Consider the impact of surgery

While television programs are full of stories about how plastic surgery transformed the lives of the patients, these grand results are much less common than the TV might lead you to believe. An improved upper eyelid won’t suddenly transform your life by helping you to get a better job, end conflict with your spouse, or make you an instant celebrity.  A realistic goal is that you will be pleased with the improvement and happy that you had surgery.  However, it is unrealistic to expect the surgery will help you land that promotion and help you pay off the cost of surgery. Don’t opt for surgery if it is a choice between basic necessities and having surgery.  Paying rent and health insurance is more important than elective cosmetic surgery.  These are personal choices, but cosmetic surgery is a luxury and not a necessity.  Make sure you aren’t over committing yourself financially in deciding to have surgery.

Consider your motivations

Before deciding to undergo cosmetic surgery, ask yourself “why.”  The first step to understanding if you are ready for surgery is to understand your motivations.  Do you want surgery to please yourself, or to please someone else?  There is no right answer, but if you want surgery to please someone else, ask yourself if the surgical outcomes are something you also want.  Do you find yourself preoccupied with thoughts of a particular surgery?  Do you avoid social situations because you are concerned that people are staring or whispering about you?  Do you spend hours every day repeatedly thinking about an issue that your friends have trouble seeing?  These may be signs of a condition called body dysmorphic disorder.  Body dysmorphic disorder is an obsessive thought pattern characterized by focusing on a slight or nonexistant flaw. Unfortunately, it is difficult to fix subtle or nonexistent issues surgically.  Occasionally this leads to a flat out misunderstanding between surgeon and patient, and even more trouble after surgery.  Dr. Steinsapir find that it is best to air these issues openly and if necessary involve a psychotherapist to help the individual better understand their motivation to have surgery.

Consider your support system

One last series of questions you should ask yourself is about support from family and friends.  Are others around you supportive of you having cosmetic surgery?  Keep in mind that a negative environment can be harmful to your healing process following surgery.  It is so important to make sure those you love are supportive of your decision before you undergo cosmetic surgery.  Don’t try to hide the fact that you are undergoing cosmetic surgery; be open about your plans and find support from those around you.

About Dr. Steinsapir

Dr. Steinsapir is a board certified ophthalmologist 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 cosmetic surgery.

Common side effects of surgery

Many people become concerned when swelling in the eyelid persists for several weeks after surgery; some amount of bruising is also common following surgery, but neither bruising nor swelling are cause for concern unless they are excessive.  Remember that that it does take time to heal and many issues resolve with time.  For this reason, it is best to give the eyelid plenty of time before considering revisions to your surgery, especially if the issue is mild ptosis.  Dr. Steinsapir usually recommends six to twelve months before considering revisions.  There can be pressing reasons to operate earlier.

Certain lower eyelid surgeries (primarily transcutaneous lower blepharoplasty) have a finite risk of damaging the lower eyelid.  These issues can be complex.  It is often true that when something is not right several months after eyelid surgery, the problem was evident very soon after surgery.  Because many things will show improvement over time, a period of healing is often recommended, even if reconstructive surgery will be necessary.  Treatment with medication such as steroids and simple mechanical treatment such as finger winking can help with the ultimate lower eyelid position.  In this situation especially, it’s important to wait and allow time to heal before deciding on reconstructive surgery.

Causes for concern

There are occasions when immediate action is necessary to correct a problem that may result in a much more complex reconstructive surgery down the road or immediate damage to the cornea.  These situations are unusual.  Worrisome issues that occur within the first 24 hours of surgery include bleeding, bruising that rapidly expands across the eyelid, loss of vision, or persistent or severe pain.  These types of issues should prompt an immediate call to your surgeon.  If you are not able to reach your surgeon, consider calling 911 .  It is better to be seen for something that turns out to be nothing serious than to miss something truly important.  Other issues are much less urgent and may not make themselves clear for several days or weeks after surgery.  Even when it is clear that the issue does not require immediate attention, call your surgeon and discuss the situation with the office.  Most often the surgeon will want to assess you personally and assure themselves of what is going on.

