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October 27, 2011

Upper blepharoplasty made my eyelids heavier and the skin wrinkled. What is going on?

Filed under: blepharoplasty,brow lift,cosmetic eyelid surgery,Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,fixing eyelid surgery,forehead lift,oculoplastic surgery — Tags: , , , , , , , , , — admin @ 8:48 am

Dr. Steinsapir specializes in fixing unsatisfactory eyelid surgery.  As a fellowship trained oculoplastic and cosmetic surgeon, and a board certified ophthalmologist, Dr. Steinsapir is experienced in working closely with his patients to create a personalized treatment plan.  If you are experiencing eyelid ptosis and crepey (wrinkled) skin following upper blepharoplasty, it may be that your original surgeon did not have the proper experience to successfully perform your upper blepharoplasty.

Crepey Skin

When performing upper blepharoplasty, simply removing extra skin is not enough to create a desirable outcome.  Successful blepharoplasty requires what Dr. Steinsapir calls a ‘structured’ blepharoplasty.  It is essential to properly support the upper eyelid skin to avoid crepey upper eyelid―platform skin that simply won’t hold makeup.  To correct this problem, your surgeon will need to remove skin from below the upper eyelid crease and anchor the eyelid platform skin and underlying muscle to the levator tendon, which raises the upper eyelid.  This places the upper eyelid skin on a slight stretch resulting in a smooth platform for makeup.

An experienced and skilled surgeon can address crepey upper eyelid skin after unsatisfactory upper blepharoplasty with a carefully planned excision of the excess skin left on the eyelid platform.  With the eyelid open, the upper eyelid skin is anchored to the levator tendon to create a long lasting adhesion to the eyelid elevator.  Recovery is usually somewhat shorter than standard upper blepharoplasty.

An anchor blepharoplasty is an important part of any comprehensive eyelid surgery. This part of your procedure specifically addresses loose skin and drooping eyelashes on the upper eyelid platform.  Excess, wrinkled or loose skin here can give you a tired appearance associated with eyelash ptosis and crepey eyelid platform skin.

While ideally anchor blepharoplasty is a part of every blepharoplasty, unspecialized or less skilled surgeons may not be comfortable offering this important aspect of treatment.  Anchor blepharoplasty is a very technical skill that requires great precision and specialized expertise.  Without great experience, education and an artistic skill, your cosmetic doctor may have difficulty performing an anchor blepharoplasty as part of your upper blepharoplasty; unfortunately, in these cases you may find yourself disappointed after you heal and wish your eyes appeared more alert.

Heavy eyelids

Heavy eyelids following upper blepharoplasty are often the result of a pre-surgical condition that your surgeon failed to address during you consultations.  Before you underwent blepharoplasty, you presumably already had heavy lids and heavy brows.  The brain compensates for the heavy eyebrow by activating the frontalis muscle, the forehead elevator.  The forehead lifts the eyebrow until the skin in the upper eyelid no longer rests on the upper eyelashes.

Clinically, this situation can be detected by looking for lines in the forehead and an abnormally elevated eyebrow.  When upper blepharoplasty is performed in this setting, the excess skin in the upper eyelid is removed. This reduces the amount of forehead muscle activation that is needed to keep the upper eyelid skin off the upper eyelashes.  The forehead relaxes and the eyebrows come down. The net result is that it appears that almost nothing was done surgically.  Of course the forehead is smoother but if the objective was to make the eyes brighter by clearing space above the eyelashes, the net effect can be disappointing.  Under these circumstances the best option is to perform a forehead lift in conjunction with the eyelid surgery.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked at the top with a handful of medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center.  Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns.  Contact us today to schedule a personal consultation with Dr. Steinsapir.

 

 

 

 

October 15, 2011

What are the treatment options for syringoma of the lower eyelid?

Filed under: blepharoplasty,chemical peel,chemical peel alternatives,cosmetic eyelid surgery,Cosmetic Surgery,Dr. Steinsapir,Eyelid Surgery,fixing eyelid surgery,oculoplastic surgery — Tags: , , , , , , , , , , — admin @ 10:28 am

Syringomas on the lower eyelid are a common, benign growth.  Although they tend to be seen more often in women, both men and women can begin noticing them around adolescence.  Syringomas are derived from the eccrine sweat gland ducts and are small or large expansions of normal sweat glands in the eyelids.

