In contrast, Dr. Steinsapir developed Microdroplet ^TM botulinum toxin as an alternative method for addressing brow ptosis and forehead lines without freezing facial expression or creating the risk of a droopy eyelid. Microdroplet ^TM botulinum toxin concentrates treatment in the muscles that account for eyebrow depression. These muscles live right along the eyebrow. The key to the treatment is using very small doses of botulinum toxin just below the level of the skin where the muscles of facial expression insert. This effective traps the botulinum toxin so the treatment can’t diffuse into the upper eyelid. Because only the muscles that pull the eyebrows down are relaxed, the frontalis muscle of the forehead does not have to work as hard to lift the eyebrows. This means fewer forehead lines without paralyzing the frontalis muscle. That frozen look is associated with heavy forehead treatment. Microdroplet botulinum toxin creates a forehead lift without freezing the forehead. This means you have natural forehead movement.

Microdroplet ^TM botulinum toxin treatment is so unique that the United States Trademark and Patent Office recognized Dr. Steinsapir as the inventor of this method and issued a rare medical method patent for this treatment.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.
To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.
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.

The double fold suture methods for Asian eyelid surgery, are ostensibly closed methods. Small incisions are made in the eyelid for the purpose of hiding the sutures used to form a crease. In contrast, anchor blepharoplasty is an open eyelid method. In order to perform an anchor blepharoplasty, the surgeon must make an upper eyelid crease incision. Through this incision, the orbital septum is identified and opened. A very clear operational understanding of eyelid anatomy to perform the surgical dissection needed to perform the surgery. Unfortunately, many eyelid surgeons lack this basic but specialized anatomic knowledge. In my experience operating with senior plastic surgeons, less than 5% of these surgeons possess the knowledge, skill, and experience to correctly perform this dissection.

Anchor blepharoplasty anchors the upper eyelid platform skin and the underlying orbicularis oculi muscle to the levator aponeurosis, the tendon like expansion of the levator palbeprae superioris muscle as it inserts into the upper eyelid tarsus. Attachments from this tendon to the skin are responsible for holding the upper eyelid platform skin firmly. As these attachments give way, the eyelid platform skin above the eyelashes becomes lax. Unfortunately this is precisely the area of the eyelid that must be taut to hold eyelid make up. Also when this skin lacks appropriate support, the upper eyelid lashes are not well supported and the upper eyelid lashes droop. This is known as lash ptosis. Lash ptosis is one of those subtle things that contribute to the eyelids looking tired.

For an Asian eyelid, a double fold is created when there are attachments under the skin between the upper eyelid crease and the levator muscle. For many Asians, these attachments are under developed. This accounts for the absence of a double fold. In some cases these under developed attachments may produce an incomplete partial fold. The suture methods force the crease to form along the path that the sutures are treaded. So long as the sutures remain intact, the crease is present. When the sutures break the scar tissue created by the passage of the sutures is seldom strong enough to maintain the crease and fold. This accounts for why the threading procedures do not hold up long term.

In contrast, the open double fold surgery produces eyelid structure that is permanent. The most critical aspect of successful double fold surgery is placing the crease at the correct position of the eyelid. The precisely height of the upper eyelid crease seems to be a bit of a mystery for most surgeons. Many surgeons being very diligent students have followed what is described in the textbooks. That would be great but for one fact. The appropriate height of this crease is not correctly reported in most plastic surgery textbooks. In Converse’s Textbook of Plastic Surgery, the height of a Western eyelid is noted to be 10 mm. Other texts note that for Asian eyelids the crease height should be 8 mm. These numbers are wrong on two counts. A surgeon making a crease at 10 mm will not find that the crease will heal to the desired position. As the upper eyelid wound heals, it migrates superiorly 1 to 1.5 mm. This means that a crease placed at 10 mm will heal at 11.5 mm above the eyelashes. An Asian crease cut at 8 mm will heal at 9.5 mm. At this height, the fold will never properly drape the upper eyelid. Most Asian women will feel that their eyelid is Westernized. Not the desired effect! I typically make my Asian upper eyelid crease incision at 5.5 to 6.5 mm. This means that the upper eyelid retains its quintessential Asian character.