About Dr. Steinsapir

Dr. Steinsapir is board certified in Ophthalmology and has completed numerous fellowships, including three years of Orbit and Eyelid fellowships at the prestigious Jules Stein Eye Institute at the David Geffen School of Medicine at UCLA and a separate two year cosmetic surgery fellowship under the auspices of the American Board of Cosmetic Surgery.  He is widely respected for his work and has published over thirty scientific papers and eight book chapters.   He is a true innovator, having developed Microdroplet™ BOTOX®, a unique patented method for injecting BOTOX®, Deepfill™ under-eye Restylane® treatment to address the dark circle and under-eye hollow for up to a year without the need for retreatment.  Dr. Steinsapir is one of the foremost eyelid surgeons in the world.  He is on staff at the UCLA Hospital and Medical Center where he is an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute.  He is also on staff at Harbor/UCLA Medical Center where he serves as an attending surgeon.  He is in practice in West Los Angeles and is in high demand by discerning individuals from Los Angeles, Beverly Hills, and Southern California.  Many of his patients also come to see him from around the country and the world. Very few doctors offer the level of skill and expertise he brings to cosmetic surgery and aesthetic restorative surgery to address prior unsatisfactory eyelid surgery.  Please contact us today to learn more about evidence-based treatment options with Dr. Steinsapir for proven results.

Consult First

We have found that 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 take a long drive to Los Angeles, have their consultation and have surgery on the same trip.  This is an alluring idea because then you only have to book a flight and pack your suitcase once, and you’ll probably save a little money—but please reconsider this approach.

At Dr. Steinsapir’s practice, we don’t believe performing an initial consultion 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.  In particular, Dr. Steinsapir has noticed that many people seeking revisional eyelid surgery and help for fixing other cosmetic treatment concerns initially got into their predicament because they were pressured into having surgery in the first place.

This is not our philosophy.  Cosmetic surgery and revisional cosmetic surgery should be something you and your surgeon approach calmly, thoughtfully, and with confidence.  Instead of too much pressure, we strongly advise and encourage you to take the time to make sure you have found the right doctor and right treatment approach.  We want 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.  However, you are much more likely to make a choice that is right for you.  This philosophy means that when you consult with Dr. Steinsapir, we do not 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 having cosmetic surgery or revisional cosmetic surgery.

Make Thoughtful Decisions

For these reason, even for those who travel very far, we don’t believe in doing surgery at the time of the initial consultation.  In fact, we don’t believe in cutting any corners with cosmetic treatment.  The best surgery is always performed with the utmost of care, consideration, research, and planning.  We want you to go into surgery comfortable that you have made the right decision and confident in your cosmetic surgeon’s qualifications and ability to meet you treatment needs.

We invite you, near or far, to visit Dr. Steinsapir in Los Angeles and Beverly Hills for your initial consultation.  Find out about his treatment philosophy, skilled experience, top educational and training background, the best individualized treatment for you, and simply whether your personalities mesh well.  We think you’ll find that Dr. Steinsapir’s friendly, caring, and honest approach demonstrates the highest ethical standards and thoughtful planning for best results.  Please contact us today to learn more about how taking the time now can give you the best outcome later.

BOTOX Before and After Photo

Yes, it is true that BOTOX is a safe alternative to surgery that has been demonstrated to relax overactive muscles and restore a youthful appearance, but this doesn’t mean that anyone should administer BOTOX treatment.  As with other medical procedures, BOTOX safety and results depend on the skill, training, and experience of the provider.

You should never receive BOTOX from a spa, lay injector, nonspecialist, or at home.  The best BOTOX results rely on precise consideration of the subtleties of your individual facial anatomy; your personal diagnosis, medical history, and goals; the experience and educational background of a doctor who specializes in facial cosmetic treatment; and your doctor’s ability to customize your treatment plan.

Differentiated Treatment Plans

BOTOX services are not all the same.  You need only glance at the cover of a gossip magazine in the grocery checkout stand to hear about someone who got the wrong treatment and now has the “BOTOX forehead freeze” that the media loves to publicize.  How does this unintended effect happen?  Here’s how: when people (both providers and recipients) misunderstand the purpose or application of BOTOX, when patients insist that a doctor gives them too much treatment or a treatment not suitable to their individual needs, or when they “cheap out” on service and are more concerned about just getting BOTOX under their skin rather than its controlled aesthetic placement.

How BOTOX works is by relaxing overactive muscles that are negatively impacting your facial features and the way your facial anatomy communicates with your brain.  Neuropathways in fact have much to do with how we look, because our brain “tells” our muscles what to do and how to compensate for the affects of time, gravity, age, stress, and sun damage.  It takes a specialist physician to with medical training to understand these complex processes on an individual basis, not an assistant technician or nonspecialist who lack the training, skills, and experience needed to make the most of your treatment.  You don’t go to a podiatrist when what you need is heart surgery; but as comic as that seems, there are people everyday who overlook the importance of specialized cosmetic training.  We believe that many would find deeper satisfaction from their cosmetic treatment much sooner if they recognize their need for a top specialist to begin with.

