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October 27, 2011

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

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

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

Crepey Skin

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

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

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

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

Heavy eyelids

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

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

About Dr. Steinsapir

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

 

 

 

 

October 15, 2011

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

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

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

Treating Syringomas

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

Deep Dermis Treatment

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

Factors for Successful Removal

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

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

October 5, 2011

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

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

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

Immediate post-operative issues

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

Dry eye

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

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

Bruising

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

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

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

Stitches

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

Swelling

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

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

August 27, 2011

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

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

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

Why won’t my eyes close?

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

What are my treatment options?

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

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

Is this a long-term issue?

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

I chose an experienced surgeon, what happened?

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

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

August 10, 2011

Is Laser Eyelid Surgery the Best Method of Eyelid Surgery?

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

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

The risks of using lasers

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

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

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

Is it possible to correct laser damage?

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

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

August 6, 2011

Can I visit the United States for Reconstructive Surgery?

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

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

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

Consult First

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

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

Take Time to Reflect

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

Make Thoughtful Decisions

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

About Dr. Steinsapir

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

June 25, 2011

What should I expect with my upper eyelid surgery?

Filed under: blepharoplasty,Eyelid Surgery,oculoplastic surgery,ptosis,safe cosmetic surgery — Tags: , , , — admin @ 3:10 pm

When you undergo upper blepharoplasty, eye tuck, eye job, eye lift, or lidlift surgery, your surgeon removes excess skin and sculpts fatty tissue that creates the appearance of droopy, deflated eyelids.  Certain eyelid structures may also be tightened as part of your surgery.  As the fat deposits, loose skin, and drooping of the eyelids typically occur due to aging, this procedure serves to restore a more youthful, refreshed, and rested appearance.

Because it is a versatile procedure, upper eyelid surgery can also accomplish other goals, such as creating an upper eyelid crease, opening heavy eyes, improving lash ptosis, and smoothing the skin of the eyelid platform making it more suitable for makeup. In addition, the upper eyelid lift procedure effectively leads to a reduction in skin tissue above the eye, allowing for better peripheral vision for some individuals.

Where is surgery performed and what type of anesthesia will my surgeon use?

Some doctors, like Dr. Steinsapir, maintain a dedicated procedure suite in his or her office and for healthy patients, many eyelid surgeries can be performed under local anesthesia in the office setting.  Others need to have surgery in a surgery center and this is typically done at a center or the outpatient wing of a larger hospital facility.  Dr. Steinsapir often brings his patients who need this level of service to the Surgery Center at The Ronald Regan UCLA Medical Center.  The location of your procedure varies based on the resources available to your surgeon and your unique health needs.

Eyelid surgery is very comfortable and most procedures are easily performed under local anesthesia with or without intravenous sedation.  Dr. Steinsapir advises against having eyelid surgery under general anesthesia.  To get the best possible result it is essential that the eyes can open and close to command during surgery.  If you are asleep, this is impossible and the surgical results will be compromised.  As an alternative, Dr. Steinsapir recommends having surgery under intravenous sedation where the anesthesiologist controls the level of sedation.  You would be minimally aware but still able to cooperate during surgery.  Because of the drugs used, you may not form memories of the surgery and yet you are able to cooperate during surgery, which is ideal.

What are the physical restrictions following surgery?

Before you undergo surgery, a reputable oculoplastic surgeon will ask about your medical history and perform a detail examination of the eyes and eyelids to ascertain your risk level and special considerations.  If you must be on a medication like Plavix or aspirin for medical reasons to thin your blood, your surgeon may advise you that you are not a candidate for cosmetic eyelid surgery, or may recommend a less extensive eyelid surgery.

During the first part of your recovery, you will need to take it easy, avoid bending over, and immediately call your surgeon should you experience any pain, bleeding, or impaired vision after surgery.  After 24 hours, Dr. Steinsapir will encourage you to go for a walk.   Bruising and swelling are normal after surgery.  However, many find that large sunglasses hide these bruises making shopping possible even in the first week after surgery.  Most people take a full week off from work.  However, many find that within a day of surgery, they are able to handle phone calls and email without a problem.  It will be about 10 days before most people may not notice that you just had something done.  We generally advise people to wait about this long before going back to the gym.  However, because workouts vary so much, it is best to discuss your workout with your surgeon to get advice that is tailored to your particular workout.  When you see your cosmetic surgeon, he or she will go over your pre-op and recovery plans in depth, giving you instructions and making sure you have the opportunity to ask all of your questions.