With the eyelid open and the levator tendon carefully exposed, the presence of upper eyelid ptosis can be addressed with sutures that reinforce the upper eyelid tendon or, when necessary an actual anterior levator resection ptosis procedure can be performed. This permits as much or as little correction of upper eyelid ptosis as needed. Also this exposure is needed to anchor the upper eyelid skin and orbicularis to the levator tendon at the height of the new eyelid crease. No closed method permits this type of correction.

Not sure about your potential Asian eyelid surgeon? Have a frank conversation about their assessment of your eyelids. What height will they be placing the upper eyelid creases? How much skin do they intend to resect. Will the surgery only involve removal of skin, or skin, muscle, and fat, and why? Do they intend to open the orbital septum? (They should) If not, what is their plan to form a long-term upper eyelid crease and what height are they planning to place the crease? If the answers to these questions are lacking, you should consider interviewing more eyelid surgeons. These are very basic issues.

Dr. Steinsapir
Los Angeles

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.

Dark under-eye circles can be caused by a number of conditions, including thin lower eyelid skin and not having enough fat between the skin and underlying muscle (the orbicularis oculi).  The deepest part of the dark circle is where this lower eyelid muscle attaches to the bones of the face. The only permanent solution for this problem is to add volume to the under eye area.  The best approach is to use hyaluronic acid fillers such as Restylane, which can be adjusted to create the perfect taut under-eye area.

Fat grafting is another method that is often used to treat this problem.  Unfortunately, fat grafting requires a surgery.  The surgery may be accompanied by a number of unpleasant side effects, including profound bruising, persistent swelling, and the development of bumps and lumps that sometimes require additional surgery to address.

Ending a long day by putting slices of cucumbers under your eyes may help you relax, but it won’t make a dent in your dark circles. If you’re truly interested in permanently lightening or erasing dark circles, consult a cosmetic surgeon who specializes in 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.

The only time you need to get clearance from an ophthalmologist is when your plastic surgeon is not appropriately trained to take care of the eyes and is therefore unqualified to properly assess the health of your eyes. Board-certified general plastic surgeons lack the necessary training, skills, and experience to accurately assess eye health. Of course they are not the only surgical specialty that offers cosmetic eyelid surgery without these important skills.  Facial plastic surgeons, dermatologists and cosmetic surgeons of various stripes and background all offer cosmetic eyelid surgery without the detailed knowledge needed to provide care for the eyes. For this reason, if they are performing your eyelid surgery, they should send you to your general ophthalmologist for clearance.

Unfortunately, the general ophthalmologist may not fully understand the procedure, so they might not know what signs to look for in regards to whether you’re a good candidate for the surgery. As a result, the ophthalmologist may unintentionally clear you for a surgery that could compromise your eye health and comfort. It makes sense that a surgeon who is both board certified in ophthalmology and fellowship trained in to perform eyelid surgery will be the best choice.

Without in-depth training in oculoplastic surgery, eyelid surgery performed by general plastic surgeons, facial plastic surgeons and other cosmetic surgeons may not be ideal for your individual needs. Surgeons who lack training in oculoplastic surgery and board certification in ophthalmology don’t have the skills, training, and knowledge to manage post-surgical eyelid issues that may arise. Often this lack of training also means that they lack the finesse that sets the stage for successful results when foreseeable issues are considered and factored into the design of a surgery. Even the choice of which eye drops to use after eyelid surgery to comfort the eyes or a thoughtful discussion before surgery regarding what to expect can make all the difference.

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.

Fat transfer has become very popular. Doctors are even calling them “stem cell facelifts.” Technically, adults stem cells are in the grafted fat, so there is a tiny grain of truth to this. Mostly though, it is a lie. These stem cells have nothing to do with the results accomplished with a facial fat transfer.

Dr. Steinsapir finds that fat grafting to the lower eyelid is an inferior treatment. First it requires a surgical procedure to obtain the fat. Harvesting the fat requires a small surgery with definite, though rare, harvest site healing issues.

Placement of facial fat also requires a surgical procedure. It is common for the face to bruise with placement of the fat. The bruising commonly takes about 10 days to resolve. The take of the fat is not predictable. Experienced fat grafters including Dr. Steinsapir believe that about 60-70% of the grafted fat survives. Over filling the face with fat can make the face too full. Where that fat is placed in the cheeks, chin and temple areas the grafted fat tends to hide in existing facial fat. Dr. Steinsapir likes fat grafting when the face needs a good deal of volume.

