide them into two main age groups: those under 35 years old and those 35 years old and above.

Let’s take young people for example: they don’t look old, they look young! Most of them want to look in a specific way. For example, they want to have a specific kind of double eyelid that looks like a Caucasian eyelid; or they feel like their nose doesn’t fit in with their overall face, they want something slimmer, sharper, higher. Or they want their face shape to be a bit more oval, as the typical Asian face shape tend to be a bit square, boxy and a bit flat. Young people come for what we call structural change.

Now, older people come because they want to look young – basically reverse the science of ageing. They may be happy with their prettiness factor, but they don’t like the fact that they are now getting lines, or bits hanging down, so they want these pulled up or filled out, so that they can look more youthful. So these are two different ends of the spectrum.

2. Can we say that double eyelid surgery in Singapore is the most popular surgery nowadays?

WW: Let me take you back 25 years ago – it is true that double eyelid surgery probably was the most popular procedure.

But today, because people are more educated and they have more information on what they can do; catching up is eye bag surgery in Singapore. A lot of people know that to look good and fresh, they shouldn’t have eyebags bulging out. So many people are doing eye bag surgery. More people are also doing epicanthoplasty, to cut the inner or outer corners of your eyes to make your eyes larger. These are also very important procedures.

3. Is there any way we can create double eyelids without doing surgery?

WW: The easiest way is to put double eyelid tape. That is what a lot of patients do before they come to see me. They will put a little sticky tape – I think in Japan, you can buy a whole ton of tape to try out – you can make the eyelid line higher or lower with it.

I usually encourage my patients to bring the tape with them, put it on, to let me see what kind of eyelids can be formed on them just by using the tape. If the patient likes the results that the tape gives them, usually I can use the non-surgical method – which is what we call the stitching blepharoplasty, where we can insert a number of stitches into the eyelids which holds the skin into position, much the same way as the tape. That way, you can get a permanent set of double eyelids. But if you wear tape, your double eyelid also disappears once you take the tape off.

If you have been using double eyelid tape for many months, it’s possible that your eyelids can form a tiny little bit of a crease even if you don’t wear the tape. It’s like training the skin to fold into position. But sometimes it can’t give the desired effect, especially when the tape is not strong enough, or the tape can fall off. Or if there is too much fat in the eyelids, you also can’t get a good shape with just applying tape.

4. I’m not sure if this is a myth: does wearing double eyelid tape for a long time cause a condition called droopy eyelids?

The thing is, any rubbing of the eyelid – vigorous rubbing or constantly putting things and pulling things off – can in fact, affect the strength of that muscle which is in the eyelid. And there is a condition called seniletosis. Which means, as you get older, the muscle that is responsible for opening your eye gets weaker and weaker.

I even had patients who were born with double eyelids, but because they keep rubbing their eyes, or they keep folding their eyelid back to put on contact lenses, or every day they keep removing make up, they can actually alter or even lose their double eyelid fold. The double eyelid is a very flimsy structure; if you keep rubbing your eyes, you can actually damage it. That said, under normal circumstances, your double eyelids can last you 20 to 30 years.

5. Is everyone suitable for double eyelid surgery?

Yes, I would say everyone is suitable for the procedure. Health issues like high blood pressure or diabetes or any other underlying medical condition are not of any significance here. The more important thing is to decide what kind of double eyelid you want, and what kind of procedure will give the patient the desired result.

6. What are the different types of double eyelid procedures?

Let me quickly categorize them for you. If I take a younger patient who is 18 to 19 years old who has monolids but don’t have too much fat in the eyelids, I would almost always do the stitching blepharoplasty. Just a bit of local anesthetic, we put in a number of stitches, we create a fold – the recovery is very quick. Less than 4 days and the swelling goes down. They can go out, put make up and they look great. So it’s a very nice procedure. That’s for the younger age group.

Now let’s go to the older age group: say, someone who is 65 years old. The skin around the eyelids has become thicker, it’s not so elastic, there may be a lot more fat inside or there may be other issues with the eyes. In these patients, doing the stitching method is not appropriate because you need to remove something – some skin, some muscle, maybe some fat – and then you have to reshape it due to the sagging and drooping issues. We call this open double eyelid surgery. So that’s two different operations for two different ends of the spectrum for double eyelid surgery.

Do we do open double eyelid surgery on younger patients? The answer is yes, we do – if the eye shape is not nice, if there is too much fat bulging at the top – no matter how nice a double eyelid you give them, it won’t have a nice effect. So you may have to remove fat or some skin first. But I generally try not to do open eyelid surgery on a young person, because young people can always change their minds. I have had patients who come in to do double eyelid surgery and then a few months after, they decide they want to go back to single lids. If it’s a stitching method, all I need to do is find the stitches and remove them, and she will go back to her having her monolidded look as she did before.