Further, there are different methods of administering BOTOX, some with better demonstrated results.  Dr. Steinsapir has invented Microdroplet BOTOX, a patent-pending method that avoids the BOTOX freeze and addresses the root cause of problems like forehead wrinkles, crow’s feet, and worry lines.  This esteemed method meticulously accounts for how each component of the face works together to restore an overall balanced and natural look.

If you have had unsatisfactory treatment in the past, the good news is that the effects of BOTOX will eventually wear off.  Now it’s time to consider how a more qualified physician can help.

Affordable Treatment Plans with the Best Providers

Cosmetic treatment and results are not cheap, nor will they ever be.  You must realize that when you seek cosmetic treatment from a reputable provider, you must help cover the expenses of medical school, research and development, the maintenance of a facility with the highest medical standards and cleanliness, materials, years of experience and training, specialized and uncommon skill, and the time it takes to carefully (rather than quickly) administer treatment.  That said, many people can and do afford BOTOX and enjoy its benefits.  A number of reputable providers offer cosmetic treatment payment plans that can make quality cosmetic treatment a reality for you.

If you are seeking the best BOTOX in Los Angeles, we encourage you to consult with Dr. Steinsapir at a no-risk meeting to determine if BOTOX is right for you and learn more about how you can obtain safe, natural results.  Dr. Steinsapir has been providing BOTOX treatment since 1988, making him one of the most experienced BOTOX doctors and leading him to develop his exclusive Microdroplet BOTOX approach.  His prestigious educational background and specialized focus make him among the best cosmetic surgeons in California for BOTOX, which is why many individuals travel nationally and internationally for his top-rated treatment plans.  Contact us today to find out how Dr. Steinsapir can individualize your BOTOX treatment to enhance your look.

Upper and Lower Blepharoplasty

Beyond that, once you and your oculoplastic surgeon determine the best procedure, it must be customized even further to fit your features and obtain natural results. In short, of the various types of lower eyelid surgery, the one or ones best for you will need to be tailored. Conversely, the worst lower eyelid surgery takes a standardized, one-size-fits-all approach.

The Many Choices in Lower Eyelid Surgery

Let’s review a few lower eyelid procedures to get familiar with some options and what they mean.

Blepharoplasty

There are different kinds of lower blepharoplasty, including the transconjunctival blepharoplasty transcutaneous blepharoplasty, and transconjunctival arcus marginalis release. A blepharoplasty is plastic surgery on the eyelid that can be designed to address concerns ranging from eyelid ptosis, excess fat or “puffiness,” and loose or hanging skin. The doctor performing your blepharoplasty must carefully consider the subtle details of your facial features in order to determine details like how much (if any) fat to remove and where, how tight the eyelid skin should lie, and so on.

Canthal Surgery

Canthoplasty and canthopexy can be effectively combined with other eyelid procedures when the lower eyelid needs to be tightened with great precision, the canthal angle needs to be adjusted, or the eyelid position should be reinforced.

Fixing Eyelid Surgery

If you have had prior surgery whether from a specialist or nonspecialist and are now dissatisfied with your eyelid results, there is hope. By carefully choosing an oculoplastic surgeon whose practice emphasizes fixing eyelid surgery, you can improve your appearance and your confidence. Be sure to find a doctor who specializes in your concern, has a prestigious educational and professional background, and demonstrates his or her ability through natural-looking before and after photos. If you communicate clearly with a qualified doctor who makes sense to you, you can usually prevent unsatisfactory results.

Eyelid Reconstruction

Perhaps you have had lower eyelid cancer, partial facial paralysis, eye loss, or other medical complications that make you a candidate for beneficial eyelid reconstruction even if your issue occur years ago. The key here is examining and understanding the damage, then designing a treatment that addresses the structural needs of your condition. This type of surgery should address underlying problems and the special needs of trauma reconstruction.

Midface Lift

The midface lift is not specifically an eyelid surgery, but rather a midface surgery, as the name suggests. Many people who seek treatment for their lower eye concerns are surprised to learn that the problem may not be localized to the eyelid, but a problem of tissue descent in the midface. Restoring these tissues to their natural positions can make your eyes appear more alert and beautiful.

