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In December 2020, the International Society of Aesthetic Plastic Surgery (ISAPS) released the results of its annual Global Survey on aesthetic/cosmetic procedures that showed an increase in the numbers of both surgical and nonsurgical aesthetic procedures in 2019 (7.1% and 7.6%, respectively).

The top nonsurgical procedure remained the same: botulinum toxin or botox. Meanwhile, breast augmentation remained the most common cosmetic surgical procedure, making up 15.8% of all procedures, followed by liposuction and eyelid surgery.

Based on the data above, an eye procedure – eyelid surgery – appears to be the most popular facial surgical procedure. The eyes are indeed the window to the soul. The eyes can tell so much about a person, and are the focus of others’ attention when talking to someone. With so much emphasis on eyes, it is no surprise that the pursuits to achieve the ‘ideal’ eye aesthetics have gotten increasingly popular over the years.

Surely we have heard of the controversy surrounding American model Sarah McDaniels, who is known for her differently coloured eyes or heterochromia. Recently, there have been public accusations of her allegedly faking her heterochromia, which she has since denied. One thing is for sure, if she is indeed lying, her pursuit of the ideal eye aesthetics is not even the most bizzare.

The first part of this series has discussed the different optical beauty standards from all over the world, and in this part we will cover the lengths that people go to achieve their desired aesthetics. We will categorise the efforts by whether or not they involve surgical procedures.

First, let us look at the non-surgical options. Non-surgical eye-lifts are some of the most popular procedures, with different methods used to achieve it. The first one being botox injection into the tail of the eyebrow and between the brows, which stop the muscles from pulling downward. Botox blocks signals from the nerves to the muscles so that the injected muscle cannot contract. This then makes wrinkles relax and soften. Usually the result of such injections will last for three to four months.

Next, we have fillers. As we age, the skin under our eyes loses volume, which causes hollowing and makes fat pockets more pronounced. Many doctors attempt to camouflage bags under our eyes by pumping fillers along the orbital rim of the lower eyelid, which smooths out the area.

Commonly used fillers include Hyaluronic acid, Poly-L-lactic acid, Calcium hydroxyapatite, as well as fat transfers from the abdomen, buttock, or thighs. Risks may include allergic reactions, redness, puffiness, small red dot at the injection site(s) and bruising; although, in most instances, the side effects from eye fillers are minimal and short-lived. The results usually last for about one year.

Sometimes, micro-needling is used to tighten upper and lower lids. After a numbing cream and eye shields are applied, a stamping pen with multiple thin needles penetrates the skin from one to two millimeters to stimulate collagen production, which tightens and improves the tone, texture and firmness of the skin.

Beyond non-surgical eyelifts, many choose to get eyeliner tattoos to improve the aesthetics of their eyes. Vanessa, 30, got her lids tattooed two years ago as she was enticed by the convenience it offered. An avid diver and yoga practitioner, she welcomed the fact that she did not have to redo her liner after each session. She loved that the tattoos saved her time every morning when she got ready for work, as well as her makeup expenses to buy eyeliners regularly.

She said that at the beginning, the doctor would put numbing cream on her lids before creating the lines. She found the procedure to be quite painful, as it is identical to the procedure to get normal tattoos, with needles drawn across the skin to create lines. She loves the result, but will not go for it again due to the pain, although she does recommend it to those with higher pain tolerance.

This is by no means a new procedure. Mrs. Sri, 57, underwent an older version of it back in 1998 when it first got popular. The steps were quite different: the anaesthetic drug, for example, was administered via injection as opposed to numbing creams. And instead of drawing lines as Vanessa experienced, Mrs. Sri’s procedure involved dotting the needle to create lines, which she found to be extremely painful.

Perhaps the most extreme – and certainly the most controversial – nonsurgical eye procedure is eyeball or scleral tattooing. Eyeball tattooing is the permanent colouring of the white of the eye (the sclera). It is performed by injecting ink with a needle underneath the top layer of the eye onto the sclera, in several locations, from where the ink then slowly spreads to cover all of the sclera. This procedure is undertaken by only a few tattoo artists around the world and is permanent and non-reversible.

Medical practitioners, particularly ophthalmologists, generally advise against it as they view the procedure as extremely dangerous and unnecessary. There are many potential health risks from undergoing eyeball tattooing, ranging from mild, such as a mild eye irritation, to severe risks, such as blindness and loss of the entire eye.

Then, there are the surgical option. As the survey by ISAPS indicated above, eyelid surgery is one of the most popular cosmetic surgical procedures globally. And for the past year, in particular, eyelid surgery has grown in popularity among men. Cosmetic eyelid surgeries generally fall under the following categories: upper eyelid surgery, lower eyelid surgery and double eyelid surgery.

The first two are usually done to remove sagging skin, excess fat, or bags around the eye, whereas the third procedure – also known as Asian blepharoplasty - is a specific type of eyelid surgery in which creases in the upper eyelids are formed, thus creating double eyelids.

And then there is keratopigmentation, or corneal tattooing, which has long been a common cosmetic restoration technique for severely impaired eyes. Recently, however, researchers have found that using the procedure to change the colour of the eyes for purely cosmetic reasons can be a safe surgical option with positive feedback. This method of eye surgery consists of applying a pigment into the cornea via a circular micro-tunnel made with a femtosecond laser. It does not involve any permanent alteration of the internal structure of the eye or the application of any intraocular foreign object.

If the aforementioned procedures are too much for you, there are always the removable options. This includes eyelid tapes to create creases, eyelid correcting strips a.k.a. instant eyelift and, of course, contact lenses.

Wella Christie, Director of Eyelovin, a contact lens and beauty e-commerce, believes that contact lenses are particularly popular in Indonesia because they offer different looks for everyone. “There are contact lenses for small eyes, for big eyes, for eyes with creases, lenses especially made to make eyes look bigger, coloured lenses for those who want to change their eye colours, as well as natural-looking and dolly-look lenses,” Wella explains.

While contact lenses may be temporary, they still have to be worn responsibly. A respondent we interviewed admitted that she used to wear expired second-hand lenses because at the time, her utmost concern was her appearance, while her comfort (and safety to an extent) placed lower on her priority list. “I don’t do that anymore,” she added.

At the end of the day, everybody has their own image of the ideal eye aesthetics and how to achieve it. Some of the methods are perfectly safe, while some are not. Whatever we decide to do, educating ourselves on the risks and methods of each procedure is key. Let us open our eyes to all the information we can find before we sign ourselves up for any procedure.

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