Treating Syringomas

Syringomas are difficult to permanently remove because they originate from the deep dermis level of the skin.  The most common forms of removal include shaving, chemical peel, electrocautery, and lasers.  All of these methods are intended to superficially flatten the bumps caused by syringomas.  These treatments often have to be repeated regularly.  Smaller growths are easier to remove using these methods.  Although this is not a long-term solution, it carries less risk of scarring, permanent tissue damage, and slow-healing.

Deep Dermis Treatment

In order to completely remove syringomas, the treatment needs to penetrate the deep dermis under and around your eyes.  There are many different opinions among physicians about which method is the most effective.  Some physicians use CO2 lasers, while others prefer the deeper laser resurfacing of a Fractional CO2 laser.   Likewise, deep electrocautery may also effectively remove the lumps, however, all of these methods carry a risk of scarring.  Even after the syringomas are removed from the deep dermis level they can still return.  The overgrowth of eccrine sweat glands is not related to any external causes, but is a genetic trait that can’t be treated with skin creams.

Factors for Successful Removal

Smaller syringomas are easier to remove so the earlier you address the problem the better results your doctor can achieve.  Although the bumps can always be removed using chemical peels or shaving, there is a substantial risk of scarring.  Electrocautery and CO2 lasers can damage the delicate tissue around your eye and the deeper the penetration, the more damage can be done.  Removing syringomas requires a skilled hand and experience with lower eyelids.  Dr. Steinsapir utilizes his advanced understands the structure of the lower lid and skin healing to minimize skin damage that can be associated with the treatment of the syringoma.  Generally he will recommend removing one or two syringomas to learn how your skin responds before performing a larger scale treatment.

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 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.

October 5, 2011

I had eyelid surgery 8 days ago and I am certain that my surgeon made a mistake. What should I do?

Filed under: blepharoplasty,cosmetic eyelid surgery,eyelid reconstructive surgery,Eyelid Surgery,fixing eyelid surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , — admin @ 7:53 pm

Blepharoplasty is an invasive surgical procedure and by definition, requires time to heal.  Eye surgery causes trauma to the tissue surrounding your eyes and it’s difficult to determine how your eyes will look, even after a week or more.  In the grand scheme of things, eight days is not enough time to determine the majority of mistakes.  Even if your doctor did cause a complication, it’s possible it will clear up during the healing process.  However, there are some rare complications to be mindful of and consult your physician immediately if you are experiencing the symptoms.

Immediate post-operative issues

Dr. Steinsapir uses the term “immediate” to describe post-operative issues and complications that last from moments after surgery to up to six months, whereas long-term complications are issues that persist for more than six months.  He uses the six month time frame because a number of concerns related to upper eyelid crease height, difficulty closing the eye, mild lower eyelid retraction or alterations in eyelid shape often resolve spontaneously within this time period.

Dry eye

One of the most common problems after surgery is dry eye.  Swelling and temporary lid dysfunction can exacerbate pre-op dry eye issues.  When the eyelids are swollen after surgery, they do not move the tears around very well and this can cause drying and irritation.  This type of swelling can typically affect eye comfort for ten days or more when there is normal tear production.  When the eyes are dry, eye comfort may be affected by post-operative eyelid swelling for several weeks before resolving.

If, however, the surgery damages the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), the blink mechanism may be permanently affected causing long-term eye surface drying and dry eye symptoms like irritation, sensation of burning, grittiness, and redness. Fortunately, many of these closure issues get better over time. You can treat these dry-eye symptoms with artificial tears and bland ophthalmic ointment.  Additionally, Dr. Steinsapir may choose to supplement this by plugging the tear drainage system, and taping the eyes closed.

Bruising

Bruising is natural and anticipated following surgery; it is a normal part of recovery.  On rare occasions, a much more significant bruise can occur. If this happens deep behind the eye, the bruise can cause blindness. This type of bleeding is called a retro-orbital hemorrhage.  While these cases are very rare, it is this very significant risk that prompts the eyelid surgeon to advise potential patients to avoid medications and herbal products that can thin the blood and predispose to bruises in the first place.

Bleeding that causes bruising after surgery can occur from straining, coughing or other activities that disrupt the clots that normally form from the surgical wounds.  For this reason, it is essential for your potential eyelid surgeon to know if you are taking a blood thinner such as aspirin, coumadin, or Plavix.  In these circumstances, Dr. Steinsapir will advise against elective or optional eyelid surgery.