Also, for the older patient, it doesn’t mean to say I strictly don’t do the stitching method at all. I can still do the stitching method for them, provided they don’t have a lot of excess skin, fat or muscle.

So every patient needs to be assessed and that’s where I as the doctor will guide them in recommending the best option for them by explaining to them that they are in this particular category of patients, and showing them examples in pictures and also after-pictures to let them know this is the typical result of how your double eyelids will look like after surgery.

7. Okay, walk me through the whole process if I want to do a double eyelid procedure – what are the considerations, what can I expect, etc.

Basically, when you come in and see me to tell me – Dr Wu, I want double eyelids – I would ask you the first important question: what kind of double eyelid do you want? Do you want an innie eyelid or an outie eyelid?

An outie eyelid is where the fold is parallel to the opening of your eye – a little bit pan-Asian looking. An innie eyelid is what we call a tapered fold where the fold comes in and joins into the corner of the eye – a little bit more Oriental looking.

When you come in, I would use some surgical instruments to try and create the fold for you. I would be able to tell whether naturally, you are an outie or an innie. You’ll be able to see both examples of an outie and innie double eyelid on you.

So for example, I would say no matter how I stitch, it will still be a tapered fold because that’s how your eyelid skin folds. But then the patient may say: but I really want a parallel fold, because I want to look more pan-Asian. Then in order to do that, we will need to do another procedure called the epicanthoplasty to open up the corner. In this way, you can convert a tapered fold to a parallel fold. It is very important to decide what is the patient’s desired eyelid fold.

Then we go on to see which method is suitable for you – the stitching method or the open surgery method, typically where I will remove some skin and fat. You will see the scar line for about 6 weeks and then it will gradually fade. So there is a longer recovery process with the open surgery method as opposed to the stitching method.

8. Is the stitching double eyelid method a temporary measure?

The answer is no. There are many different kinds of stitching method, and the method that I use is the one I pioneered about 30 years ago in 1989. I fixate the skin in a special way such that the fold never comes off and it can last many years.

I have done this for patients as far back as in 1990. It’s been thirty years now and they still have the double eyelid, but of course it’s a little bit lower due to ageing, but the double eyelid has never been lost. However, you can lose your double eyelid folds if fat begins to grow, and the fat pushes the skin outwards on the stitches, causing it to fail.

9. In general, how much is the cost of double eyelid surgery in Singapore?

A ballpark range is around $5,000++ for the stitching and open double eyelid surgery is about $6,000++.

10. How can I choose a good double eyelid surgeon?

It is getting increasingly difficult to select surgeons because there are so many. There is a lot of advertising which sometimes may not be as accurate and people put in multiple credentials to make themselves look more qualified. I guess one of the things is to ask people online or offline. Ask your friends.

Most of my patients come see me by word of mouth anyway. They look at my website. I always believe like education is the most important thing – so I try and treat every patient like I’m teaching them something, so they will gain information. I try to make my website more educational, like: these are the things you need to consider, etc. I always end my answers with: you don’t have to do it with me, but you should look for a well-qualified plastic surgeon.

One of the problems is patients don’t know the difference between a plastic surgeon and an aesthetic doctor. You have to be careful that aesthetic doctors are not surgeons and if you’re doing anything that is surgical, look for a qualified plastic surgeon. You can just Google plastic surgery Singapore and start your research from there.

11. Any tips for us patients, for example, what questions to ask doctors to determine if he or she is a good fit?

Well, I’ve been in this business for so long that even if patients don’t ask me any questions, I will ask them the questions!

One of the questions I like is, what kind of effect do you want? Show me a picture of a celebrity or a movie star whose eyelids or face you want. And then I will analyze the picture and ask, what is it about this face you like? Is it because you want to look not so Chinese? Is it because you want to look more pan-Asian? The usual examples are Diliraba and Angela Baby. Or do they want to look like Shu Qi or Gong Li, who are more oriental.

I try to get into the psyche of the patients – what is it they want to portray? Do you want to be subtle or have the more in-your-face dramatic eyelids? What kind of make-up do you like to put on? Some patients don’t like to put on make-up, but some patients like to put on a lot of make-up. They may want deep, high folds to accentuate the eye make-up.

And then you’ve got the girl next door, who doesn’t want anybody to know she’s had a double eyelid surgery done, she just wants to look like she was born with it and she wears little to no make-up.

