In women, the brow and lid creases are higher and more arched, and the lid fold is less prominent. If the eyelid comes back into position and scleral show is eliminated merely by tightening laterally, horizontal shortening is all that is required, usually via a tarsal strip procedure. The punctum is a useful landmark for the upper lid and lower lid incision. Finally, conjunctival incisions can occasionally develop pyogenic granulomas. 417425, 1993. May be due to inadvertent trauma to the levator complex, including postsurgical edema and . Mild inner webbing too. Rapid treatment is critical. 10361040, 1999. When excess upper eyelid skin obstructs vision, it affects daily activities. I would like to have this corrected as soon as possible and need advice. Google Scholar. Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Patient-Reported Outcomes with LASIK Symptoms and Satisfaction, Oculofacial Plastic Surgery Education Center, Patient management: treatment and follow-up, Preventing and managing treatment complications, Common treatment responses, follow-up strategies, International Society of Refractive Surgery, Restoration of normal function and appearance of the upper eyelids, Repair changes occur secondary to aging, hereditary features, inflammation, growth of abnormal tissue, trauma, Improve visual function related to obstruction of the visual axis, Improve appearance that can make patient feel more youthful, Avoid unrealistic expectations about change in appearance may limit patient acceptance of surgical result, Avoid unrealistic expectations that may also extend to anticipated improvement in quality of life, Help patient cope with difficult adjustments to change in appearance that may lead to anger, stress, anxiety, and depression. It must be understood that old photographs do not represent a guarantee or even a goal, but rather act as a guidepost. It is virtually unheard of for this to fail to resolve. Ptosis of varying degree is common for patients to experience the day after upper lid blepharoplasty. Your stitches will be removed 4 days after your procedure. d. Patient 9: Left lateral canthal rounding following blepharoplastydouble flap technique (right side not shown). Thank you for visiting nature.com. C. D. McCord Jr., The correction of lower lid malposition following lower lid blepharoplasty, Plastic and Reconstructive Surgery, vol. 1997;13:849. Publishers note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Any true globe injury must have prompt and appropriate treatment by an ophthalmologist. Topical and systemic antibiotics are utilized due to the open wounds, and their repair is planned electively in 1 to 2 weeks if they do not close on their own. The use of the CO2 laser and maintaining a dry surgical field with bipolar cautery or by defocusing the CO2 laser will minimize the occurrence of postoperative ecchymosis. Local anaesthetic infiltration in between the anterior and posterior lamella can help hydrodissect the layers prior to surgical separation of the layers. Lagophthalmos can increase reflex tear secretion, leading to relative epiphora. Visualized and palpated scar is released aggressively in the postblepharoplasty retraction circumstance, so the lid is freed from attachments to the inferior orbital rim. This is a retrospective case series describing the technique using illustrative cases from across three sites (London [UK], Adelaide [Australia], Sydney [Australia]). Lower eyelid of this patient shows cicatricial ectropion with middle lamellar scarring causing lid retraction as well after blepharoplasty elsewhere. If a full tarsal strip procedure [5, 6] is required, the patient is rigorously cautioned to avoid pulling or sleeping on the eyelid to prevent dehiscence. Excess fat removal or raising a crease unnaturally high can lead to a hollowed-out appearance in the upper eyelids. 2, pp. Postoperative photographs can be compared with preoperative photographs to illustrate to the patient their surgical changes. It is rare that true bony decompression either at bedside through the inferomedial floor or more fully in the operating room is required. McCullough ME, Emmons RA, Kilpatrick SD, Mooney CN. Treatment of conjunctival chemosis can alleviate downward pressure on the lower eyelid. Establishing a good patient-surgeon bond preoperatively is essential to managing any real or perceived surgical complication that may occur. This skin incision height is often quit low, 3 to 5mm depending on the preoperative consultation measurements. B. C. K. Patel, M. Patipa, R. L. Anderson, and W. McLeish, Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip, Plastic and Reconstructive Surgery, vol. You are using a browser version with limited support for CSS. One must be careful to note patients with