fixing eyelid surgery « Cosmetic, Facial & Eye Plastic Surgery Blog

January 29, 2012

My lower eyelid is sagging after eyelid surgery-what should I do?

Filed under: canthal surgery,cosmetic eyelid surgery,Dr. Steinsapir,eyelid reconstructive surgery,fixing eyelid surgery,revisional eyelid surgery — admin @ 1:42 pm

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

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

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December 9, 2011

I had a midface lift at the time of my eyelid surgery, and now my eyes look different. Will canthal surgery correct my problem?

Filed under: eyelid reconstructive surgery,Eyelid Surgery,fixing eyelid surgery,irregular eyelids,Lateral canthal surgery,midface lift,midface surgery,Plateau Midface Defect — Tags: Lateral Canthoplasty, midface surgery, Plateau Midface Defect, Reconstructive Surgery — admin @ 9:41 pm

The most critical issue here is to understand how your face has changed.

You are absolutely correct to say that your eyes have changed. However, your analysis of the problem is not correct. I suspect that very few surgeons you consult will understand the issues. At the same time I am equally certain that many surgeons would be more than happy to perform a lateral canthoplasty for you. They will mean well but they are simply going to make your situation worse, not better.

I completely agree that surgery has altered the shape of the eyes. This is the most obvious change. The outer corners of the eyes are higher after surgery compared to your preoperative status. There is also a subtle lower eyelid contour abnormality of the lower eyelids. It is true that a properly executed lateral canthoplasty has the potential to reposition the lateral canthal angle. In my many years of repairing prior eyelid surgery, I have found that very few surgeons are capable of actually achieving that type of result in a natural way. Not impossible, just very difficult as the surgery must be done with the patient at least awake enough to open and close the eyes to judge the effect of repositioning of the angle. If surgery is performed under general anesthesia, then in my opinion, the likelihood of success is very low.

Canthoplasty, and to a lessor degree, cathopexy, risk over shortening the lower eyelid. It is true that many surgeons will shorten the lower eyelid as part of the canthoplasty procedure. The procedure is taught this way and this maneuver is important for pathologically lax eyelids. However, over shortening an eyelid that does not need to be shortened will simply force the lower eyelid below the curvature of the eye. This will actually make the lower eyelid look more pulled down. The outcome will be disappointing.

So lets talk about the real issue. It is interesting how important the eyes are in interpersonal interaction. Subconsciously, we scan the face of the person we are speaking to. During conversation, we actually scan a triangle on the face that includes the eyes, the nose and to a lesser degree, the mouth. This is so profoundly ingrained, that one expects someone listening to you to look at you in this manner. We are not even be aware of this gaze pattern. However, we can be acutely aware when the pattern is altered in someway. What you would experience when you are speaking to someone is the sense that they are not really paying attention to you. When does this happen? Studies have shown that changes in the face will alter this scan pattern. There are some very nice studies of this in the head and neck literature in looking at scan patterns when viewing someone who has a facial lesion or just had surgery to remove a facial lesion.

How does this apply to this situation? If you look carefully at your after photograph, you face demonstrates a classic facial defect caused by your mask lift. The forehead dissection has resulted in atrophy of the fat pads that extend from the temple to the orbital rim. This hourglass hollowing of the temple areas I call the plateau midface deformity. Essentially the loss of the fat volume skeletonizes the zygomatic arch. This little bit of facial fat plays a critical role. This cushion of fat at the side of the face serves to separate the eye aesthetic area from the temple aesthetic area. This slight cushion of volume helps maintain gaze on the eyes. Without this fat volume, the scanning gaze is falls off the eyes and is drawn into the temple area. You are left with the feeling that people are not paying attention to you. Since the primary reason many women (and men) have cosmetic surgery is to stay relevant, this feeling of being ignored can precipitate a narcissistic crisis. The fact that your surgeon cannot understand your concerns (and I promise you they really don’t get it) is even more infuriating. Because like you, they don’t see what the issue is, you get treated like a problematic, ungrateful, impossible to satisfy (insert your own description here) person. Naturally this can precipitate a break down in the doctor patient relationship.

In the example shown here, surgery was used to correct the problem. Previously placed cheek implants were removed and replaced with a hand carved ePTFE orbital rim implant. The lower eyelid was also lengthened using hard palate graft. Because it is necessary to sew the eyelid closed for a week to allow healing means that only one eye can be done at a time. For some individuals who only have the plateau midface, fillers can be used as an alternative to facial surgery.

First, there is no substitute for an actual personal consultation. Generally for this type of problem the best solution for many is adding hyaluronic acid filler to the area where you have lost volume. These products last quite a while and this can be a workable alternative to corrective surgery. For some, surgery is necessary. The most important thing is to avoid having a fix by doctors who do not understand what the issues are. Unfortuately, if you don’t see it, you can’t fix it.

