What does Dr. Steinsapir think of tear trough implants for under eye hollows?
Indications
Dark circles under the eyes can be responsible for a tired, haggard appearance, and they don’t simply go away with makeup or “beauty sleep.” This is because the underlying cause of dark under eye circles is not staying out too late, but a tissue deficiency just under the eye and above the cheek bone. Because the skin is quite thin and fragile in this region, when you lack enough volume under the eye, the interaction of the light here creates the dark circle which makes you look sickly, tired or simply older in appearance. An effective treatment must successfully address this key issue.
Background
Tear trough implants are a surgery where an implant is placed in the under eye hollow area just below the orbital rim on the facial skeleton. It provides more volume in this hollow area. The implant is placed thorough a skin incision, an intraoral approach, or from behind the lower eyelid. Generally the effect of this surgery is modest given the effort needed to place the implant. While modern facial cosmetic surgery is very safe, it is always best to opt for the least aggressive approach, including nonsurgical options when they are available or can even yield better results. The bottom line is that tear trough implants were a great technology 20 years ago, and they worked well for accomplishing treatment of the under eye circles in a time when this was an advanced procedure. However, thanks to hyaluronic acid fillers, we have much better treatment options today. By placing a small amount of Restylane in the under eye hollow, extremely natural results can be achieved during an office visit with a leading specializing physician of hyaluronic fillers. The service can last a year or more and has essentially made this surgery obsolete.
Modern Advances
Hyaluronic acid fillers — such as Restylane and Perlane — have revolutionized modern day cosmetic treatments, providing safe, adjustable, nonsurgical treatment options for those seeking to improve their facial aesthetic. These fillers can be administered in a comfortable office visit, and have long-lasting benefits yet are not permanent and can also be readily and comfortably adjusted with hyaluronidase if needed. This enzyme breaks down the filler should an adjustment be necessary such as from a post treatment highlight, ridge or bump. A service can be feathered with this enzyme making it possible to achieve truly natural treatment results.
Dr. Steinsapir advocates for minimally invasive, nonsurgical treatments that yield natural results and compliment your facial contour. Sometimes surgery is indicated, but other times just as much if not more facial improvement can be achieved with modern advances in services that include fillers, botulinum toxin like BOTOX, and chemical peels. Restylane is a filler that does very well to correct the under eye hollow. It works by adding volume to the affected area, contributing to the natural fullness associated with youth. With dark circles under the eyes, what we see anatomically is a descent of the malar fat pad; in other words, with age and time the tissue under your eyes and upper cheek that gives a bright affect eventually begins to drop. Dr. Steinsapir has invented DeepFill Restylane specifically to address this problem in a safe, effective method.
Taking Action
There is no reason to fret over under eye hollows and dark circles when reliable nonsurgical options are available. By seeking expert advice you can see improvement soon. The key, as with any treatment, is to see a doctor who makes your concern a major part of his or her practice, has completed specialized education, and has proven experience with exceptional results. Dr. Steinsapir is one of the leading providers of hyaluronic acid fillers, and he has extensively studied and published on the treatment of under eye circles as they relate to an overall balanced facial aesthetic. His observations and research led him to invent DeepFill Restylane, an under eye treatment for which many individuals travel to his practices in Beverly Hills and at UCLA. To learn more about the best treatment for your under eye hollows, contact us today and schedule your consultation with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Beverly Hills where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Transconjunctival versus Transcutaneous Lower Eyelid Surgery
Transconjunctival and transcutaneous lower eyelid surgeries are each a type of lower blepharoplasty, a plastic eyelid surgery that can address a range of issues such as excess fat or “puffiness” around the lower eyelid, loose and wrinkled skin. For great results, your blepharoplasty must be carefully planned by your attending surgeon, who will consider the subtle details of your facial anatomy when determining which type of blepharoplasty is right for you, and details such as whether to remove any fat and where, how tight the eyelid skin should be, and how to achieve natural results for overall facial balance.