Superficial bruising may not threaten vision but these bruises can affect the outcome of surgery.  Severe bruises cause swelling that can stretch a healing eyelid. In the upper eyelid, this can produce heaviness in the upper eyelid that might need to be corrected surgically if there is no resolution after 6 months.  When the resulting eyelid malposition does not satisfactorily resolve by 6 months after surgery, revisional surgery may be necessary to address the issue.

Stitches

Occasionally, stitches closing the surgical incision come apart before the skin edges are healed together.  This is called a wound dehiscence.  This most commonly occurs in the upper eyelid where an incision is made to remove excess skin. The raw edges of skin separate and the wound gapes open. This can be unsightly and it is tempting to sew the raw edges back together. This may be the right thing to do, however, there may be a low-grade infection causing the wound separation in which case the best course of action is to simply observe the area, and keep it moist with extra antibiotic ointment. The most surprising thing about wound dehiscence is how well it heals on its own. It has been Dr. Steinsapir’s experience that given time to fully heal, the body pulls the skin edges back together so well that no further intervention is needed.

Swelling

Chemosis is a specific type of tissue swelling. The white of the eye is a specialized tissue called the conjunctiva.  Just like the eyelids can swell following surgery, the conjunctiva can also swell.  It looks like jelly along the edge of the eyelid. Mild chemosis is self-limited; it will resolve on its own.  More severe chemosis is very rare and is almost never seen with standard blepharoplasty.  In this circumstance, the swollen conjunctival tissues balloon to the point where they are not covered by the closed eyelids. When this happens, the conjunctiva is subject to drying that causes more swelling―becoming a cycle.  The best treatment is aggressive lubrication with an ophthalmic ointment and when necessary, occlusion with plastic wrap to prevent drying. Surgical treatments are available for the rare instances when these measures are insufficient.

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 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.

September 27, 2011

My sutured eyelid surgery only lasted 6 months; is there a way to extend the benefits?

Filed under: anchor blepharoplasty,asian eyelid surgery,blepharoplasty,cosmetic eyelid surgery,double fold surgery,Eyelid Surgery — Tags: , , , , , , , — admin @ 9:35 pm

Sutured upprer eyelid surgery is a specialized methods primarily marketed to young individuals of Asian descent who lack a double upper eyelid.  The methods go by a number of names including closed blepharoplasty, suture method blepharoplasty, double suture and twisting (DST) method, threaded eyelid surgery, non-incisional or partial incision blepharoplasty.  The method offers the promise of inexpensive, minimal down time, non-incisional eyelid surgery.  The only thing that does seem certain about these procedures is that the results are not permanent and for many the effects are gone in less than a year.  Having studied the effects of this surgery, it is the opinion of Dr. Steinsapir, a leading eyelid surgeon, it’s better to find a real eyelid surgeon who can perform permanent double-fold blepharoplasty.

How doe sutured eyelid surgery work?

Double fold surgery with a threaded suture works by using stitches to create and maintain an eyelid fold.  The crease is created by burying permanent, non-reactive sutures and pinching the undersurface of the eyelid skin to the deep soft tissue of the eyelid.  The problems arise when the sutures break over time or start migrating through the skin.  The recently developed method called Double Sutured and Twist (DST) technique purports a solution to this problem, however it does not solve the other problems created by this technique.

Problems with sutured eyelid surgery

Sutured double-fold surgery is often performed very quickly.  In some parts of the world non-medical providers will do the work.  As we have said so many times before on this blog, it is important to find an experienced medical professional to perform any cosmetic procedure, no matter how simple someone advertises it to be.

Sutured double-fold surgery and DST double-fold surgery are not a permanent solution.  Not only do the sutures have a record of breaking or migrating, but the fold is often less distinctive than a fold created using an incision technique.  Many patients who have undergone sutured double-fold surgery notice that their crease begins to lose definition over time and due to the lack of control this procedure is known for, asymmetry in the lids is also common.

The best double-fold surgery technique

To make a lasting crease, it is necessary to perform a surgery to make a strong attachment between the skin at the crease and the levator aponeurosis, the tendon that raises the upper eyelid.  Although this method occasionally fails and the crease loses integrity, for most people, the result of surgery lasts a lifetime.

Although cosmetic surgery textbooks recommend the placement of the crease 2 millimeters to 4 millimeters higher than experience dictates.  Physicians who specialize in Asian eyelid surgery are informed by experience; and experience indicates that the incision tends to migrate upward as the eyelid heals.  For the best Asian blepharoplasty results, you need a minimally invasive treatment plan that preserves as much natural tissue as possible. A less aggressive, yet highly controlled surgery creates the fastest recovery time, natural improvements, and precise results.