However, fundamentally, the lower eyelid is not an ideal location for fat grafting. The reason for this is poor tissue coverage. The dark circle or tear trough is defined where the lower eyelid orbicularis oculi muscle inserts into the bone of the maxilla. This means no fat under the insertion of this muscle, the thinnest spot of the dark circle. Putting the fat above or in the muscle is a sure way of making bumps. You don’t want bumps, especially not bumps caused by grafted fat. Unlike certain fillers that are prone to bumps, those fat bumps are not going away. 20 years from now those fat lumps will still be there. In fact if you happen to gain weight since your fat grafting, guess what? Your lumps will gain volume too.

How common are lumps after fat grafting? Gee, fat grafters as a group don’t report this information. Many of these patients find their way to Dr. Steinsapir’s office for help. Some of them were made worse because a well meaning surgeon injected the bump with corticosteroids to melt them away. They show up with a lump where the grafted fat is and a hole where the steroids have damaged the natural lower eyelid fat. 5-florouracil is sometimes used to modify the unwanted lumps from fat grafting. This is an anti-cancer medication that can sometimes modify scar tissue. However, when this does not work, actual eyelid surgery is needed to remove these nodules of grafted fat. It is Dr. Steinsapir’s opinion that as many as 30%, possibly more of patients who have had fat grafting to the lower eyelids have unwanted lumps.

Now compare this to filling the dark circle with Restylane. Restylane is an office service and does not require surgery. No second wound is needed to obtain the material. The product is available with local anesthetic. Using a topical numbing cream applied to the skin also helps to make the procedure very comfortable. Deep anesthesia is not needed. Restylane can be shaped to the face once injected. You can reapply makeup two hours after treatment so down time is minimal. It is possible to bruise from this type of treatment but typically the bruise is not as profound as that associated with fat grafting. If there are any lumps, bumps, or unwanted highlights on the skin, these can easily be modified with an enzyme called hyaluronidase.

Restylane often lasts a year or more. This treatment is easily performed by an experienced midface injector like Dr. Steinsapir. It can be adjusted at any time in the office setting with a very safe injectable enzyme. This certainly beats needing to have surgery on the face or needing the face injected with an anticancer drug.

Fat grafting does it last? Yes, certainly. However, after fat grafting it is very common for swelling to persist for several months. It is all too common for individuals to become dissatisfied with the degree of facial improvement once the swelling has resolved many months later. Individuals who have been fat grafted, often feel that the volume from the fat grafting has disappeared. While this is seldom actually true, the deflation that occurs as the fat grafting heals causes natural disappointment with the procedure. This leads many to wonder if fat grafting was worthwhile. Combine this with lumps in the lower eyelid when fat is placed in the thin tear trough area and you have a formula for unhappiness. Given this reality, Dr. Steinsapir feels that under eye Restylane is almost always the preferred option over fat grafting the lower eyelid.

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 ranks at the top with a handful of medical centers in the United States. Dr. Steinsapir performed his surgery on an outpatient basis at the Surgery Center at the UCLA Medical Center. Dr. Steinsapir addresses a broad array of cosmetic oculofacial concerns including cosmetic eyelid surgery, Asian eyelid surgery, endoscopic forehead lift, BOTOX and dark circle treatment. Contact us today to schedule a personal consultation with Dr. Steinsapir.

Dear Editor:

I read Robert Johnson’s article “A Nip and a Tuck” about cosmetic surgery for the 65-plus crowd that appeared in the October 31, 2011 WSJ.  The article only mentions a single specialty that offers cosmetic surgery: general plastic surgeons certified by the American Board of Plastic Surgery.  Either general plastic surgeons are very good at public relations (they are), or the author was unmotivated to provide readers with a balanced perspective.  General plastic surgeons are not the only board certified surgeons who offer safe, high quality cosmetic surgery.

For years general plastic surgeons failed to train their residents for cosmetic surgery. General plastic surgery residency instead focused on broad training in reconstructive general plastic surgery.  Despite claims to the contrary, treating a burn is not the same as performing liposuction, a facelift, or an eyelid surgery.  This lack of leadership has resulted in a less than ideal standard of care for these elective cosmetic surgeries.

