I have uneven eyelids after ptosis surgery. Can anything be done?
A common goal in eyelid surgery is to seek symmetry between both eyes, particularly in the cases of ptosis where the initially presenting problems may include asymmetry along with issues like functionality and aesthetics. Ptosis is commonly understood as a “droopy” eye, and the presence of ptosis may differ between two eyes.
If you have already had eyelid surgery but find that you still have uneven eyelids even after ptosis surgery, you do have options. First it is important to understand the nature of your concern, which can only be accomplished with the help of an experienced oculoplastic surgeon. The goal with any eyelid surgery is improvement, and unfortunately the nature of ptosis often causes asymmetry, which is not always completely resolved but can be dramatically improved. At times a first surgery can yield great improvements, and a second surgery my be desired to make good results even better.
Unfortunately there are times when you may be dissatisfied with a surgery for reasons related disappointment that the surgery did not accomplish what was promised or what you understood was promised. This often occurs when the procedure is performed by a surgeon who does not specialize in offering eyelid ptosis surgery. Due to the nature of ptosis, a disappointing result can also occur in the hands of a specialist, even one who did everything right. Dr. Steinsapir specializes in both eyelid surgery as well as repairing dissatisfactory eyelid surgery, as it relates to the natural appearance and aesthetic of the whole face, and is widely respected for his ability to improve disappointing results.
Before traveling to see Dr. Steinsapir for a second opinion, understand you’re your original surgeon has recommended regarding you surgical result. Sometimes something as simple as healing more can make a big difference in the outcome. Occasionally things can transpire after surgery to take the shine off your relationship with your original surgeon. It can be very difficult if you do not feel you are being hear, or feel that you lack confidence in your surgeon. Under these circumstances it is appropriate to seek a second opinion.
Dr. Steinsapir helps many individuals who are concerned about a previous procedure by listening to their concerns, providing a detailed physical examination, and advising on a plan to move forward. Sometimes a fear amounts to just “nerves” or the anxiety of someone who is not allowing themselves enough time to heal, and other times there are concerns that warrant further care. In either case, it’s important that you have access to a doctor with whom you feel comfortable, and one who closely monitors your recovery. In many cases Dr. Steinsapir has helped to repair the relationship and restore communication with the original surgeon. In other cases when you need more specialized care, Dr. Steinsapir has provided exemplary corrective surgery for many, and will be happy to help you better understand your options.
Call us today to schedule a risk-free consultation in a friendly environment where you can feel comfortable discussing your situation, and where you can receive honest answers from a caring, world-renowned oculofacial surgeon. There is no reason to remain with your doubts when there is help available now.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
What does Dr. Steinsapir think of tear trough implants for under eye hollows?
Indications
Dark circles under the eyes can be responsible for a tired, haggard appearance, and they don’t simply go away with makeup or “beauty sleep.” This is because the underlying cause of dark under eye circles is not staying out too late, but a tissue deficiency just under the eye and above the cheek bone. Because the skin is quite thin and fragile in this region, when you lack enough volume under the eye, the interaction of the light here creates the dark circle which makes you look sickly, tired or simply older in appearance. An effective treatment must successfully address this key issue.
Background
Tear trough implants are a surgery where an implant is placed in the under eye hollow area just below the orbital rim on the facial skeleton. It provides more volume in this hollow area. The implant is placed thorough a skin incision, an intraoral approach, or from behind the lower eyelid. Generally the effect of this surgery is modest given the effort needed to place the implant. While modern facial cosmetic surgery is very safe, it is always best to opt for the least aggressive approach, including nonsurgical options when they are available or can even yield better results. The bottom line is that tear trough implants were a great technology 20 years ago, and they worked well for accomplishing treatment of the under eye circles in a time when this was an advanced procedure. However, thanks to hyaluronic acid fillers, we have much better treatment options today. By placing a small amount of Restylane in the under eye hollow, extremely natural results can be achieved during an office visit with a leading specializing physician of hyaluronic fillers. The service can last a year or more and has essentially made this surgery obsolete.
Modern Advances
Hyaluronic acid fillers — such as Restylane and Perlane — have revolutionized modern day cosmetic treatments, providing safe, adjustable, nonsurgical treatment options for those seeking to improve their facial aesthetic. These fillers can be administered in a comfortable office visit, and have long-lasting benefits yet are not permanent and can also be readily and comfortably adjusted with hyaluronidase if needed. This enzyme breaks down the filler should an adjustment be necessary such as from a post treatment highlight, ridge or bump. A service can be feathered with this enzyme making it possible to achieve truly natural treatment results.
Dr. Steinsapir advocates for minimally invasive, nonsurgical treatments that yield natural results and compliment your facial contour. Sometimes surgery is indicated, but other times just as much if not more facial improvement can be achieved with modern advances in services that include fillers, botulinum toxin like BOTOX, and chemical peels. Restylane is a filler that does very well to correct the under eye hollow. It works by adding volume to the affected area, contributing to the natural fullness associated with youth. With dark circles under the eyes, what we see anatomically is a descent of the malar fat pad; in other words, with age and time the tissue under your eyes and upper cheek that gives a bright affect eventually begins to drop. Dr. Steinsapir has invented DeepFill Restylane specifically to address this problem in a safe, effective method.