Under Eye Restylane

Under eye Restylane is a nonsurgical procedure to improve the under eye hollows, bags, or dark circles. This is an excellent option for those who may not be ready for surgery due to personal reasons, or for those who simply have a milder issue that does not need surgery yet.

Seek Specialized Treatment

After this briefest of tours through just some of the science-based lower eyelid treatments that have been proven effective, you can see why your best lower eyelid surgery is personal to you. If you are concerned about your lower eyelid appearance, we invite you to a no-risk consultation with Dr. Steinsapir today. Dr. Steinsapir holds extensive experience, education, fellowship trainings, and research leadership in the art of customizing lower eyelid surgery to fit each individual’s complex situation and obtain natural results. He believes that no two surgeries are identical, because he has never met two people with the same set of eyes. The goal of eyelid surgery is not to make you look like a different person, but to enhance your features through improved details and restoration that brings out your individual best. Dr. Steinsapir’s minimally invasive approach, friendly demeanor, and proven outcomes make him a leader of eyelid surgery in Los Angeles and internationally. Please contact us today to learn more about how his caring practice can lead you to an improved eyelid aesthetic.

Oculoplastic Surgery Before and After Photo

Some individuals have tissue damage from prior eyelid surgery performed by well-meaning but non-specialized plastic surgeons.  This is usually the result of seeing a generalist who may be a great choice for a number of other procedures, but who does not have focused training and experience in the art of oculoplastic surgery.

Your specific treatment will of course depend on your unique situation, individual needs, medical history, and goals.

The Key to Natural Results

Natural results can be achieved when you communicate honestly with a highly skilled and experienced physician specialist.  Dr. Steinsapir is an oculoplastic surgeon in Los Angeles with extensive training and multiple fellowships in both oculofacial surgery and cosmetic surgery, with an emphasis on minimally invasive treatments and natural results.  Dr. Steinsapir preserves as much of your natural tissue as possible so that way, should you need revisional eyelid surgery, your results can be modified later.  Those who seek eyelid surgery from Dr. Steinsapir are usually satisfied with ideal results the first time, in part because Dr. Steinsapir performs conservative surgery that is natural instead of the “surgical look.”  To this cautious precision Dr. Steinsapir adds a prestigious educational background, experience, leadership, and demonstrable results you can see at his before and after eyelid surgery photos.

Not only must your surgeon be an experienced specialist who takes a conservative approach to preserving eyelid tissue, he or she should also custom-plan your treatment according to your unique features.  When you seek natural results, you can’t just pull out a sewing pattern, follow the standardized directions, and expect your results to have a tailored finish.  None of us have the same eyes or surrounding features, which is why only customized treatment plans yield exceptional results.  Dr. Steinsapir can help by listening to your needs and goals, providing a medical examination, and working with you to determine the best customized treatment that is both realistic and beneficial.  Whether you need a special blepharoplasty, Asian eyelid surgery, correction for eyelid asymmetry, or a solution for another concern, Dr. Steinsapir will meticulously plan your treatment and include you through each step.  He is a perfectionist when it comes to designing the most suitable oculoplastic surgery on an individual basis.

As a specialized oculoplastic surgeon and ophthalmologist in the Los Angeles area of Southern California, Dr. Steinsapir has studied at the David Geffen School of Medicine at UCLA, and the University of Chicago.  He is an Associate Clinical Professor at UCLA where he is a leader in definitive eyelid and undereye treatments and research.  He focuses on restoring the facial balance through natural results that emphasize how the entire facial structure works together and with the brain.  To learn more about how Dr. Steinsapir can help you improve your unique eyelid concerns, contact us today to schedule your no-risk, no-commitment consultation.

Chemical Peel Before and After Photo

When Do I Need a Chemical Peel?

Your doctor will go over this with you at your consultation.  Some general indications are:

•    acne with or without scaring
•    dark spots that have developed over time
•    aging skin from sun exposure
•    intrinsic skin aging
•    fine lines
•    creases and deep furrows
•    loss of skin elasticity
•    scaly dry skin with irregular brown spots
•    premalignant lesions
•    an overall yellowish hue to the skin due to chronic sun damage

Some patients may benefit from other procedures, like a facelift or facial filler, which can only be determined by an experienced surgeon at an individual consultation.

Which Chemical Peel Should I Get?