Over the past 40 years, otolaryngologists, ophthalmologists and dermatologists have built excellent fellowship training programs in facial plastic surgery, oculofacial plastic surgery, and dermatologic surgery that provide in-depth training in cosmetic surgery to allow these surgeons to offer cosmetic surgery to the American public that is arguably safer and of better quality than that offered by general plastic surgeons.   The American Board of Cosmetic Surgery, a non-ACGME board, accredits high quality cosmetic surgery fellowships that are open to a number of surgical specialties including general surgeons, gynecologists, oral maxillofacial surgeons, as well as general plastic surgeons. These highly trained specialists provide a quality alternative to board certified general plastic surgeons who lack formal training in cosmetic surgery.  It is now well accepted that fellowship trained dermatologists practicing liposuction are much less likely to be sued for liposuction malpractice than general plastic surgeons to cite just one example.

It is not controversial to state that general plastic surgery residencies do not provide adequate training in cosmetic surgery.   Fortunately the field of general plastic surgery has recognized this and now offers a growing number of fellowships in aesthetic surgery for board eligible general plastic surgeons.  However, compared to fellowship trained specialists in facial plastic surgery, oculoplastic surgery, dermatologic surgery, and cosmetic surgery; general plastic surgeons still have a ways to go before the public trust in this specialty is truly deserved. Unfortunately readers of Mr. Johnson’s article were left unenlightened about these issues.

Sincerely,

Kenneth D. Steinsapir, M.D., Los Angeles, Ca.

Associate Clinical Professor

Division of Orbital and Ophthalmic Plastic Surgery

Jules Stein Eye Institute

David Geffen School of Medicine at UCLA

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.

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.

Like Restylane, Perlane® is intended for volumizing, but it differs from Restylane in that Perlane is intended to provide facial volume in the deep dermis and superficial subcutaneous fat.  Perlane and Restylane are not equivalent products.  It is essential that your doctor places Perlane deeper than Restylane.  When used properly, Perlane is an excellent alternative to volumizing products like Scluptra® and Radiesse® and even fat transfer.  Treatment with Perlane also lasts well over a year.

Where are injections commonly performed?

Hyaluronic acid fillers are office-based services. You may see estheticians and unqualified individuals like medical assistants offering injections illegally in spas and salons under the justification that they have a “medical director.”   No States permit this arrangement.  Unless a doctor is present and performs the service, this type of situation is the illegal practice of medicine.  As with BOTOX®, don’t let an unqualified individual perform your Restylane or Perlane service.

Just like BOTOX, only a licensed medical doctor or a nurse under the direct supervision of a licensed medical doctor can inject hyaluronic acid fillers.  The exact details of the required qualifications vary by State so it’s important to research the individual you wish to perform the injection to ensure he or she is qualified.  However, just because your doctor or nurse is minimally qualified to perform the injection does not necessarily indicate he or she is the ideal choice for the procedure.  As with many other medical procedures, the best results require a certain level of qualification, skill and experience; these concerns are perhaps even more important when considering modifications to your physical appearance.

What’s the typical recovery course and what are the physical restrictions?

Many of Dr. Steinsapir’s patients resume their normal activities just after leaving the office with the exception of no workouts for 24 hours.  Wait a day before going to the gym.  If you don’t bruise, there will be about thirty to forty hours during which you experience minimal swelling.  Many patients, both men and women, can hide this swelling right away with a camouflage makeup that matches their skin color if necessary.  If your lower eyelid skin quality is poor and you often collect a small bag of puffiness under the eye, the doctor may counsel you regarding the need to consider a procedure like a chemical peel or surgery prior to getting regular filler treatments so you don’t experience prolonged recovery after each filler service.  This can be discussed when you have your initial consultation.

What are common complications and how are they addressed?

Most people, about 70 percent, do not experience bruising after a Restylane treatment; the other 30 percent experience some degree of bruising; most of it mild.  But a very few (one or two in a hundred) will develop a black eye.  The black eye can take about two to three weeks to completely resolve, and this is a cosmetic concern without health dangers.  The worst part of this is that many will assume that you were the victim of domestic violence.  Glasses and makeup help to hide the bruise while it is resolving.  Considering that Restylane will last over a year, the recovery process is very mild and comfortable even for these few.

For the few Restylane recipients who experience bruising, the short-lived bruise is worth the long-term results.  It’s a good idea to obtain treatment at least three weeks before big events like vacations.  For the biggest occasions such as your own wedding, Dr. Steinsapir advises have treatment 2 months ahead of the event to be completely certain that your pictures will turn out great.