Restoring the eyelid fold

When sutures fail, the defined upper eyelid crease begins to disappear.  There can be changes to the fold that are unsatisfactory with asymmetry between the two eyelids.  Careful incisional anchor blepharoplasty can be performed to restore the appearance of the eyelids despite prior suture procedures.  Since these types of situations can present unique issues, there is no substitute for a personal consultation with an eyelid surgery expert like 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 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.

August 27, 2011

My surgeon performed eyelid surgery 6 weeks ago and now my eyes don’t close at night. What should I do?

Filed under: blepharoplasty,eyelid reconstructive surgery,Eyelid Surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , , — admin @ 10:39 am

Eyelid surgery is a delicate operation that has as many rewards, but it is still surgery and requires adequate healing time.  As you begin to heal, you may notice problems with dry eyes, or your lids not closing properly.  Immediately after surgery and for about ten days following, swelling may cause discomfort and concern about the new position of your lids.  However, as your body heals, your lids may resume a more natural position.  There is a small risk that the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), may be temporarily or permanently weakened causing long-term eye surface drying and dry-eye symptoms.  Six weeks following surgery is too early to become alarmed, but Dr. Steinsapir strongly recommends visiting your original surgeon for a complete assessment of your condition to determine your treatment options. If your surgeon is not a fellowship trained oculoplastic surgeon, you may need to see one or a cornea specialist.

Why won’t my eyes close?

Surgery can produce long-term damage to the function of the eyelids causing dry eye symptoms.  If your surgeon removes too much upper eyelid skin and underlying muscle, your eyes may not close completely, causing dry spots to develop on the cornea.  Depending of the design of the blepharoplasty, the nerves that supply the muscle that helps to close the eye can be damaged weakening the blink reflex.  This means that during a blink there may not be sufficient speed or force to cause the upper and lower eyelids to meet during the blink.  Since the eyelids move tears on the eye surface around, the net result is surface drying.

What are my treatment options?

The first line approach to treating these issues is to increase the frequency of artificial eye drops and, when indicated, ophthalmic ointment at bedtime.  If necessary, your tear drains in your eyelids can be closed temporarily with plugs to see if symptoms improve.  If these measures fail, there are some additional mechanical measures available.  Depending on the corneal status early surgical reconstruction may be necessary.

The extent of the solution depends on the severity of the symptoms and the degree of drying seen on the surface of the cornea.  Although a range of options are available, the key objective is to make the eyelids meet and to create sufficient force of eyelid closure to help spread the tears over the corneal surface.

Is this a long-term issue?

Common post-operative issues can be thought of in two broad categories: immediate and long term.  Immediate issues are post-operative issues and complications that present anytime from moments after surgery up to six months.  Long-term complications are issues that continue to persist beyond six months.  The six-month time frame is useful because a number of concerns related to difficulty closing the eye and mild lower eyelid retraction often resolve spontaneously in this time frame.  In contrast, it is Dr. Steinsapir’s experience that when these types of problems are present six months after surgery and continue to be a concern, then they often need to be addressed with a corrective surgery.

I chose an experienced surgeon, what happened?

No matter how technically superb the surgeon, surgery can tip a marginally compensated dry eye to discomfort.  Unpredictable individual factors may also contribute to a particular situation.  Dr. Steinsapir is acutely aware of the importance of eye comfort after surgery and what steps are needed to make the eye as comfortable as possible. Unfortunately, specialists lacking the training in Ophthalmology can underestimate the impact of these easily addressed issues.  For this reason, Dr. Steinsapir closely follows his patients after surgery.  Your post-operative follow-up schedule is based on how you are actually doing rather than on a scheduled based on how everyone one else has done in the past.

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 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.

August 10, 2011

Is Laser Eyelid Surgery the Best Method of Eyelid Surgery?

Filed under: asian eyelid surgery,blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,double fold surgery,fixing eyelid surgery,lower blepharoplasty,oculoplastic surgery — Tags: , , , , , , , — admin @ 6:35 pm

Whether your doctor uses a specialized cutting cautery, a scalpel, or a laser to make the incisions for your eyelid surgery doesn’t significantly impact the results of your surgery.   The most critical aspect of eyelid surgery is the proper design of the procedure and this in turn is dependent on a proper work up and diagnosis.  Finding a doctor who will listen to you and customize your treatment based on your desires and unique facial features is much more important than finding a doctor with the newest and most hyped surgical tools.