Lower eyelid blepharoplasty can be approached either through the skin, transcutaneously, or from behind the eyelid, transconjunctivally. There can be very specific reasons for choosing one approach over another. More commonly, surgeons use a particular approach, not due to inherent advatages of the approach but rather that was they way they were trained. For the most part, tranconjunctival surgery is performed by oculoplastic surgoens who by training are comfortable working near the eye. General plastic surgeons and others lack the specialized training in oculoplastic surgery. They prefer an approach to the eyelid that does not require they to work so close to the eye surface. This is unfortunate because the skin incision usually is made through the underlying muscle. This can damage the function of the underlying muscle, the orbicularis ocli muscle. After surgery, this muscle weakness account for the alteration of the lower eyelid contour that is routine associated with transcutaneous lower eyelid surgery.
Here is an overview of some important features of each surgery type:
Transconjunctival Blepharoplasty
• Incision made behind the lower eyelid
• Minimizes the risk of altering the contour of the eyelid margin after surgery
• Arcus marglinalis release can be performed through the same incision, wherein the eyelid fat is preserved and rotated into the hollow under eyes
Transcutaneous Blepharoplasty
• Incision made just below the lower eyelid lashes
• Can possibly damage the function of the orbicularis oculi muscle and affect the lower eyelid contour
• Permits the removal of excess skin
For some, removal of the lower eyelid fullness from behind the eyelid and removal of excess skin from the front is indicated, via a skin pinch technique or an infracillary incision just below the eyelashes that preserves the underlying muscle. Ultimately, the only way to know what treatment method is right for you is to consult with an experienced oculoplastic surgeon who will meet with you, discuss your concerns and treatment goals, perform a physical examination, and work with you to design an approach that addresses your specific anatomical features and overall facial balance. These are highly complex and specialized procedures that require a skilled and experienced hand, and can bring you many benefits both functional and aesthetic. To schedule a consultation with Dr. Steinsapir, a leading cosmetic eyelid surgeon who practices in Beverly Hills and at UCLA, please call us today.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
What does Dr. Steinsapir think of the “Madonna Lift?”
For the last few years, the “Madonna Lift” — yes, named for the famed pop star — has received attention for purportedly dramatic results akin to an eyelid lift without the surgery. The procedure itself involves fractional CO2 laser resurfacing, with a goal to tighten the periocular skin in the eyelids and adjacent facial regions. Marketing claims for this procedure promise that it will give the effect of an eyelid lift through use of light columns to treat and tighten the skin. Claims include a diminishing of wrinkles, tightening of the skin, reduction of under eye circles, and elevation of the eyebrows. In essence, we are talking about the full benefits of an eyelid lift but without any surgery at all.
Does the Madonna Lift live up to the hype? Reasonably, the Madonna Lift can make a modest difference in your eyes’ brightness, but individuals undergoing the procedure might feel that it didn’t seem worthwhile. To get real results cosmetic procedure must address the root causes of your concerns. The best and most natural results come from addressing actual issues — which may include excess tissue or tissue deficiencies or both; stretched, sagging, and sun-damaged skin; ptosis; a drooping brow; or other concerns. Short cuts may help but they can also be disappointing because the lack the power to make a real difference.
Dr. Steinsapir is a leading advocate of minimally invasive facial cosmetic procedures, including nonsurgical procedures like under eye Restylane, the chemical peel, and Microdroplet BOTOX when indicated. There are many nonsurgical procedures with minimal downtime that can make a huge difference in your appearance. However, the key to satisfactory results is catering to your unique facial structure and goals, while choosing the best procedure to match your needs (whether surgical or not)–rather than setting your heart on a procedure full of promises but that may not be right for you.
The Madonna Lift is not a substitute for surgery if that is what you actually need. This is just another example of a modest procedure with a catchy name. For real results, we strongly encourage you to seek a personal consultation with a physician who is an eyelid specialist and can advise you on a personalized treatment plan. This may or may not include eyelid surgery, but the key is that your treatment will be based on your needs rather than a promise of a one-size-fits-all cure with a catchy name.
Dr. Steinsapir is an international leader in both eyelid surgery and minimally invasive, nonsurgical facial cosmetic procedures. Much of the appeal of the Madonna Lift is the absence of surgery, and it’s of course understandable that you may be hesitant to consider surgery. Dr. Steinsapir’s philosophy is that all treatments should be both individualized and minimally invasive. What does this mean? If surgery is not indicated, he will not recommend it. And when surgery is indicated to address the cause of your concerns, he opts for a treatment that is conservative and preserves as much of your natural tissue and eyelid contour as possible, enhancing your features, speeding up recovery time, and avoiding the “surgical look” famed by gossip magazines. Many people see phenomenal results from an upper eyelid blepharoplasty and related eyelid surgeries, and many also see incredible improvements from nonsurgical procedures like undereye Restylane and an individualized chemical peel. The bottom line is, you may or may not need surgery to get the results you desire — but for an outcome that meets your needs, you should never limit yourself to one procedure just because it was marketed to you. For the best results, consult with a leading oculoplastic surgeon to determine which treatment plan is right for you.