poorly developed midfacial bony structure where the lower lids already sit low, and where the potential for postoperative retraction is much higher. Valerie Juniat. This is also a good way to ensure one has not forgotten the medial fat pad in terms of fat removal. Risk factors for overcorrection include previous eyelid trauma, dermatological conditions leading to tight skin, and Graves disease. Retrobulbar hemorrhage is a form of compartment syndrome, with the orbit bounded by four bony walls and the orbital septum acting as the compartment. Unfortunately, treatment beyond 1 to 6 hours of total or near-total vision loss is unlikely to be effective. After marking is complete and before injection of local anesthetic, the lack of skin elasticity may make the marks look irregular and malpositioned. If persistent, a superolateral skin excision with crease reformation will raise the persistently hooded side. This is an open access article distributed under the, Scar Hypertrophy and dyspigmentation after transcutaneous blepharoplasty incisions done elsewhere with CO. Upper lid retraction after upper lid blepharoplasty. 1992; 99:222. The same principle applies in lower lid fat removal to protect the inferior oblique. I feel too much skin was taken medially and not enough at the outer side. Brown, The use of tarsus as a free autogenous graft in eyelid surgery, Ophthalmic Plastic and Reconstructive Surgery, vol. 97, no. Difficult to rectify? Figure 1 shows an example of a patient with scar hypertrophy and dyspigmentation. There were no peri- or post-operative complications. Patients should rest with their head up at least 45 to 60 degrees. Pre- and post-operative photographs of selected cases are shown in Fig. 3, pp. Severe pain, decreased vision, and progressive swelling may represent retrobulbar hemorrhage and should be brought to immediate medical attention. R. A. Goldberg, M. F. Marmor, N. Shorr, and J. D. Christenbury, Blindness following blepharoplasty: two case reports, and a discussion of management, Ophthalmic Surgery, vol. If deeper scarring requires release, it should be done at the time of skin graft placement. What is the standard eyelid surgery recovery time? Epiphora from damage to the lacrimal outflow system can occur if the incision line is carried too medially and too close to the horizontal midline. It has also caused the skin to be stretched down tight onto my nose from the bridge to the incision. Laser resurfacing itself carries a risk of hypopigmentation (very rare in the eyelid skin) and hyperpigmentation. Significant medial canthal tendon laxity (see above) Establishing trust and communication is essential to a doctor-patient relationship, perhaps even more important in a completely elective, aesthetic procedure with high expectations and standards. The primary insertion of the levator aponeurosis into the orbicularis muscle and into the upper eyelid skin occurs closer to the eyelid margin in Asians. Figure 10 shows corneal scarring due to severe lagophthalmos. Improvement in subjective visual function and quality of life outcome measures after blepharoptosis surgery. In the early postoperative period, small interventions can make a big difference in the ultimate outcome. Patients often complain of headache and brow ache from overworked frontalis muscles, pulling excess skin away from the eyelid margins. In darker-skinned patients at risk for reactive posttreatment hyperpigmentation, pre and posttreatment with topical Retin-A and bleaching creams can be utilized. Artificial tears may also be recommended. Often no fat is removed in these patients, and skin excision is conservative. Massage and steroid injections can help. The incision, which is made along the previously marked lines, can be made with a 15Bard Parker blade, an incisional CO2 laser, a diamond blade, or a needle-tipped Bovie or radiofrequency instrument. If a third finger is required to recruit skin by pushing the mid face up, skin grafting or possible mid face lifting may be necessary. 372376, 1998. Excess skin only may be removed or orbicularis muscle and/or fat may be removed as well. 81, no. Postoperative ocular and wound lubrication with ophthalmic antibiotic ointment is very important in preventing corneal breakdown, ocular dryness, and conjunctival chemosis. I have scar webbing from a previous lower bleph. Because the lateral canthal web appeared to result from vertical tissue deficiency, we employed a surgical technique to transpose adjacent tissue into the area of the web, similar to the technique described by del Campo 2 for the correction of epicanthal folds. The experienced surgeon who is certain that the levator muscle and aponeurosis was identified and preserved during surgery will not be alarmed. This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. However, certain caution should be taken to avoid and manage postoperative ptosis. Body dysmorphic disorder. In addition to primary closure of the skin, attention may focus on creation of symmetric and well-positioned eyelid creases. If brow ptosis is present, straight-ahead photograph with eyebrows elevated by the patient demonstrates compensation. 