What are some complications from surgery and how they are addressed?

If anyone tells you that you can’t go blind from eyelid surgery like blepharoplasty, they aren’t being honest with you.  The truth is, while this is an extremely rare complication, there is a risk of blindness from eyelid surgery.  Of course no doctor thinks this will happen to them, but the best oculoplastic surgeon will acknowledge it’s a possibility, be honest with you about this, and take precautions to minimize the risk as much as possible.

Loss of vision after eyelid surgery is general due to bleeding behind the eye called a retrobulbar hemorrhage.  If someone tells you that they have never this type of problem after eyelid surgery, then they probably have not seen enough cases, or simply lack adequate training in eyelid surgery.   Avoiding medications and herbal products that thin the blood, like aspirin and Ginko help reduce this risk.

Your doctor will have you avoid blood-thinning medications to significantly decrease the already-low risk of retrobulbar hemorrhage.  This means that, with the consent of your general practitioner or family doctor, you won’t be able to take certain prescription medications as well as over-the-counter medications like Aspirin, Ibuprofen, Advil, and Motrin.  You will also need to abstain from most herbal products for a while.  If you have been prescribed a medication by a physician specifically for the purpose of reducing the risk of clotting, such as Plavix, coumadin, or aspirin, do not stop these medications on your own.  This needs to be done under direct medical supervision.  In some circumstances, your doctors may decide that these medications cannot be stopped and this will have a bearing on going forward with elective eyelid surgery.

Other issues may be more common but are less serious.  Dry eye after eyelid surgery is very common.  This is typically because your eyes were on the dry side before surgery and eyelid swelling makes this a bit worse.  As the swelling settles down, typically the dry eye symptoms settle down to what they were before surgery.  Some complications are very specific to the type of eyelid surgery you are considering.  For this reason, it is incumbent upon your surgeon to discuss these possibilities with you at the time of consultation.  If they spend 5 minutes with you, you are being short changed of this discussion.  A detailed surgical consultation appropriate for eyelid surgery can last an hour or more.

What is the time frame before full recovery?

Generally the bruising and swelling that is common after eyelid surgery rapidly diminishes.  Most people are comfortable returning to work and social activities within seven to ten days following surgery.  Complying all your surgeon’s post-op care procedures will ensure your recovery is as swift as possible.  Generally it is about 8 weeks before the swelling in the eyelids won’t be obvious to you when you look in the mirror.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.   Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

June 15, 2011

Micro-blepharoplasty

Filed under: blepharoplasty,Eyelid Surgery,oculoplastic surgery,ptosis — Tags: , , , — admin @ 8:11 am

Sometimes people begin to experience droopy eyelids at and early age.  You may have noticed older family members suffering from the same problem, but just because you’re under 50 doesn’t mean you shouldn’t consider cosmetic surgery as a means to remedy this problem.  Sagging upper eyelids will make you appear tired and older than you really are.  Even problems that may run in your family can be helped with surgery.

Options for droopy eyelids

Droopy eyelid surgery isn’t just for the Medicare crowd.  Long before sagging eyelids are so bad that they block vision, they rob our eyes of that youthful sparkle.  Make-up just can’t replace this.  There is no faking it.  The biggest challenge in recapturing this bright-eyed look is finding a surgeon who will do what Dr. Steinsapir calls Micro-Blepharoplasty.  Micro-Blepharoplasty is a form of very precise eyelid surgery.  These are customized surgeries that precisely address the issues that make the eyes look tired.  Important issues that are addressed include loss of support for the upper eyelid lashes, loose skin in the upper eyelid, heaviness of the upper eyelid so that it rests too low on the eye.  These changes account for an older, less youthful upper eyelid appearance.  The goal of Micro-Blepharoplasty is to restore the upper eyelid without the overcorrection that is all too common with standard upper eyelid procedures.  This type of customized approach helps restore a fresh, natural appearance.