We invite you to consult with Dr. Steinsapir today, a pioneer in minimally invasive cosmetic facial procedures with particular attention to the eyelid and its balance with the rest of the face. Dr. Steinsapir has proven results for both surgical and nonsurgical cosmetic facial procedures; and his friendly, approachable, and honest demeanor will help you feel comfortable asking questions, receiving answers, and planning for the procedure(s) right for you.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Will photo facial treatments affect my Restylane service?
Minimally invasive procedures have become a very popular way of improving one’s appearance. Several different treatments can be performed at one time minimizing downtime. Photo facial and facial filling with Restylane and Perlane is a very common combination of services. The fillers address volume deficiencies like under eye dark circles, lip lines, loss of facial fullness and Photo facial can improve sun damage, facial redenss to even the complexion. The filler is placed sufficiently deep in or below the skin that it is unaffected by the Photo facial. So there is no reason to be concerned if you are having both services at the same time or if you previously were treated with fillers. Your suitability for either or both of these procedures is best determined at a private consultation with a qualified oculoplastic surgeon or cosmetic surgeon. The good news is that these procedures are compatible, safe, and comfortable.
Understanding the basis for how Restylane and Fotofacial both work will clarify why it is safe to receive both treatments. Photo facial is an intense pulse light treatment (IPL) that improves red spots, small blood vessels, and sun damage. These treatments are the basis for photo facials, and they are generally delivered over the course of four to six sessions at three weeks intervals. This is sufficient time to see improvements in your skin’s appearance, creating a more even tone and skin firming. Fotofacial works by directly treating your skin where the sun damage, pigmentary, and capillaries responsible for redness reside.
Restylane treatment, on the other hand, is carefully placed under the skin to correct deficiencies in facial volume, such as the under eye circle. For example, under eye Restylane is safely placed beneath the skin to address the volume needs, thus improving what we perceive as dark circles under the eyes. Because Restylane works from under the skin while Fotofacial directly targets the skin itself, Restylane treatments are unaffected by IPL treatment, and vice versa.
It is important to always disclose your complete past and current medical history with your physician as you develop your treatment plan. This will ensure that your care is as safe and personalized as possible. Dr. Steinsapir specializes in both Fotofacial and Restylane treatments and is the inventor of of Deepfill Restylane method, the breakthrough approach to correcting under eye hollows. Dr. Steinsapir is friendly and approachable, and will gladly answer your questions and help you feel confident in your treatment choices. Call us today to schedule an individualized consultation and see results.
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
Laser liposuction is better, right?
The marketers know that lasers are sexy. For everything from wrinkles to fat, people want to know, is laser better? It sounds cutting-edge and many individuals are certainly willing to drop money for laser marketing’s promise of superior results, but when we consult science, peer-reviewed studies, and expert physicians there just isn’t a basis for the the claims that laser liposuction, laser resurfacing, and so on are better choices than the meticulously researched and developed methods of tumescent liposuction, chemical peels, and other standards of top care that laser treatments are attempting to replace.
Some facilities are invested–literally–in selling you laser liposuction treatment because the laser tools used are very expensive to lease or to buy. Once this purchase is made, in order to make up the cost a provider is then motivated to do as many laser procedures as possible. This is a sad predicament for both the doctor and the client; for many had good intentions and high hopes for laser technologies in liposuction, and many clients are being recommended these purportedly “miraculous” laser treatments that aren’t right for them.
How does liposuction work? Answering this question can shed light onto the marketing claims of laser treatments. Laser liposuction is actually a variation of tumescent liposuction, which is a safe and fast-healing procedure in which a small cannula is inserted into a small incision that enables a skilled cosmetic surgeon to sculpt the contour of the body in that region through removal of fat. This is not a weight-loss method but a shaping technique for people with relatively stable weights but certain areas on the body with excess fat that has not been improved through diet and exercise. With laser liposuction, the cannula has a laser attached to its end, and it must go through a larger incision. Dr. Steinsapir utilizes a smaller microcannula to perform tumescent liposuction, enabling precise control and refined shaping, and minimizing tissue trauma. More importantly the thermal injury associated with laser liposuction is avoided. Dr. Steinsapir feels this speeds recovery compared with laser methods.