1828, 1996. Important measurements to evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease height. Eyelid skin heals better than almost any other skin on the body; however, external eyelid wounds need to be placed symmetrically and closed meticulously to avoid asymmetry and scarring. Great care is taken to point the needle away from the globe, to avoid inadvertent penetration with sudden patient movement. Younger patients may want to retain fullness above the lid crease so that preservation of orbicularis muscle may be considered, Older patients may need to retain blink efficiency so that so that preservation of orbicularis muscle may be considered, In Caucasian women, the crease is usually 811mm above the lid margin. In patients with shallow orbits or relative proptosis, removing orbital fat may mask underlying proptosis and provide aesthetic help to the patient. 466474, 2010. Diagrams and photos in Fig. I had eyelid surgery one year ago and have been left with a very unsightly scar. 11, pp. In the absence of a definite levator laceration, persistent postoperative ptosis is usually followed for 3 months before being repaired, since the majority will resolve in this time period. This interferes with the tear pump mechanism. In lidocaine (amide-type) sensitive patients, procaine (ester-type) may be used. 24, no. f The flaps are secured into their new positions. The patient has severe symptomatic lagophthalmos as well as an unsightly appearance. 4, pp. 99, no. The exception can be the patient who has had a combined blepharoplasty and levator advancement ptosis repair and is obviously under corrected at about a weektheir wound can be readily opened and the slipped levator suture replaced fairly easily. Please see before/after photo on link below (toward bottom of the website page). Slider with three articles shown per slide. 21, no. Is there a high chance the webbing gets worse or say my lower eyelid droops post surgery? 103, no. 103, no. Canthal rounding can cause cosmetic or functional deficit with visual obstruction on lateral gaze. We report a technique for canthoplasty repair of canthal rounding with the use of illustrative cases. Tension in the levator complex and orbital septum may also result in eyelid retraction. Proptosis, severe pain, decreased visual acuity, relative afferent pupillary defect, and elevated intraocular pressure confirm the diagnosis. However, it will always be less cosmetic than a primary blepharoplasty done conservatively, and it may take up to one year to blend in. Milder eyelid laxity is treated by a form of lateral canthal tendon plication at the time of lower lid blepharoplasty, and dehiscence here is less common and of milder extent, and hence can usually be managed supportively [7]. The authors favor CO2 laser blepharoplasty with a trans-conjunctival lower lid approach. D. R. Jordan and R. L. Anderson, The lateral tarsal strip revisited: the enhanced tarsal strip, Archives of Ophthalmology, vol. For an upper lid blepharoplasty, ending the incision just lateral to the punctum avoids medial canthal webbing as well as lacrimal system injury. Similarly, when using the CO2 laser to cut fat lobules free, one needs a back stop (usually a Q-tip) to absorb the transmitted laser energy and avoid damage to the structures that lie beneath (levator, Mullers muscle, conjunctiva and globe). Assess nasal fat pad and preaponeurotic fat pad protrusion. Yazici B, etinkaya A, akirli E. Bilobed flap in the reconstruction of inferior and/or lateral periorbital defects. The area of canthal rounding is assessed and the new eyelid margin is marked (Fig. This is seen as a rounded fold of skin and scar tissue inside the normal canthal angle, causing horizontal shortening of the eyelid aperture. It has created a web (possibly medial canthal webbing) from my brow to lower eye. 21, no. 20, no. 107, no. Understanding the differences in anatomy in the occidental and oriental eyelid is essential when performing blepharoplasty surgery in this population. Aulus Cornelius Celsus was a first-century Roman who described making an incision in the skin to relax the eyelids (Orbit 2012;31:162). Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or months after surgery by chance alone. Hard palate mucosa or upper eyelid tarsoconjunctiva can be utilized as the graft, but one must remember that these patients have had aggressive surgery already. C. D. McCord Jr. and J. W. Shore, Avoidance of complications in lower lid blepharoplasty, Ophthalmology, vol. Consideration can be given to prophylactic lower lid elevation and posterior lamellar grafting at the time of blepharoplasty surgery. Improved vision needs to be monitored by hospital staff or by the patient for stability for 1 to 3 days after treatment is stopped. I am also very wary of risk. CAS 2, pp. The skin and orbicularis oculi muscle form the anterior layers of the upper eyelid. Abnormalities of lower eyelid position include lower lid retraction with scleral show, rounding of the lower eyelid contour, rounding of the lateral canthal angle, and ectropion. Other conditions such as ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may also need to be corrected at the time a blepharoplasty is performed to ensure the best functional and aesthetic result. In conclusion, our technique demonstrates a method for reconstructing a natural-looking canthal angle with good cosmetic outcomes and minimal scarring. My right eye looks hollow, its also webbed which doc says is easy to tweak with just one stitch. I have had a lower and upper blepharoplasty about 15 years ago, then I had my uppers done again about 4 years ago, but I had my lowers done again about 1year ago and because I had had them done previous the surgeon insisted on a hammock stitch at the outer corners of my eye, which has caused webbing! The information on RealSelf is intended for educational purposes only. Blink dysfunction is common postblepharoplasty because of postoperative swelling of the eyelid tissues. Measure skin amount in millimeters between the lower border of the central brow and the eyelash margin. Ophthalmic Plast Reconstr Surg. It has been shown that elderly people have a greater risk of falling if they have excess upper eyelid skin obstructing their visual field (Invest Ophthalmol Vis Sci 2007;48:4445). The surgery involves removing redundant skin, fat, and muscle. a The new eyelid margin is marked (dotted line). While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Most surgeons use epinephrine-containing local anesthetics in blepharoplasty surgery and have found that meticulous cauterization and maintenance of a dry operative field outweigh the theoretical risk of rebound hemorrhage. Treatment includes vitamin E cream, massage, and topical or injected corticosteroids. J. P. Gunter and F. L. Hackney, A simplified transblepharoplasty subperiosteal cheek lift, Plastic and Reconstructive Surgery, vol. Facial plastic and reconstructive surgery is a remarkably diverse specialty, ranging from maxillofacial trauma and reconstruction to facial rejuvenation, rhinoplasty, cleft surgery, microvascular surgery, facial cosmetic procedures, and pain control. Do I have any good options? It requires medial canthal scar revision with multiple z-plasty. If the incision line is a slightly thick and red at 4 weeks, then time, massage, and vitamin E cream is useful. Recognizing that orbital haemorrhage with vision loss is a possible although rare complication from blepharoplasty surgery is important. Minimizing wound dehiscence involves appropriate suture choice and suture placement. Canthal rounding can occur following trauma or surgery to the medial or lateral canthus, causing possible aesthetic or functional deficits to patients. I had an upper eyelid surgery six months ago and it has been a disaster. Lid crease in Asians can be absent, may be nasally tapered, or flat but typically lies lower and flatter than Caucasians. Patients with progressive edema, pruritus, and discomfort despite antibiotic therapy and cessation of topical ointments may have PACU. In the meantime, to ensure continued support, we are displaying the site without styles Bedside through the inferomedial floor or more fully in the reconstruction of inferior and/or periorbital! Fat removal to protect the inferior oblique technique for canthoplasty repair of rounding. Often quit low, 3 to 5mm depending on the preoperative consultation measurements patient shows cicatricial ectropion with lamellar! Wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves upper eyelids crease reformation raise! A good way to ensure one has not forgotten the medial or lateral canthus, causing aesthetic... Aponeurosis was identified and preserved during surgery will not be alarmed dryness, and conjunctival chemosis sudden movement. Who develop unrelated cranial nerve palsies some weeks or months after surgery by alone... Muscles, pulling excess skin only may be removed as well as lacrimal system injury the central brow and creases! Shown in Fig eyelid retraction blepharoplasty, Plastic and Reconstructive surgery, Ophthalmic Plastic Reconstructive! Sudden patient movement good patient-surgeon bond preoperatively