Kenneth D. Steinsapir, MD

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.

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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: anchor blepharoplasty, brow ptosis, crepey lids, crepey skin, eyelash ptosis, fixing blepharoplasty, fixing lash ptosis, fixing upper blepharoplasty, lash ptosis, upper blepharoplasty — 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.

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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

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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: blepharoplasty, blepharoplasty complications, corrective eyelid surgery, eyelid surgery complications, fixing blepharoplasty, fixing eyelid surgery — 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

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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: asian blepharoplasty, blepharoplasty, eyelid surgery, eyelid surgery risks, laser blepharoplasty, laser eyelid surgery, laser eyelid surgery risks, upper eyelid surgery side effects — 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

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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: corrective eyelid surgery, Cosmetic Surgery, Dr. Steinsapir, facelift in los angeles, los angeles cosmetic surgeon, travel for cosmetic surgery, travel to see Dr. Steinsapir — 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.

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May 28, 2011

Do 1 in 30,000 eyelid surgeries really result in blindness?

Filed under: blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,fixing eyelid surgery,oculoplastic surgery,safe cosmetic surgery — Tags: blindness, corrective eyelid surgery, Cosmetic Surgery, eye surgery risks, oculoplastic surgery — admin @ 11:06 am

The risk of eyelid surgery resulting in blindness is real. Every time a doctor performs eyelid surgery there is a risk of vision loss. For this reason, it is important that you undergo an eye examination before your eyelid surgery, including an assessment of your vision. Experience has some bearing on the rate of visual loss and certain procedures may have a higher risk of bleeding behind the eye, the most common cause of blindness after eyelid surgery. Your eyelid surgeon needs to be able to identify and manage bleeding behind the eye, also known as retrobulbar hemorrhage.

Managing Risk

If a surgeon you are interviewing states that he or she has never experienced a retrobulbar hemorrhage in a patient, they have not been in practice long enough. A retrobulbar hemorrhage, which may occur in one case in a 1,000, does not necessarily lead to blindness. An experienced and capable surgeon can mitigate the damage if he or she can immediately recognize the problem; identify pushing forward of the eye, recognize signs such as reduced vision, pain, and impairment of the pupillary function; assess elevated intra-ocular pressure; and rapidly intervene to preserve vision.

Realistic Numbers

What is the actual risk of visual loss? It’s only estimated, but approximately 250,000 cosmetic eyelid surgeries were performed last year in the United States. If the rate of vision loss was one in 30,000 cases, only about 8 patients lost vision in one of their eyes as a result of eyelid surgery.

Being a responsible patient

Bottom line is: yes, it is possible to lose your vision as a result of an eyelid surgery, but some of the responsibility rests with you as a patient. You can reduce your risks by disclosing all medications and herbal supplements you are taking to your surgeon. Follow all the directions your surgeon gives you regarding preparations for surgery. Choose your surgeon carefully and make sure her or she personally performs an examination of your eyes and checks your vision prior to eyelid surgery. The risk of visual loss is small, but not zero. If you are concerned about this risk, discuss the issue with your eyelid surgeon and seek a surgeon who is qualified to handle any eye emergencies that might arise in association with your eyelid surgery.

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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April 17, 2011

What is the difference between blepharoplasty and ptosis surgery?

Filed under: blepharoplasty,Eyelid Surgery,fixing eyelid surgery,ptosis — Tags: blepharoplasty, corrective eyelid surgery, oculoplastic surgery, ptosis, ptosis surgery, upper eyelid surgery — admin @ 7:22 pm

Blepharoplasty and ptosis surgery are not exactly the same thing, but the differences between the two are subtle. Ptosis surgery is a type of blepharoplasty; blepharoplasty is the general term for eyelid surgery. Ptosis surgery, on the other hand, refers to a specific procedure that corrects an upper eyelid that has fallen due to a problem with the levator muscle in the eyelid.

Blepharoplasty

There are many different types of surgery for the eyelids. Blepharoplasty includes all of them; both for the upper eyelid and the lower eyelid. If you’re suffering from eyelid ptosis, your cosmetic surgeon may recommend ptosis surgery, a type of blepharoplasty to correct the problem. But blepharoplasty can also be used to remove fatty bulges around the eyes, and eliminate hanging skin from the eyelids. There are lots of reasons to consider blepharoplasty, both cosmetic and medical. Dr. Steinsapir often performs blepharoplasty to correct eyelid surgeries―performed by other surgeons―that fail to meet the client’s expectations.

Ptosis Surgery

Ptosis is when the upper eyelid droops. Before performing surgery, your surgeon will need to distinguish between excessive skin in the upper eyelid with a heavy fold and an actual fall in the eyelid margin. Excessive skin and heavy eyelids does not indicate ptosis, however, you and your surgeon can discuss options for removing the heaviness of your lid and opening up your eyes.