The risks of using lasers

Dr. Steinsapir avoids using the laser for surgery because the laser devitalizes the edge of the wound for approximately a half millimeter on each side.  This means that sutures need to be in for a prolonged period of time potentially leading to cysts and wound separation.  Using a CO2 laser for eyelid surgery is more marketing hooey than anything else.  Using a laser may be fun and sound high-tech, but it does not make for a better surgery.  For eyelid surgery, especially double fold surgery, the most critical aspect of the procedure is the surgeon’s skill and experience; does he or she understand eyelid surgery and the critical eyelid anatomy?

Why isn’t a laser more precise than a scalpel?

Precision during surgery is always important; eyelid surgery requires an experienced hand.  The CO2 laser may sound like it’s more precise, but in reality, it damages the skin surrounding the incision whereas a cold steel scalpel, if used by a skilled surgeon does not damage the adjacent skin.  If your surgeon uses a scalpel, the sutures can be removed much earlier that if the surgeon uses a laser.  Eyelid surgery performed with a scalpel has a down-time of about a week.  Your eyes may look a bit swollen for several weeks after surgery, but this is the case regardless of the type of cutting tool.

Is it possible to correct laser damage?

 The CO2 laser increases the risks associated with eyelid surgery.  The laser smoke voilitalizes free radical agents  and other carcinogens into the operating room aire even when smoke scrubbers are used.  While metal contact lens are used to minimize the risks of unwanted laser contact with the eye tissues, past pointing of the laser is a constant risk that can cause unwanted damage both to you and to operating room personnel.   The laser beam has caused operating room fires as well.  For these reasons and the unwanted tissue damage caused by the laser beam, Dr. Steinsapir generally does not feel that the limited benefits which included marketing hype do not outweigh the downside risks of using a CO2 to perform the cutting during blepharoplasty.

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 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.

August 6, 2011

Can I visit the United States for Reconstructive Surgery?

Filed under: blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,Dr. Steinsapir,eyelid cancer reconstruction,eyelid reconstructive surgery,facial cosmetic surgery,fixing eyelid surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , , — admin @ 9:32 am

When it comes to reconstructive facial surgery, Dr. Steinsapir has extensive experience with eyelid, midface, and orbital reconstruction including repair of prior unsatisfactory eyelid surgery, removing unsatisfactory facial implants, correcting eye changes associated with thyroid eye disease, orbital and tear duct surgery, and repair of the eyelid after skin cancer removal or trauma.

Many people travel from across the United States as well as internationally to have surgery with Dr. Steinsapir.  He is world-renowned for his leadership in facial cosmetic surgery.  If you are considering traveling to have reconstructive surgery or other cosmetic treatment with Dr. Steinsapir, here are some important considerations that will help you have the best experience possible.

Consult First

Many people who travel for cosmetic treatment feel they should be able to have surgery at the time of their initial consultation.  They want to take care of everything in just one trip, so they may fly or make a long drive to Los Angeles, have their consultation, and have surgery all during the same trip.  This idea may seem appealing because you only have to book a flight and pack your suitcase once, and you may even save a little money—but please reconsider this approach.  Dr. Steinsapir doesn’t believe in performing an initial consultation and surgery at the same time.  Even if you save a few dollars in airfare, in the end this amounts to hasty and high-pressure decisions.  Your choice to move forward in having surgery with the right doctor is important, and it’s not a good idea to cut corners here.

Reconstructive surgery should be something you and your surgeon approach calmly, thoughtfully, and with confidence.  Instead of too much pressure, Dr. Steinsapir strongly advises and encourages you to take the time to make sure you have found the right doctor and right treatment approach.  He wants you to have time to think about the options and be completely comfortable with the proposed surgical plan.

Take Time to Reflect

Consulting now and having surgery later is a sound approach for anyone seeking the right cosmetic treatment with any doctor.  Although admittedly not convenient, slowing down, thinking about your choices and being fully comfortable ensures that you can make a fully informed choice without the pressure of time.  When you consult with Dr. Steinsapir, he won’t pressure you into committing to surgery.  It is better for everyone if you have the opportunity to meet with the surgeon, then have time to think about the issues discussed well before undergoing reconstructive surgery.

