Face & Eyes

Migraine is an invisible condition, but its impact can be very visible, affecting work, family life, relationships, and the ability to simply get through the day. Yet, the statistics are hard to ignore. More than two thirds of people with migraine say they have felt that people don’t believe them when they describe their symptoms. Up to a third of people without migraine admit there has been a time when they didn’t believe someone when they said they were having a migraine at

Case 1: The Patch I Could Barely See A patient came in asking for surgical excision and skin grafting for a patch of facial pigmentation. On examination, the pigmentation was barely visible. I had to look closely to even find what he was referring to, and if I were to be honest, he probably had better skin than I did. To him, though, it was the dominant feature of his face. He had already gone through five to seven sessions of PICO laser elsewhere with no perceived improvemen

In the world of aesthetic medicine, the default answer for a scar or an unwanted tattoo is almost always the same: topical creams/gels, steroids or some kind of "healing" injection, or laser packages. When these methods fail, or worse, mask a deeper issue, the conversation needs to change. Often, what's required is a structural approach and a surgical solution to address the actual cause. Case 1 - The "Keloid" That May Not Be a Keloid A patient presented with a recurrent scar

A 70-year-old Asian patient presented with lateral hooding of the upper eyelids. She had already undergone two upper blepharoplasties for Asian eyelid crease creation. The first was performed abroad and the second locally; both were done more than 20 years ago. The textbook answer for lateral hooding is an extended upper blepharoplasty. In this case, that would likely have been the wrong operation. Why the Standard Approach Was Risky in This Patient On examination, her eyes w

Filler complications are far more common than the aesthetic industry acknowledges, and most are still managed blindly by eye, feel, and protocol. Below are some cases I have evaluated recently that illustrate why point-of-care ultrasound (POCUS) transforms complication management: it replaces guesswork with anatomy. Case 1 - Aquamid in the Radix: A Permanent Filler and Its Consequences A patient presented with a wide, flattened nasal bridge, often termed an “Avatar nose.” Ove

A Chinese patient came to me wanting to address her double chin. She had done her research - botulinum toxin for a V-shaped jawline, energy-based skin tightening, fat-dissolving injections. Each was discussed in consultation. None of them permanently removes fat, and for a patient looking for a definitive result, the case for surgery was clear. This was her own conclusion as much as mine. But the more important conversation was not about which procedure to choose. It was abou

Ultrasound is not new to medicine. What is less common is its use as a routine point-of-care tool in plastic surgery, not just to confirm a diagnosis, but to guide clinical decisions in real time and spare patients unnecessary procedures and associated risks. The cases below illustrate how. Case 1 - Ultrasound-Guided Filler Injection A patient underwent hyaluronic acid filler injection to the chin for augmentation, specifically targeting the labiomental crease, the fold betwe

For many patients, earlobe repair is not just about restoring appearance. It is about getting back to something they love - in this case, wearing earrings. A patient came to me with a near-complete earlobe cleft. Over many years of wearing earrings, the piercing had gradually stretched until it could no longer hold the earring in place and she reported bouts of inflammation previously. She was not bothered by the appearance of the earlobe so much as the loss of function. She

Why fillers alone are often overused In recent years, injectable treatments have become increasingly volume-driven. Patients are frequently told they “need more filler” - more syringes, more sessions, more top-ups. What is often overlooked is this: many facial aesthetic concerns are not primarily problems of volume loss, but of muscle activity and imbalance. As a plastic surgeon, I think first in terms of anatomy and mechanics, not product. The face is not static The face is

Facelift surgery is often judged by its final appearance, but much of the patient experience unfolds during recovery. Patients who have had surgery overseas may return home with questions, not because something is necessarily wrong, but because recovery can be difficult to interpret without context. Rather than relying on arbitrary timelines, it is often more helpful to look at real cases and how healing actually presents. Case 1 - Scalp Incisions and a Sense of Tightness A p

The eyelids are small in size but incredibly complex. They rely on the balance between the eyelid crease, levator function, brow support, canthal tendons, and midface tension. When any of these are altered, especially without proper preoperative diagnosis or postoperative follow-up, the entire periorbital region can be affected. Here are several real cases that highlight how varied eyelid problems can be, and why accurate assessment matters. Case 1: Three Procedures Done at O

In aesthetic medicine, some of the hardest decisions aren’t about what can be done - but what should be done. Recently, I saw a 19-year-old male with fair (Fitzpatrick I) skin who had been under a private Dermatologist for acne. His condition was well-controlled on isotretinoin (Accutane), with no active breakouts - only a few mild rolling scars across the cheeks. Traditionally, the teaching has been to avoid ablative (even fractional) lasers for at least 6–12 months after st