2021: A New Year- New Possibilities

2020 has been an incredible year. For sure it has been a tough year but in all the difficult periods there are the big life lessons. The paranoia of the early days of the pandemic has given way to a little breathing space now. This pandemic has been a pause button on our lives and it was a time to take stock. It made us realise how privileged we were to have the things we had taken for for granted. It showed us what was truly important in our lives and what was the fluff in it.

The Hooded Eyelids!

After ruling out any connective tissue disorder which could also cause such a condition, I performed the Lateral Canthoplasty (Reconstructing the lateral canthus) thus restoring the ideal almond shape of the palpebral (eyelid) opening. Not just a new lateral canthus needs to be reconstructed, we also have the make sure the eyelid do not stick back together by using silicone bolsters as tissue spacers.

A Nose to Remember!

Our team consisting of a Neuro-surgeon, Oculoplastic Surgeon (Me) and Maxillofacial Surgeon operated on him for nearly 10 hours to get this young man back to his pre-accident status. The Neurosurgeon fixed his CSF leak after taking a bi-coronal flap approach and we then painstakingly fixed his frontal bone fractures piece by piece using titanium plates and mesh as a framework. I then repaired both his orbits👀 with pre-fabricated combined medial and floor titanium implants using the trans-conjunctival approach to avoid any extra skin incisions. The left anterior nasal buttress had to be fixed with a titanium mini-plate from an oral incision. The flattened nose 👃still had to be fixed which was then suspended from the frontal bone titanium frame while using internal nasal splints and external POP splint to hold the nasal bones in the desired position. This was perfect team work which reflected in the excellent post-operative outcome.

The Dumbbell on the Eyelid

Epidermal Inclusion Cyst (also known as Epidermoid cyst or Sebaceous cyst) is a benign encapsulated, sub-epidermal nodule filled with keratin material. This is one of the commonest masses seen in the eyelid.

Eyebags of Worry- Trans-conjunctival Lower lid Blepharoplasty

Blepharoplasty is the removal and repositioning of the skin, muscle and fat of the upper and/or lower eyelid. In the lower eyelid the incision is made along the skin just beneath the eyelashes or in the moist surface of the eyelid known as conjunctiva. This involves repositioning of prolapsed orbital fat on both sides by draping the fat to the orbital rim area- which gives an aesthetically better appearance. This technique is done with an incision on the inside of the eyelid without a skin incision making the surgery “scarless”.

Blepharoplasty- Eyelid Lift Surgery

Blepharoplasty is the removal and repositioning of the skin, muscle and fat of the upper and/or lower eyelid. In the upper eyelid the incision is made and hidden in the natural lid crease. In the lower eyelid the incision is made along the skin just beneath the eyelashes or in the moist surface of the eyelid known as conjunctiva.

An Eye for an Eye- Customised Ocular Prosthesis

A 48 year old patient had a painfully blind right eye for which he wanted resolution with best aesthetic outcome.

When will Artificial Intelligence replace Human Doctors?

AI robots will be complementary to human doctors and won’t be a zero-sum game for a long time to come. AIs will help us reduce our mistakes, decrease our workload, make us work more sane hours and in turn manage our work-life balance- but at least in the foreseeable future they aren’t going to replace us. Maybe it will lead to lot of us doing less mundane, repetitive jobs and with doctors doing much higher intellectual level work.

The rodent that dug into the eyelid! Basal Cell Carcinoma

BCC is one of the commonest eyelid malignancies in India. While in the west, BCC accounts for nearly 90% of the eyelid malignancies, in the Indian subcontinent, BCC cedes it’s top position to Sebaceous cell carcinoma in India. BCC is a non-melanocytic cancer of the skin arising from basal cells of the epidermis. It is mostly seen on sun exposed areas, particularly in the head and neck region. BCC is caused by skin damage caused by prolonged exposure to ultraviolet light thus explaining the preponderance of this cancer in Caucasian skin which does not have the protective effect of melanin.

The Dog and the Eyebrow! Eyebrow Reconstruction

The Eyebrow is a unique facial aesthetic unit and it’s importance to the face is apparent only when it is disfigured with loss of the hair bearing skin like in this case. Likewise, reconstruction of the eyebrow is challenging because the thickness and direction of the eyebrow hair which is unique and not easy to replicate with hair transplants from other hair bearing areas.