October 15, 2011

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

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.

July 27, 2011

Invisible Eyelid Surgery―Be Careful What You Look For

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.

March 6, 2010

Is it safe to do a home chemical peel?

Trying to perform a chemical peel on yourself is a sure way to turn a very safe procedure into a disfiguring one.  Because chemical peels are safe and highly beneficial when performed by an experienced cosmetic surgeon, and because they are a nonsurgical treatment, many people wonder if they can give themselves a chemical peel at home to save some money.  The internet has made these chemicals available. When someone asks us for advice on how to give themselves a home chemical peel, our advice is always this: Don’t!

Yes, the facial chemical peel cost is higher if you have it done right by a doctor, but that’s before you consider the cost of damaging yourself. If you try to perform this procedure on yourself, you will likely permanently alter the coloration of your face by introducing irregularities, scars, and hypopigmentation.  Further, you will not know how to care for your skin after the initial treatment without a doctor’s guidance in monitoring your healing.  In the end, you will have to bear the emotional cost of your damaged appearance and the financial cost of finding the best doctor who can help you reverse some of the destruction you have caused.  You wouldn’t do brain or heart surgery on yourself, right?  How about facial surgery?  That really is what is involved in doing your own chemical peel.

What can a doctor do that I can’t?

A chemical peel may seem deceptively simpler than it is.  Those who are just learning about the procedure often mistake it is merely a matter of dipping the face in a beneficial substance and then washing it off.  In truth, correctly performing a facial chemical peel takes a cosmetic surgeon years to master through education and first-hand chemical peel experience.  A licensed and highly trained cosmetic surgeon can perform a chemical peel so well because he or she understands the following:

•    The indications for a chemical peel treatment
•    The different skintypes classified in the Fitzpatrick scale
•    How each skintype responds to chemical peels
•    What concentrations and combinations help each skintype
•    How to give you enough treatment to see results
•    How to not give you too much treatment, which will damage you
•    How each type of problem respond to different treatments
•    How to assess the condition of your skin
•    Factors like skin thickness, sensitivity, sun damage
•    How your medical history effects your current treatment needs
•    Who is a good candidate for a chemical peel
•    Who is not a good candidate for a chemical peel
•    What to do in the rare incidence in complications
•    Post chemical peel treatment and how to follow up with care for your skin during and after the healing process
•    How to apply the chemical peeling agents differently to each facial area depending on the needs of the skin in each area
•    The powers and limits of each type of chemical peel

This is not something that any instruction manual can give you.  This is not something you can learn without training in biology, anatomy, medicine, and chemistry and many years of clinical experience.  This is not something you can learn without being mentored over a year or more.  This is not something you can “pick up” this weekend with a kit you ordered on the internet.  Most importantly, chemical peels are not a do-it-yourself activity.

Perhaps the most dangerous aspect of nonsurgical, minimally invasive treatments like the chemical peel is the fact that there are those who think that because it is so safe in a doctor’s office, it is something they can do at home in the kitchen.  Individuals trying to save a few bucks by treating themselves may be surprised and upset to see their experiment go so horribly wrong, but these poor at-home results don’t surprise a cosmetic surgeon who specializes in chemical peels and understands their complexity.  It is true that chemical peels are very safe, but only when performed in a medical setting by a qualified, experienced cosmetic physician who specializes in chemical peels.

Think of it this way: If you broke your leg, would you try to make a cast for yourself at home?  Of course not!  Doctors treat broken bones in emergency rooms everyday and consider this a safe, important procedure, but you would never dream of doing this to yourself.  Similarly, there is a lot more to the art of a chemical peel than you may imagine.

Finding the Best, Safe Treatment

Dr. Steinsapir specializes in individualizing each chemical peel to a patient’s unique facial needs.  He will answer your questions and develop a safe, effective treatment plan based on your individual goals.  Call us today to find out how a chemical peel performed safely on an outpatient basis can help you.