Taking Action
There is no reason to fret over under eye hollows and dark circles when reliable nonsurgical options are available. By seeking expert advice you can see improvement soon. The key, as with any treatment, is to see a doctor who makes your concern a major part of his or her practice, has completed specialized education, and has proven experience with exceptional results. Dr. Steinsapir is one of the leading providers of hyaluronic acid fillers, and he has extensively studied and published on the treatment of under eye circles as they relate to an overall balanced facial aesthetic. His observations and research led him to invent DeepFill Restylane, an under eye treatment for which many individuals travel to his practices in Beverly Hills and at UCLA. To learn more about the best treatment for your under eye hollows, contact us today and schedule your consultation with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Beverly Hills where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Transconjunctival versus Transcutaneous Lower Eyelid Surgery
Transconjunctival and transcutaneous lower eyelid surgeries are each a type of lower blepharoplasty, a plastic eyelid surgery that can address a range of issues such as excess fat or “puffiness” around the lower eyelid, loose and wrinkled skin. For great results, your blepharoplasty must be carefully planned by your attending surgeon, who will consider the subtle details of your facial anatomy when determining which type of blepharoplasty is right for you, and details such as whether to remove any fat and where, how tight the eyelid skin should be, and how to achieve natural results for overall facial balance.
Lower eyelid blepharoplasty can be approached either through the skin, transcutaneously, or from behind the eyelid, transconjunctivally. There can be very specific reasons for choosing one approach over another. More commonly, surgeons use a particular approach, not due to inherent advatages of the approach but rather that was they way they were trained. For the most part, tranconjunctival surgery is performed by oculoplastic surgoens who by training are comfortable working near the eye. General plastic surgeons and others lack the specialized training in oculoplastic surgery. They prefer an approach to the eyelid that does not require they to work so close to the eye surface. This is unfortunate because the skin incision usually is made through the underlying muscle. This can damage the function of the underlying muscle, the orbicularis ocli muscle. After surgery, this muscle weakness account for the alteration of the lower eyelid contour that is routine associated with transcutaneous lower eyelid surgery.
Here is an overview of some important features of each surgery type:
Transconjunctival Blepharoplasty
• Incision made behind the lower eyelid
• Minimizes the risk of altering the contour of the eyelid margin after surgery
• Arcus marglinalis release can be performed through the same incision, wherein the eyelid fat is preserved and rotated into the hollow under eyes
Transcutaneous Blepharoplasty
• Incision made just below the lower eyelid lashes
• Can possibly damage the function of the orbicularis oculi muscle and affect the lower eyelid contour
• Permits the removal of excess skin
For some, removal of the lower eyelid fullness from behind the eyelid and removal of excess skin from the front is indicated, via a skin pinch technique or an infracillary incision just below the eyelashes that preserves the underlying muscle. Ultimately, the only way to know what treatment method is right for you is to consult with an experienced oculoplastic surgeon who will meet with you, discuss your concerns and treatment goals, perform a physical examination, and work with you to design an approach that addresses your specific anatomical features and overall facial balance. These are highly complex and specialized procedures that require a skilled and experienced hand, and can bring you many benefits both functional and aesthetic. To schedule a consultation with Dr. Steinsapir, a leading cosmetic eyelid surgeon who practices in Beverly Hills and at UCLA, please call us today.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Dr. Steinsapir Featured in The New York Times
http://www.realself.com/article/eye-color-surgery-updated
Dr. Steinsapir Featured in The New York Times
If you keep up with the New York Times, one of the most reputable newspapers in the world, you may have read about Dr. Steinsapir in the recent article Looking for a Match. Published on January 2, 2013, this report takes a hard look at a relatively new surgery designed to change the color of the iris. This procedure, which is being offered in a few places outside of the United States, surgically changes eye color by implanting an artificial iris that cosmetically changes the appearance of the iris color.
This sounds appealing to some individuals who have always wished for a different eye color, or who have eyes of different colors and wish for symmetry. However, this surgery is a risky one that can seriously alter your vision, and at this time the potential complications do not justify undergoing this surgery for purely cosmetic reasons. An ethical and reputable surgeon should only recommend a type of iris implant surgery on an individual basis for serious medical needs that require attention, and frankly do not include changing eye color. As the Times reported:
“Dr. Kenneth Steinsapir, an oculofacial surgeon and ophthalmologist in Los Angeles, also received calls from patients wanting their eye color changed, so he began investigating New Color Iris. He found no positive reports, but he did find a number of studies reporting serious complications. In July 2010, he blogged about it on his Web site, lidlift.com. ‘The colored disk that is put in the eye has been shown to cause harm,’ he wrote. ‘If you are not albino and missing iris pigment or have part of the iris missing either from a birth defect or from trauma, then there is no compelling medical reason for this surgery.’” — Abby Ellin, The New York Times, January 2, 2013
When Dr. Steinsapir received inquiries about the surgery from those potentially interested in surgically altering their eye color, he investigated the surgery, its advertised claims, its scientific outlook, and all the information available on this controversial surgery that is gaining interest. Not surprisingly, he found studies that reported complications, and information that raised questions about the reputability of claims. These surgery advertisements are not marketed in a transparent way, and upon Dr. Steinsapir’s research, willingness to speak up, as well as expertise in opthalmology, his professional opinion has been sought by many regarding the advisability and risks of flying outside the country in order to undergo this surgery. For good reason, it seems very unlikely that eye color surgery will gain F.D.A. approval in the foreseeable near future.