Make Thoughtful Decisions

Even if you’re traveling from very far, Dr. Steinsapir will not perform surgery at the time of your initial consultation.  The best surgery is always performed with the utmost of care, consideration, research, and planning.  You should go into surgery comfortable and confident that you have made the right decision.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked third among all medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center. Larger procedures may also be performed on an inpatient basis at the Jules Stein Eye Institute. Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns.  Contact us today to schedule a consultation, followed by a brief consideration of the more common reconstructive issues that bring people to see Dr. Steinsapir.

July 29, 2011

What should I expect with my forehead surgery?

Filed under: blepharoplasty,brow lift,Cosmetic Surgery,forehead lift,forehead surgery,open vs closed forehead lift,open vs closed forhead lift,Ronald Reagan Medical Center at UCLA — Tags: , , , , , , — admin @ 6:51 pm

Forehead lift surgery, also referred to as a brow lift or eyebrow lift, is designed to achieve a younger, more refreshed look by smoothing the forehead, reducing frown lines, and elevating the eyebrow line position.  In some cases, it’s preferred over upper eyelid surgery for achieving rejuvenation.  Although the forehead lift elevates the eyebrows, it differs from eyelid surgery because eyelid surgery deals with the height of the crease, the crease structure, and eyelid and lash ptosis.  Although eyelid surgery can freshen your look as well, the forehead lift addresses one of the focal points of your face–one that can make the difference between looking tired and run down and looking youthful and refreshed.  In some instances, combining a brow lift with eyelid surgery will provide the total facial rejuvenation you are seeking.

Different types of forehead surgery

There are three major types of cosmetic forehead lifts; endoscopic, also called closed forehead lift, open forehead lift, and thread, or suture lift.  Of these three types, endoscopic forehead surgery is the safest, most effective, and most natural-appearing surgical solution.  Both the open and closed forehead lifts are long-lasting, with the open forehead lift showing no clear advantage in any area and some clear disadvantages.  Healing time for the endoscopic forehead lift is about five times faster, so you’ll see improvements sooner, and your risk of forehead lift complications is greatly reduced.

The thread lift, or suture lift is often advertised as a cheap alternative to the facelift.  The thread lift is a procedure in which a barbed suture is threaded through the face.  This is supposed to lift the face with minimal surgery.  It costs less than a facelift, and sometimes recovery time is shorter, but this procedure doesn’t last and can have associated complications.  Most cosmetic surgeons do not perform thread lifts because they feel that they are ineffective.  For cosmetic purposes, Dr. Steinsapir primarily performs endoscopic forehead lifts, or closed forehead lift.  The endoscopic forehead lift offers many advantages to other alternatives.

Where is surgery commonly performed?

A forehead lift, whether open or closed is a surgical procedure and cannot be performed during an in-office visit.  Surgery is typically performed in an outpatient surgery center.  Dr. Steinsapir performs this procedure at the UCLA Outpatient Surgery Center where he is on staff as an Associate Clinical Professor and Attending Surgeon.  An endoscopic forehead lift requires intravenous sedation but general anesthesia is typically not needed.  This means that you have surgery with minimal drug exposure contributing to a faster recovery.

What is the typical recovery course and physical restrictions?

Swelling and bruising following an endoscopic forehead lift can last for several weeks.  However, most women find that after 7 to 10 days and a little makeup, they can go out and about without calling attention to themselves.  Most men find they can return to their work routine without makeup at 7 to 10 days.

Endoscopic forehead lifts involve a relatively short recovery process and patients usually experience minimal discomfort.  Smaller incisions mean less healing and a faster recovery and is associated with few complications compared to the open forehead lift technique.  Numbness of the scalp, which was universal with the open forehead lift, is rare with the endoscopic forehead lift.  There is very little if any hair loss with a small incision forehead lift.

What are some common complications and how are they addressed?

An endoscopic forehead lift offers faster healing time and fewer negative effects like scalp numbness, hair loss, or a long scar.  Although a few who insist on continuing to perform the open forehead lift may say that the resulting scar from the open forehead lift can be “hidden” underneath your hair, the reality is that this breaks up the natural hair growth pattern.  The untrained eye will recognize that something looks slightly “off” about your hair line―even beveled incisions that allow some hair to grow through the scar can look wrong.  In hair grafting circles, this is referred to as “compression.”  Natural hairlines do not have compression.  Many who have had this procedure also do not like the long term numbness that results from cutting large sensory nerve in the scalp.  The open coronal forehead lift can also be associated with permanent hair loss along the incision line.  These complications are not seen with the small incisions used for the endoscopic forehead lift.