Upper eyelid ptosis has a number of causes. These causes can be anything from congenital ptosis, to acquired ptosis caused by the levator muscle being cut during surgery, or most often, the levator aponeurosis muscle becomes stretched with age. Other causes of acquired ptosis include four broad categories: neurogenic, myogenic, traumatic, and mechanical. Because the type of acquired ptosis has a bearing on your surgeon’s approach to repairing your eyelid, it is important for you surgeon to classify and properly diagnosis the basis of the droopy eyelid.

There are two principle surgeries used to correct the position of the upper eyelid: Anterior levator resection ptosis surgery and Mueller’s muscle resection. Anterior levator resection ptosis surgery strengthens the effect of the levator muscle, which elevates the upper eyelid. The surgery shortens the tendon of this muscle called the levator aponeurosis and effectively elevates the eyelid making the eye look bigger. Mueller’s muscle resection is performed from behind the upper eyelid using a special clamp called a ptosis clamp.

About Dr. Steinsapir

Dr. Steinsapir is a board certified ophthalmologist (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 provider of ptosis surgery, which can be a vital part of your evidence-based treatment plan.

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January 20, 2011

Fixing Lower Eyelid Surgery

Filed under: best cosmetic surgeons,Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,fixing eyelid surgery,lower blepharoplasty — Tags: corrective eyelid surgery, Cosmetic Surgery, lower eyelid surgery, oculoplastic surgery, under eye treatments — admin @ 1:34 am

Eyelid surgery is a great option for many people seeking to improve their looks and their interactions with others. You can usually anticipate that your lower eyelid surgery will be a positive experience that improves your appearance and your confidence, but there are still occasions when an individual may need to seek revisional eyelid surgery with a top oculoplastic surgeon, especially if the original operating surgeon was not chosen with the greatest care. If you are concerned about the outcome of a past eyelid surgery and want to know how to address any issue you perceive, here are a few items to consider as you move forward toward attaining your treatment goals.

Have you had time to heal?

After an eyelid surgery, you might experience some apprehension as you anticipate your results and wonder if you made the right decision. Most individuals find that they are very happy with their eyelid surgery results, so before you start to fret make sure you’ve allowed yourself healing time to see improvement. In a very few, rare cases an individual needs to seek immediate medical attention for eyelid surgery complications, but this is not common.

If your concerns are aesthetic, it’s generally advisable to wait six to twelve months after a lower eyelid surgery such as lower blepharoplasty to seek revisional treatments. This is because it’s important to allow all the tissues to fully heal and observe your final results before modifying the outcome with additional surgery. Especially in cases when an overaggressive surgery leads to the need for corrective surgery, your corrective surgery should preserve your tissue as much as possible to improve your look rather than making the problem worse. This is why a conservative approach after ample healing time is most effective.

Since you begin to see the results of your eyelid surgery earlier than the time for corrective surgery, you should be openly expressing any concerns that arise with your original surgeon on an ongoing basis. If you feel you could benefit from a second opinion with a specialist in eye plastic surgery and its correction, this can also help you to calm your worry and consider your options.

Who can help?

In many cases, individuals worry needlessly about an overall great surgery because they haven’t let themselves heal or are nervous enough to imagine problems that aren’t there. On the other hand, with any medical procedure you run a risk that it will not go exactly as you had hoped, and eyelid surgery is no exception. If you want to learn more about whether you might need your lower eyelid surgery fixed, you can be glad that expert help is available.

First you should consult with your original surgeon wherever possible. Your surgeon who performed your first eyelid surgery should be eager to help you address any concerns you have and find the best solution together. However, sometimes part of the problem may be that your surgeon lacks the specialized skill in conservative eyelid surgery that is needed for precise and natural results, and in these cases consider consulting with an additional doctor for a new viewpoint based on experience and expertise.

It takes extensive training, experience, skill, and specialization to be able to perform the best eyelid surgery, and additionally there are very few doctors with focus on skillfully correcting eyelid surgery. We invite you to consult with Dr. Steinsapir, who makes eyelid surgery as well as corrective eyelid surgery based on years of education, training, and experience a major focus of his practice in Los Angeles and Beverly Hills. Dr. Steinsapir works from a philosophy that natural results are achieved through conservative surgery that enhances your eyelid’s natural contour. This approach helps to prevent the need for corrective surgery to begin with. If you are already concerned about a prior eyelid surgery, or if you are seeking lower eyelid surgery and want to minimize your risk of needing corrective surgery later, contact us today and consider how a fresh opinion from Dr. Steinsapir can help set you on the right track for to achieve your goals.

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