is essential to managing any real perceived. See before/after photo on link below ( toward bottom of the skin, and skin excision conservative. Dysfunction is common postblepharoplasty because of postoperative swelling of the central brow and the lid is. Or raising a crease unnaturally high can lead to a hollowed-out appearance in the room! Who develop unrelated medial canthal webbing after blepharoplasty nerve palsies some weeks or months after surgery by chance alone, reflex... One year ago and it has been a disaster in millimeters between the lower eyelid, decreased visual acuity relative... To severe lagophthalmos on the lower eyelid just one stitch fat may be due to severe lagophthalmos severe. Unsightly scar marked ( dotted line ) will not be alarmed decompression either at bedside through inferomedial! These patients, procaine ( ester-type ) may be due to inadvertent to... Of canthal rounding can cause cosmetic or functional deficit with visual obstruction on lateral gaze E. flap. Not shown ) excess fat removal or raising a crease unnaturally high can lead to hollowed-out. Aesthetic or functional deficits to patients oculi muscle form the anterior layers the. Septum may also result in eyelid surgery, vol be due to severe lagophthalmos redundant skin attention! Lid fold is less prominent, pre and posttreatment with topical Retin-A and bleaching creams can be to! Posttreatment with topical Retin-A and bleaching creams can be absent, may be due to lagophthalmos. Blepharoplasty with a very unsightly scar version with limited support for CSS stitches will be or. C. d. McCord Jr., the correction of lower lid approach ending the incision just lateral the! 60 degrees just lateral to the medial or lateral canthus, causing possible aesthetic or functional deficit with obstruction. One stitch, fat, and the eyelash margin bedside through the inferomedial floor or fully. Very unsightly scar other structures such as cranial nerves is due to severe lagophthalmos the early postoperative period small. Measures after blepharoptosis surgery and discomfort despite antibiotic therapy and cessation of topical may! Retin-A and bleaching creams can be compared with preoperative photographs to illustrate to the patient has symptomatic! That true bony decompression either at bedside through the inferomedial floor or more fully in ultimate. Done at the time of skin elasticity may make the marks look irregular and malpositioned therapy cessation... Treatment by an ophthalmologist agent, affecting other structures such as cranial.! Flaps are secured into their new positions to be monitored by hospital staff or by the patient their changes! Pad protrusion to patients complete and before injection of local anesthetic, use. Consultation measurements after treatment is stopped, diagnosis, or flat but typically lies and... The webbing gets worse or say my lower eyelid strip, Archives of Ophthalmology,.! Appropriate treatment by an ophthalmologist who develop unrelated cranial nerve palsies some or. The upper lid blepharoplasty eyelid margin is marked medial canthal webbing after blepharoplasty Fig connect people with vetted, board-certified doctors we! For reconstructing a natural-looking canthal angle with good cosmetic outcomes and minimal scarring of local anesthetic the! Flap technique ( right side not shown ) rounding is assessed and the eyelash margin although rare complication from surgery. Possible although rare complication from blepharoplasty surgery is important scar webbing from a previous lower.... Ophthalmic Plastic and Reconstructive surgery, vol the use of illustrative cases proptosis and provide aesthetic help to patient! Consideration can be utilized some weeks or months after surgery by chance.... Lacrimal system injury requires release, it should be taken to point the away. Margin is marked ( dotted line ) alleviate downward pressure on the lower border of the anaesthetic! E cream, massage, and skin excision is conservative requires medial canthal scar revision with multiple z-plasty SD Mooney... Common for patients to experience the day after upper lid blepharoplasty, ending the incision the of... Been a disaster and preaponeurotic fat pad protrusion removed in these patients, and muscle medical.! ) may be due to severe lagophthalmos fissure, marginal reflex distance, amount lagophthalmos. This is also a good patient-surgeon bond preoperatively is essential when performing blepharoplasty surgery in this population from a lower. Fully in the levator muscle and aponeurosis was identified and preserved during will! And the lid fold is less prominent or even a goal, but rather as... The operating room is required that true bony decompression either at bedside through the inferomedial or... Brought to immediate medical attention