Dr. Steinsapir quickly became a leading voice on this rising issue as more and more people took interest in the new eye color surgery. As an ethical philosophy and treatment approach, Dr. Steinsapir advocates for minimally invasive treatments that rely on cosmetic procedures rather than surgery whenever possible, and conservative surgical approaches when indicated — so naturally he would recommend colored contact lenses over a surgery in the area of so many crucial functions of the eye. But this surgery goes beyond giving preference to safe nonsurgical procedures over safe surgical procedures — for example, opting for proven BOTOX treatment instead of a proven forehead lift — because eye color surgery has not been shown to be safe. In fact there have been both personal anecdotal stories of negative experiences with the surgery, as well as published scientific papers highlighting the concerns and complications that physicians have observed.
At a time when not much is known about a newly marketed cosmetic surgery for the eye itself, Dr. Steinsapir’s opinion as highlighted in the New York Times is not only an educated medical position, but it is also a sound of reason. You can read more about the report’s findings, including interviews with an individual who pursued the surgery and experienced complications, as well as commentary by Dr. Steinsapir and others. The take-home message in the Times seems clear: instead of a risky new surgery about which relatively little is currently known, and which would surely be discouraged by your personal ophthalmologist (eye MD), please understand that surgery to permanently change your eye color is not a safe option.
To read the full story, visit the New York Times article here:
http://www.nytimes.com/2013/01/03/fashion/questions-surround-iris-implant-procedure-skin-deep.html?pagewanted=all&_r=0
This feature about Dr. Steinsapir is a testament to his leadership, reputation, and expertise as a world-renowned oculofacial surgeon who focuses on achieving natural results by minimally invasive cosmetic treatments and nonaggressive surgeries that are considered to be safe and effective. To learn more about Dr. Steinsapir’s experience and commitment to achieving the absolute best results possible in a safe, ethical, and scientifically proven manner, contact us today.
Can I go blind from my Restylane treatment?
While the probability of going blind from Restylane treatment is extremely low, the risk is not zero. Indeed, every medical procedure including the very safest ones comes with some level of risk. With any procedure, the key is in weighing the potential risk against the benefits of surgery. Dr. Steinsapir only advises treatments that he considers to be very safe, and he further recommends the most minimally invasive approach that addresses your needs. In this way risk is minimized but can never be made absolutely zero.
The total number of published cases of visual loss associated with injectable hyaluronic acid fillers like Restylane can be counted on a single hand and this is over approximately 10 year of clinical use. Weigh this against greater than 10 million treatments in this same time frame to understand the rarity of visual loss associated with a filler service. Because of this rarity, many injecting physicians do not feel it is realistic to even mention this potential risk. This position is understandable. If you are reading this article, you are probably searching for information on this very subject. Will you feel reassured understanding that these numbers are very low or more concerned that yes visual loss has actually happened after this type of treatment? Like many decisions we make, this often comes down to personal comfort level and choices. Most individuals will understand that the risk is so small that the likelihood of the event does not really weigh into practical considerations.
Restylane is a very useful filler around the eyes because it works well with the thin and delicate nature of the skin in this area, and provides nonpermanent, natural-looking results that can be altered with the enzyme hyaluronidase. To get the best treatment result, it’s crucial that your doctor possesses exceptional expertise in the anatomy of the eyelid and its surrounding areas. A skilled injector will be able to place Restylane with precision and control, while avoiding any areas of greater risk. It’s absolutely critical that your injector possesses intimate surgical knowledge of any anatomy being treated; for in respecting the anatomy of the treatment area, complications can be avoided or minimized. If you seek treatment from a lay-filler or nonspecialist, you’re at greater risk for complications. The wrong injector may inject filler intravascularly, which can substantially increase the risk of a potential complication. You are also much more likely to be satisfied with your results when you undergo treatment with a cosmetic surgeon who specializes in fillers, eyelid anatomy, and facial aesthetics.
Dr. Steinsapir has developed and published a very safe procedure called Deepfill Restylane, which places Restylane in the undereye hollows to correct volume deficiencies there. He is a physician consultant to Medicis, Inc., the distributor of Restylane, and is among the top 3% users of these hyaluronic acid fillers. He values clear communication, gives straightforward answers, and closely monitors follow-up care and to ensure that you heal well, are satisfied with your results, and that any arising complications can be addressed immediately. To learn more about the safety and benefits of Restylane placements customized for your particular goals and unique anatomy, call us today to schedule a consultation with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