All these different things give you an idea what is in your patient’s mind, and then you can judge whether they would be good candidates, happy patients or if the reason for surgery is due to other more deep-seated issues and that whatever you do for them, it’s still not right.

I usually spell everything out: for sutures, this is how what the outcome will be; for the cutting method, this is how it will be – you probably won’t look nice for 3 months because that’s how long it takes to recover. If they are not able to accept it, then it’s really up to the surgeon to tell them he can’t do what they expect.

12. What is the Woffles lift?

The Woffles lift is something I invented in 2002. It is a non-surgical face lifting method using a special thread which I patented. It’s in the Singapore encyclopedia etc. It’s a special thread that can be inserted into the face through a needle so there is no cutting. You insert the needle and the thread goes up to the temple and comes back down again. When you push the face upwards, the soft tissues get attached to the tiny little barbs on the thread and it becomes quite a strong fixation. Patients can get a couple of years out of this procedure.

Now, others call this a thread lifting procedure but there is a lot of confusion in the market about thread lifting right now, because there are many made of dissolvable threads from Korea and other countries. Ours is not dissolvable; we are plastic surgeons and we want to have a longer duration for our patients. If we use a dissolvable thread, they may get a nice result for the first few weeks but rapidly it will be lost because the thread disappears. So ours is a permanent suture, it stays in, it’s very safe and it’s easily removed, and gives a longer duration. You can also add on to it – if a patient comes back in a few years’ time after ageing a little bit, we can add one or two threads to add to the uplifting effect. It’s a very convenient procedure.

If we compare it with a traditional face lift – which involves a lot of scars at the ears and in the hairline, and then you pull everything upwards – the result can take up to 3 months to look decent. It’s always overstretched, sometimes you see the scar and sometimes the scar turn into a keloid and then it becomes very visible.

With the Woffles lift, it’s totally invisible – you can’t see the needle marks that have been put into the cheeks. For 24 to 48 hours, those marks disappear. There is a little swelling, there’s a bit of facial distortion – you may look a little overly tight but within a week that settles and the patient can start enjoying their rejuvenated looks.

Why has the Woffles lift become so important? It’s because many patients today, especially those going for non-surgical treatments, they are used to having Botox or fillers, to fill the nose and cheekbones. But once they start having issues of sagging, when the face begins to lose volume, you can put a filler in but it will never have the same result to physically lifting the structures back into its original position. The Woffles lift is a lifting, restorative procedure.

13. Would you recommend Botox or fillers in general?

I would say Botox, because Botox is safer than fillers. There is some risk with fillers you can get an infection called skin necrosis and in worse cases, you can get it into the wrong blood vessel and block off the ophthalmic artery, causing blindness.

If it’s an expert administering it, he would probably deliver the filler and the Botox well and safely. But if it’s a junior doctor or an aesthetic doctor just starting out, and you analyze which is safer, it’s actually the Botox is safer.

14. What beauty procedures would you advise a woman who is entering her big 30s to take note of and look at?

Prevention is better than treatment. Most people do start to have a lot of lines at their eyes called crow’s feet when they are into their 30s. If this begins to bother the patient, then she can look into things like Botox. Some people also start getting a lot of laugh lines or sunkenness in their cheek area, then you can start putting a filler in as well.

Fillers and Botox are actually just to restore patients to how they look like before. Because when we’re young, we don’t have a lot of lines on our face, we have the ability to move, we’re all quite full in the face. It’s only as we begin to age, very subtly, we notice that everything is beginning to deflate. At that point, around 30 to 35 years old, it’s good to just go in and reinflate the balloon. Not to reinflate to the point it becomes like a very weird looking balloon, but just to reinflate so that it gives you a not-so-tired and more youthful appearance.

Things like eyebags or double eyelids, most of this are genetically determined. So look at your parents – if your parents have big eyebags, chances are you will develop eye bags. It’s just a matter of time. When you do develop those eye bags, at least you know what you should do or who you should be going to look for to remove it.

15. What is one beauty hack you personally subscribe to?

I always talk about nutrition and exercise. Every day, if you can do some form of exercise where you’re sweating, your cardiac rate’s up, and your pores are functioning because you’re sweating, all the sebaceous material on your hair also gets that sweat and then you wash it all off.

And then you also must make sure you get adequate hydration and nutrition to replace what is lost. If you have a balanced diet and healthy lifestyle, that will create that glowing, elastic skin. And people with very clean skin always look nice. Those people with thick oily skin with a lot of greasy production you can see their pores are very big and coarse. But it can be controlled by diet, exercise, the appropriate cream to use on the face for acidification – this goes into a whole different spectrum of skincare. Also take your supplements, your Vitamin Cs and Es, other elements that can contribute to your health.

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