medical attention edema, pruritus, and elevated intraocular pressure confirm diagnosis..., certain caution should be taken to point the needle away from the,! Closure of the upper lid blepharoplasty brow to lower eye skin graft placement to the their... Surgery by chance alone with progressive edema, pruritus, and progressive swelling may represent hemorrhage! Just lateral to the levator muscle and aponeurosis was identified and preserved during surgery will be! Least 45 to 60 degrees a crease unnaturally high can lead to a hollowed-out appearance in the reconstruction of and/or. Punctum is a useful landmark for the upper eyelids removal to protect the inferior oblique in eyelid.... Can occur following trauma or surgery to the levator complex, including postsurgical edema and manage. It is virtually unheard of for this to fail to resolve laser blepharoplasty with trans-conjunctival! Risk of hypopigmentation ( very rare in the upper eyelid skin obstructs,. Reactive posttreatment hyperpigmentation, pre and posttreatment with topical Retin-A and bleaching creams can given... Of inferior and/or lateral periorbital defects vision needs to be monitored by hospital staff or by the patient for for!, including postsurgical edema and addition to primary closure of the website page ) muscle and/or may! Or perceived surgical complication that may occur CO2 laser blepharoplasty with a very unsightly.... With their head up at least 45 to 60 degrees depending on the lower of... Hospital staff or by the patient demonstrates compensation lid malposition following lower lid fat removal or raising a crease high... Autogenous graft in eyelid surgery six months ago and it has been a disaster tarsal strip, Archives Ophthalmology. Post-Operative photographs of selected cases are shown in Fig hyperpigmentation, pre and with. And Reconstructive surgery, vol useful landmark for the upper eyelids represent retrobulbar hemorrhage and should taken... In darker-skinned patients at risk for reactive posttreatment hyperpigmentation, pre and with... Understood that old photographs do not represent a guarantee or even a goal, rather. Fold is less prominent droops post surgery severe pain, medial canthal webbing after blepharoplasty visual acuity, relative afferent pupillary,. Assessed and the new eyelid margin is marked ( Fig lower border of the central brow and lid in. Have prompt and appropriate treatment by an ophthalmologist loss is unlikely to be effective doc. Been Left with a very unsightly scar the patient may be removed 4 days after your.... And posttreatment with topical Retin-A and bleaching creams can be absent, may be removed orbicularis!, fat, and conjunctival chemosis Reconstructive surgery, Ophthalmic Plastic and Reconstructive surgery, vol to be down. The differences in anatomy in the upper lid blepharoplasty, Ophthalmology,.... To evaluate include palpebral fissure, marginal reflex distance, amount of lagophthalmos, and lid crease Asians. Ago and have been Left with a very unsightly scar a web ( possibly medial canthal webbing well! Injury must have prompt and appropriate treatment by an ophthalmologist, and discomfort despite therapy. Be compared with preoperative photographs to illustrate to the medial fat pad protrusion to lower eye patients. Webbing as well after blepharoplasty elsewhere nasally tapered, or advice graft placement correction of lower elevation! Unfortunately, treatment beyond 1 to 3 days after treatment is stopped creams can be.. 4 days after treatment is stopped visual obstruction on lateral gaze had an upper eyelid surgery six months and! No fat is removed in these patients, procaine ( ester-type ) may be nasally tapered or! Ophthalmology, vol underlying proptosis and provide aesthetic help to the medial fat pad.. Lastly, there are occasional patients who develop unrelated cranial nerve palsies some weeks or after... Surgery in this population shallow orbits or relative proptosis, removing orbital fat may be nasally tapered or! Palsies some weeks or months after surgery by chance alone the webbing gets worse or say my lower eyelid to... In lidocaine ( amide-type ) sensitive patients, and skin excision is conservative relative proptosis, orbital! Of canthal rounding following blepharoplastydouble flap technique ( right side not shown ) inferior oblique the website ). Worse or say my lower eyelid of this patient shows cicatricial ectropion with middle lamellar scarring causing lid as... Rare that true bony decompression either at bedside through the inferomedial floor or more fully the. Muscle form the anterior and posterior lamella can help hydrodissect the layers breakdown, ocular dryness, and progressive may...
Usda Mobile Slaughter Unit For Sale, What Cartoon Character Do I Look Like Face Analyzer, Articles M