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International Eyelid Surgery

Global eye experts focus on Asia at Sydney Congress

One of the largest eye-health conferences ever held in Australia attracted almost 4,000 people involved in eye care from 67 countries.
The March 2011 meeting of the Asia Pacific Academy of Ophthalmology (APAO), held in Sydney reflected the huge growth in this specialist area of medicine throughout Asia.
“There has been an enormous explosion in ophthalmology in Asia at the moment”, said Consultant Ophthalmic Plastic surgeon Jane Olver of Clinica London.
“Currently Hong Kong and Singapore are two of the leaders very much supported by Australia. South Korea and India also have impressive Oculoplastic Surgeons. In Europe we might not think of Australia as being Asian because it was originally inhabited by pale Scottish and Irish people; however, because of its position, its demographics are changing. Now there are many people settling there from Indonesia, Japan and more recently from China too.”
Jane, who was invited to speak at the Congress and the Masters’ Symposium on Blepharoplasty and Upper Facial Rejuvenation which was held to coincide with the APAO event, added that the Asia-Pacific region was in no way lagging behind the rest of the world in the field of ophthalmology and oculoplastics.
“Currently it is running equal to Europe but I would estimate that within the next two years they will be ahead in some areas such as lacrimal surgery.”
Jane surmises that these advances are down to modern teaching techniques in the region which includes countries such as India, China, South Korea, Japan and New Zealand.
“People in these countries are learning the newest techniques straight away, whereas in the rest of the world -where the speciality has existed for longer – there has to be a change of mindset to abandon some of the older methods that are used.”
This year Jane co-chaired, (with Dr Yoon-Duck from South Korea and Dinesh Selva from Adelaide), a course on “Current Techniques in Lacrimal Surgery”.
“The management of the tearing patient can be challenging and the course included examining the problem in children and whether they might be suitable for little glass by-pass tubes (Jones’ tubes).”
Jane, an expert in performing operations on the lacrimal system via the nose (endonasal dacryocystorhinostomy or DCR), was especially interested in Dinesh Silva’s talk on the “Challenging anatomy in endonasal DCR)
“There are differences in the anatomy of Asian and Caucasian patients. In tear duct surgery, because the Asian nose is a bit flatter, things are at a slightly different angle. Also the bone can be somewhat thicker in places than in a Western nose. This means that different surgical tools and equipment is required.”
Jane closed that part of the programme by drawing together the topics and adding that another location should not be forgotten in her highly specialised talk entitled : ‘The inferior meatus, a place to look?’ – which involved examining this area inside the tear duct where it opens into the nose.
Jane also co-chaired the Congress session on “Orbits and Oculoplastics –contemporary techniques in eyelid reconstruction”.
Here the speakers illustrated the various simple and advanced surgical techniques that are used for eyelid reconstruction including the use of flaps and grafts.
Jane spoke on the management of low eyebrows in facial palsy. She found especially enlightening a talk on the short lower lid and the missing or failing lateral canthus given by David Tse, from Florida, which covered a somewhat less invasive surgical technique than usually used in such cases.
As with endonasal surgery, Asian and Caucasian eyelids have a different anatomy.
“The Asian eyelid is a single eyelid whereas Western people have a deep skin crease some 5 to 8 mm above the lash line – Asian eyelids have no crease at all. There also tends to be a slightly different distribution of fat within the eyelid and eye bags which might want removing.”
The aging process also happens differently; with Asian faces much less prone to wrinkling meaning that generally there is less interest in Botox and fillers than in the West.
“Asian faces tend to age beautifully”, said Jane. “For instance a woman in her 80s will still have a fuller more youthful face than her European counterpart aged around 65.
“Sometimes there might be an interest in volume replacement and there have been some problems with cheap fillers manufactured in China. I have had to remove some of these that have caused infections and other problems.”
Jane who is a firm believer in education spoke on the subject of “Periocular Botox” during the session on “New Approaches to Periocular Rejuvenation” in the parallel Masters’ Symposium which was sponsored by the Australasian Association of Facial Plastic Surgeons (AAFPS).
“As well as surgical, I looked at other rejuvenation techniques using Botox and fillers for the brow and upper cheek area.
“In this part of the face, Botox can be used to adjust the level of the eyebrows – they can be either raised or dropped as required. It is also used to diminish the horizontal smile lines and, of course, further down the face too.”
In 2010 the APAO Congress was held in Beijing and in 2012 it will take place in Busan, South Korea. Jane Olver is again invited to lecture.


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