Micro Eyelid Surgery

Micro-Blepharoplasty works by removing a small amount of eyelid platform skin just below the upper eyelid fold.  The doctor will anchor the skin of the eyelid platform and the underlying muscle to the tendon of the levator labii superioris muscle; the muscle responsible for lifting the eyelid.  This muscle is also responsible for forming the upper eyelid crease.  By creating a very precise support for the upper eyelid platform skin and muscle, the procedure smoothes and tightens the upper eyelid platform skin.  The eyelid structure is preserved and restored avoiding that surgical look.  The goal is to make the eyes look bright, refreshed, and natural.  Not only does the procedure tighten your upper lid, it also supports the upper eyelid lashes.

Choosing a physician

There are very few doctors who have the skills necessary to successfully perform Micro-Blepharoplasty.  As a board-certified ophthalmologist, and multiple fellowship-trained oculoplastic and cosmetic surgeon, Dr. Steinsapir has a reputation of excellence in issues most important to your treatment.   His training, skills, and experience set him apart from other surgeons who do cosmetic eyelid surgery.  Dr. Steinsapir will work closely with you to design a surgery that addresses your concerns.  As a fellowship-trained surgeon recognized by the American Society for Ophthalmic Plastic and Reconstructive Surgery, he has the experience and expertise to successfully perform Micro-Blepharoplasty.

Call now to schedule your personal consultation with Dr. Steinsapir to learn if this procedure is 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 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.

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: , , , , — 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.

March 28, 2011

I had Restylane service 6 months ago and still have lumps. Can anything be done about this?

Filed under: Beverly Hills Restylane,facial fillers,hyaluronic acid fillers,oculoplastic surgery,Perlane,Restylane,restylane in los angeles,Restylane Injections,restylane los angeles — Tags: , , , , , , , , — admin @ 12:13 pm

Restylane is a long-lasting but not permanent facial filler that is especially suitable for improving facial contours due to its natural-looking results, even in sensitive areas like dark circles under the eyes, and offers the ability to modify your results in the few cases when treatment isn’t completely satisfactory.  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.

When we hear from individuals who had dissatisfactory Restylane service long in the past, what is most disconcerting is that the individual was not aware that they could seek a simple adjustment from the start, or that they were not comfortable returning to their original cosmetic surgeon for this procedure.  This may indicate a problem in communication between the provider and the individual receiving services—and while this could simply be a lack of personality compatibility, it’s crucial that you are comfortable openly talking with your doctor about your treatment and any concerns that may arise.

Seeking the Best Restylane Services

While Restylane is considered a safe and routine procedure enjoyed by many who experience its benefits, this does not at all indicate that providing Restylane is an unskilled task.  You should always seek treatment from a leading and qualified provider such as Dr. Steinsapir, who is a cosmetic surgeon and oculoplastic surgeon with a major specialization of his practice being Restylane, including under-eye Restylane.  Your doctor must understand the subtleties of safely placing Restylane for natural results as well as how to adjust it should you have the need, and he or she must understand how Restylane and your facial anatomy interact to a level that could be called an art form.  Your doctor must also understand how to seamlessly adjust your Restylane treatment through comfortable hyaluronidase treatment.

Modifying Your Restylane Results

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.  In most cases its best to return to your original doctor who should be eager to make sure you are happy with your treatment and outcomes.  However, if you are concerned about the skill level of your original provider who may not have specialized in facial fillers, or if you are experiencing a breakdown in communication and lack confidence seeking further direction and treatment from this individual, then you may wish to consider seeking a second opinion.

Dr. Steinsapir often sees individuals dissatisfied with treatment received elsewhere, and in many cases he can help you to restore the relationship with your original doctor.  If this is not possible, then you can seek adjustment and further treatments from someone else like Dr. Steinsapir.  It’s very important that you are comfortable with these decisions and are empowered with knowledge and a good communication rapport with your doctor to ensure best results.  If you have been waiting as long as six months to find out if your experience with Restylane is normal and if you can have your results adjusted, we are sorry to hear that you have been needlessly stressed.  Fortunately, Restylane can be adjusted and you may learn that when your treatment is customized and delivered with great skill and precision, impressive results are possible.

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 specialization in Restylane treatments, please contact us today.

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