What is the time frame before full recovery?

Following endoscopic forehead lifts, the forehead needs to be supported while the body heals.  This support is called brow fixation and there are several options for brow fixation.  The two most common options in this practice are the Coapt endobrow Endotine or microscrew fixation.  The Coapt device is a small plate that is used in pairs.  The plate is fixed to the forehead bone and supports the forehead.  The device is completely covered and over time will dissolve.  The other method for supporting the forehead after surgery involves three or four small microscrews that poke out of the scalp.  A small staple behind each post supports the forehead.  The posts and the staples are removed about three weeks after surgery.  Again, these are hidden in the hair and are generally not noticeable to others.  Dr. Steinsapir allows a return to the gym in 10-14 days, however even the day after surgery you will be encouraged for go out for a walk.  Most find that they can resume business by telephone, email, and computer the day after surgery.

Is Dr. Steinsapir available for a personal consultation regarding this surgery?

Dr. Steinsapir believes strongly that there is not substitute for a personal consultation to determine if a particular surgery is right for you.  Dr. Steinsapir performs this consultation himself so he can get to know your medical history and personal concerns.  He will perform a detailed examination.  After assessing the totality of your personal situation, he will discuss with you his opinions, concerns, and recommendations.  This will include a through discussion of risks, benefits, alternatives, and likelihood of success.  Call today for your personal consultation.

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 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.

July 27, 2011

Invisible Eyelid Surgery―Be Careful What You Look For

Filed under: blepharoplasty,chemical peel,chemical peel alternatives,chemical peel los angeles,cosmetic eyelid surgery,eyelid fat,Eyelid Surgery,facial laser resurfacing,laser resurfacing alternatives,laser vs. chemical peel — Tags: , , , , , , — admin @ 8:45 am

Throughout Los Angeles and Beverly Hills there is a buzz about a “new and innovative” procedure that promises eyelid surgery without scarring.  The promise of no scars following surgery sounds appealing; who doesn’t want to walk away from surgery with all the benefits of a refreshed look without the evidence of surgery?  But as the old adage goes, “if it sounds too good to be true, it probably is.”

How does invisible eyelid surgery work?

According to the doctor who “invented” this procedure, invisible eyelid surgery involves both “subconjunctival blepharoplasty” (usually called transconjunctival blepharoplasty) and a simultaneous “advanced” laser treatment performed by a dermatologist.  Using a micro-fractional CO2 resurfacing laser to treat lower eyelid skin by “tightening” the area following removal of fat through an incision made on the inside of the lower lid (transconjunctival incision), this procedure touts a younger and refreshed appearance of both the upper and lower lids without cutting surgery.  And all this has a recovery period of about a week and no one will be able to see any evidence that you’ve had surgery!  Now that sounds too good to be true.

Why the skepticism?

When you break down the idea of “invisible eyelid surgery” into its basic parts, all you’re really left with is lower eyelid blepharoplasty and CO2 resurfacing; two procedures that have been offered by cosmetic and oculoplastic surgeons for years.  Invisible eyelid surgery isn’t a new idea as the advertising physician would have you believe.  It’s simply two existing procedures packaged together and given a brand new name!  No surprise this is often how “new” things are invented in Beverly Hills all the time.

The risks of transconjunctival blepharoplasty

The idea behind the transconjunctival blepharoplasty is to remove the lower eyelid fat pads to eliminate puffiness around the lower lid that makes you look tired and aged.  But transconjunctival blepharoplasty is not without some serious risks that, if performed without skill or experience can result in permanent damage.  This approach of permanently removing eyelid fat is an old approach to lower eyelid surgery.  It can be effective for a small number of people.  The more current approach is preservation of this fat using a procedure called an arcus marginalis release.  Simply throwing away the fat can cause a hollow lower eyelid.

The risks of CO2 laser resurfacing

Deep CO2 laser resurfacing has fallen out of fashion because of the negative experience many have had healing from these treatments.  There is a very real risk that your skin will suffer from permanent depigmentation, and that the scarring caused by such treatments will likely affect the texture of your face.  This is because the treatment depth needed to improve deep facial lines makes post laser resurfacing scars, particularly skin texture changes, relatively common.  In fact these types of skin texture changes and skin depigmentation are so common that many surgeons think that this is the expected outcome of the service!