Still other treatments such as Zerona Laser Treatment and i-Lipo are noninvasive in that all they do is shine a light on the skin. With no valid peer-reviewed studies to support the effectiveness of these products, and considering that they rely on your exercise regimen after treatment, you’re probably better off with a gym membership and personal trainer.
To sum it up, much has been promised from the laser liposuction market with little to support its claims and no evidence that it’s better than microcanula liposuction. For positive and customized results, and for no-nonsense answers about what liposuction is and isn’t, call Dr. Steinsapir to schedule a consultation. His friendly, conversational, professional expertise can help you demystify liposuction and develop an individualized plan for you.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
My lower eyelid is sagging after eyelid surgery-what should I do?
First take a deep breath. Things happen after eyelid surgery. Many things fix themselves with a little time. Before surgery, your surgeon went through a lengthy list of things that might happen with surgery. Of course it is human nature to think that none of that will happen to you. In some cases I think that the surgeon sends a subliminal message that even though all this stuff is in the consent, it is a mere formality. Having an issue after surgery is an unwelcome shock. If you trust your surgeon, that confidence should help get you through the rough patches after surgery.
There can be a number of reasons for why the lower eyelid sags after surgery. In some cases swelling can push the lower eyelid away from the eye. This can occur in conjunction with a process called chemosis. Chemosis is the medical term for swelling of the white of the eye or the conjunctiva. Just as the eyelid will swell after surgery, the conjunctiva can swell. When it is swollen, the conjunctiva has been described to look like “jelly.” The best treatment for this is ocular lubrication and time. This often resolves with tincture of time.
Another cause of lower eyelid sagging is preexisting laxity of the lower eyelid. Swelling after surgery causes the laxity to be exaggerated resulting in the unsatisfactory position of the eyelid. In many cases again time is the best treatment.
When the surgeon cuts the skin of the lower eyelid to remove “extra lower eyelid skin,” malposition of the lower eyelid can be more serious. Under these circumstances the lower eyelid can be short of skin or the muscle that helps hold the lower eyelid against the eye can actually be damaged by the surgery. Rather than allowing this to heal, surgeons often feel the need to provide an early fix. That early fix can help resolve the issue or make it worse.
Generally, due to mechanical issues, some of the simple treatments can actually be helpful. These include steroid injection, mechanical finger winking, and when appropriate a pull up suture placed to support the eyelid corner for a few weeks. When these measures fail, it is best to let the eyelid heal before attempting revisional surgery. So often Dr. Steinsapir is called in to fix an eyelid where the original surgeon has made several well meaning attempts to “tuck up” the eyelid early after the original surgery with each procedure making the situation worse.
What will your eyelid need? It often depends on precisely what factors are contributing to the circumstance. If your surgeon was not a fellowship trained oculoplastic surgeon, it is often helpful to see someone who is. The additional training and experience may be precisely what is needed to address the situation.
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
Even the Wall Street Journal fails to understand how cosmetic surgeons are trained!
The message that one should only go to a board certified plastic surgeon is the public relations message of general plastic surgeons. While there are many excellent skills that general plastic surgeons offer, it is essential to understand that very few of these surgeons were trained to perform cosmetic surgery in their plastic surgery residency. Additionally numerous surgical subspecialties offer high quality cosmetic surgery and were very extensively trained in these procedures in residency and fellowship programs. In many cases, the subspecialist cosmetic surgeon offers a level of service that is better than what can be obtained from the majority of general plastic surgeons. It is my opinion that general plastic surgeons betrayed their public trust by not doing more to bring up the standard of care in cosmetic surgery and for so long failing to properly train their resident surgeons to properly perform cosmetic surgery. For this reason, the public is often much safer getting their cosmetic surgical care from the subspeciality cosmetic surgeon and not a general plastic surgeon. The Wall Street Journal just published an article that completely ignored this issue. Here is the letter I sent to the Wall Street Journal.
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