To minimize your risk of bruising, your doctor will ask you to stop taking certain medications that thin the blood, such as aspirin.  If you are taking anything prescribed by a doctor, Dr. Steinsapir strongly advise that you consult with your prescribing physician before discontinuing the medication.  If your doctor suggests that you continue the medication, this does not mean that you aren’t a good Restylane candidate.  If you are willing to be at a slightly elevated risk for bruising, Restylane can still be effective.  Your regular doctor and your cosmetic specialist can help you decide the best route to take.

The incidence of allergic reaction varies with the products used and should be discussed with the treating physician but the incidence of allergies to these products is very low.

For unwanted highlights or bumps that occasionally occur after an otherwise excellent filler treatment, the enzyme hyaluronidase makes Restylane injections easily adjustable to a more desired aesthetic, and your doctor can even erase the treatment completely if you determine together that this is your best option.  In the event that you experience lumps or unwanted effects from your Restylane treatment, hyaluronidase makes it easy to adjust hyaluronic acid fillers like Restylane, Juvederm and Perlane.  This flexibility created by the ability to adjust a service is one of the most important factors making HA fillers such a popular service.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

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.

The perils of liquid silicone

Receiving silicone oil injections in Mexico ( or in the United States at “pumping parties” or from unscrupulous injectors) is a dangerous decision for several reasons.  Non-medical injectors are known to use liquid silicone illegally on the black market.  Although medical professionals using liquid silicone in an off-label fashion use medical grade material, on the black market the silicone is often not medical grade but rather industrial silicone oil, which was never intended for the human body.  There have been deaths from these types of illegal treatments.

Technically, since physicians may use FDA-approved products for non-approved uses, you can legally receive silicone oil treatments as a facial filler; but that doesn’t make it a good idea.  Injecting silicone oil into the face and other parts of the body like the buttocks is not a case of careful and thoughtful use.  It violates the very oath that every doctor takes to do no harm.  Unfortunately a few non-physicians and even physicians continue to use silicone oils this way.

Deaths related to silicone oil injections have been reported. Even small facial treatments into the lip and nasolabial fold over time can result permanent and irreparable facial disfigurement.

Don’t be fooled by the price

When it comes to financing cosmetic procedures, here is the bottom line: if you can’t afford safe, quality treatment from an actual physician (not an assistant, technician, traveling person with unspecified qualifications, the black market, or your own hand), then you are better off without any treatment.  Silicone oil injections have too many associated complications, including migration and permanent disfigurement

Instead of automatically assuming you cannot afford legitimate, trustworthy, FDA-approved fillers, consult a bona-fide, fellowship trained cosmetic surgeon to learn about the cost and payment options for a safe, dependable filler.  Silicone oil injections are cheap for a reason.  Anyone who tells you they are a good cosmetic option is misleading you and omitting the facts.

Fixing facial fillers

Unfortunately, silicone oil is a poor alternative to real hyaluronic acid fillers like Restylane® or Perlane® because it cannot easily be modified after the treatment.  The first step in addressing and removing unwanted silicone is to identify the exact source of the injected silicone.

• Was it medical grade or industrial silicone oil?
• What is the lot number and expiration date?
• Where was it manufactured?
• Did the injector take precautions and use sterile technique?

Removing silicone is difficult, which is why Dr. Steinsapir believes that it should not be used as a filler material.  Once you have identified the above information, the next step is to decide if surgery or some other approach is needed.  Silicone oil is permanent and can’t be dissolved so removing it may require invasive surgery.  The type and extent of your surgery will depend heavily on the location of the original injections, the type of silicone used, and the amount.  The benefit of removing the material must be weighed against the potential complications that might be caused by surgery.

It is important to choose an experienced and knowledgeable surgeon to perform your surgery.  Find someone you can trust and who will work with you to find a treatment plan that works for you and your individual situation.  Unfortunately, a decision to receive silicone oil in Mexico, or any other black market injector often results in a greater expense in order to have the foreseeable complications addressed.   In too many cases, there are no good options.  Dr. Steinsapir strongly encourages anyone considering a black market cosmetic treatment of any kind to take into account the fact that while the initial treatment may be less expensive than a proper visit to a cosmetic surgeon and paying full price for your procedure, the long-term costs of a decision like this far out-weigh the short-term savings.

About Dr. Steinsapir

Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge reconstructive eyelid and midface surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for his expert care.

To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.

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.