Micro fractional C02 laser is an effort to reduce this damage.  These treatments do provide freshening of the skin but generally are not powerful enough to reduce lower eyelid lines.  Chemcial peels, although they require much more training than a laser treatment are still the preferred methods.  In some cases, the chemical peel was all that was needed for the lower eyelid contour to be much smoother even without lower eyelid surgery!

What kind of eyelid surgery will work for me?

Dr. Steinsapir says this a lot, so it should come as no surprise: the best lower eyelid surgery is customized for the individual and designed to meet his or her particular features, goals, and medical needs.  This means that the lower eyelid surgery ideal for one person may be a specialized type of blepharoplasty while for another it may be a midface lift designed to correct tissue descent and return it to its proper anatomical location in the lower eye area.  Once you and your oculoplastic surgeon determine the best procedure, together, you and your surgeon must customize it even further to fit your features and obtain natural results.  Dr. Steinsapir observes: “people don’t do well with a one size fits all, cookie cutter approach.”

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 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.

June 29, 2011

Complications after surgery

Filed under: beverly hills facelift,blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,lower blepharoplasty,midface lift,midface surgery,oculoplastic surgeon — Tags: , , , , , , — admin @ 7:53 am

Complications following a midface lift and eyelid surgery are especially disconcerting because they can affect the basic functions of your eyes.  Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason to be concerned.  But sometimes, inexperienced surgeons panic in these situations (even long-in-practice, but inexperienced surgeons) and respond with a shoot-from-the-hip, fix-it mentality, and may push you to undergo corrective surgery immediately.  Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may feel pressured to have a corrective surgery.  There are certainly times where immediate work is appropriate.  Before you agree to such a fix, ask yourself if you are still comfortable trusting your surgeon.  In his book Blink, Malcom Gladwell describes the process of “thin slicing;” the way our intuition rapidly assesses a situation.  That intuition is ignored at our peril.  If the hair on the back of your neck is standing up because your surgeon wants to hustle you back to surgery, ask yourself: are you comfortable with what is being proposed?  If you are not comfortable, your best course of action is the natural one―dig in your heals.  There are occasional situations that are medical emergencies.  However, these are truly rare.  There is almost always time for a second opinion.

Undergo a consultation

Before taking any action to correct your complications, carefully weigh your confidence in your current surgeon.  There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see, and fully understand the physical complications.  Occasionally, the description of what is going on and the actual physical complications are not the same.  Fixing complications is specialized business.  Even if your surgeon does a lot of primary cosmetic surgery, he or she may be relatively unsophisticated when it comes to repairing surgical complications, especially when this work affects the function of the eyelids.

If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings.  Do not blindly follow the recommendations your original surgeon or any surgeon whose recommendations do not make sense to you.  Don’t commit to a second surgery unless you have a clear understanding of the following:

  • What is going on and why these complications are occurring,
  • What type of surgery your doctor has planned,
  • Why a surgical solution is necessary,
  • The risks of a second surgery, and
  • The probability of success or failure.

The risks of midface and lower eyelid surgery and corrective surgery

Lower eyelid surgery and midface surgery have significant risks associated with them.  Your surgeon may not fully understand these risks.  If you’re experiencing complications it does not mean that your surgeon did something that another surgeon might have done in a similar circumstance.  However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.

The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate.  Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium.  Some of the core papers describe anatomic hypotheses rather than proven anatomic fact.  Unfortunately, a hypothesis is a scientific guess―it does not make an established anatomic fact. Lower eyelid surgery through the lower eyelid skin is one example of this.  Surgery damages the motor nerves that help support the lower eyelid margin leading to complications that can surprise the unsuspecting surgeon.  Naturally, they are not going to say that they are surprised but be assured they would not perform surgery this way if they thought it would cause a problem.

So why do doctors still perform this kind of surgery despite the risks?  Despite the inaccurate papers it is possible to dissect in this plane in some cases without significantly altering the nerve supply to the orbicularis oculi muscle.   Motor nerve damage to the orbicularis oculi muscle near the upper and lower eyelid margin affects the blink and weakens eye closed.  Without this critical blink function, tears do not move across the corneal surface properly resulting in dry eye and tearing issues.  When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.

The remedy for midface and lower eyelid surgery complications

To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal.  By preserving as much of the lower eyelid function and not cutting out additional tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal.  While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery.  Be skeptical of solutions that must be done “urgently” or don’t make sense.  While very few of these complications mend themselves, with time it may improve so less work than originally  thought may be necessary.

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 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.

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