This depends on factors like the condition of your skin and what kinds of problems it has, your treatment goals, your skin color as classified by the clinical Fitzpatrick scale (which factors in how easily you sunburn), and other individual conditions.  To give you an idea of available chemical peels, here are some that are effective depending on the personal circumstances:

Alpha Hydroxy Agents

This peel is usually delivered in a series of treatments to improve mild brown spots and freshen the skin tone.  We derive alpha hydroxy acids (AHA) from fruit and dairy products, most commonly using glycolic acid to smooth the skin.  If your skin is suffering from discoloration and darkening from damage, skin bleachers combine synergistically with AHA to lighten the skin nicely.  Repeated treatments yield new collagen and elastin, which is thought to reduce skin sagging.  AHA can be used in an acne facial peel to improve your complexion, too.  Very low concentrations of about 2-15% are available over-the-counter, which generally are not concentrated enough to cause dramatic improvement on their own, but can be used as an effective at-home treatment in conjunction with stronger treatments from a cosmetic physician.

Jessner’s Solution

This balance of resorcinol, salicylic acid, and lactic acid is a mild treatment that can be combined with TCA to treat the skin more deeply.  When combined with TCA, which by itself is a mild to moderate peeling agent, Jessner’s Solution is a mild peel with increased skin effects.  Generally, those being treated with Jessner’s peel alone need frequent treatments (perhaps monthly) and would likely benefit from a stronger peel performed two or three times per year, which would create similar or better results.

Trichloroacetic Acid

Depending on your needs, your doctor can apply trichloroacetic acid (TCA) in any number of strengths to achieve your desired results.  Depending on the concentration strength, your doctor may administer a regional anesthesia and oral or intravenous sedation to ensure your complete comfort.  After TCA treatment, your skin will be fresher and smoother.  Generally the maximum concentration of TCA used is 35%.   TCA solutions of 50% are less predictable and can sometimes result in scaring.  The better option is to opt for an effective but less concentrated treatment that will provide predictable benefits without unwanted scars or use phenol which will safely peel deeper into the skin.  The exception to this is the so-called Cross method using 95% TCA for acne scar pits.

Phenol

This peel, when made into an 89% solution, creates a medium-deep chemical peel used to peel the face.  Phenol formula is remarkably effective at addressing problem lines, improving all but the deepest ones.  The tightening of the facial skin achieved with this treatment can, in some cases, rival facelift results without the need for surgery.  This peel can address sun damage, sun-spots, pre-malignant actinic keratosis, which left untreated can progress to in-situ squamous cell carcinomas. Since this agent is both strong and effective, your doctor must be cautious in its application.  Conservative applications are best because, when overdone, phenol can contribute to scaring, but in lower quantities it is a reliable, powerful treatment.  Very few patients require treatment of this depth on their whole face.  Instead, your doctor should use phenol to treat only small areas of the face where problems are most severe.  It may take 10 to 12 days to heal from a phenol peel while your skin rejuvenates.  Because the skin can stay red up to four to six months, some patients wear coverup and love their results, while many men find that this subtle hue readily blends into their complexion without concern.

Are Fruit Peels Safer Than Chemical Peels?

It’s important to understand that fruit peels are chemical peels, but milder and usually less effective than the chemical peels outlined above.  The word “chemical” scares a lot of people, but it’s important to understand that everything is a chemical, scientifically speaking, and chemical peels have a safe track record.  Fruit peels are generally made of mild alpha hydroxy acids and citric acids extracted from fruits.  Some may think it’s better simply because they hear the word “fruit” instead of “chemical,” but this peel is superficial with minimal benefits.

Should I Get the New Melange Peel?

This peel, which you receive at an office and then leave on for several hours at home, does receive a lot of internet hype.  There have been fantastic claims made about the Melange Peel. It is important to separate marketing hyperbole from reality: while you can expect mild improvement in skin tone, the real issue is do you get real value for what you have been asked to pay?

Expert Treatment

Chemical peels are not something a doctor can learn in a weekend seminar, but something a doctor must perfect by treating hundreds of faces.  The peel is an art form and your physician will assess the best peel or combination of peels for your unique situation.  Find a board certified surgeon with actual fellowship training in cosmetic surgery who has a long history performing facial peels for satisfied patients.

Dr. Steinsapir demonstrates his face peel expertise through years of experience, and his chemical peel before and after photos demonstrate his skill as both a cosmetic surgeon and an artist.  Call us today to schedule your consultation and find out which peel is most suitable to your needs.

1.    Local anesthesia is safer.
While cosmetic procedures today are overall considered extremely safe, it’s noteworthy to point out that in the rare cases of malpractice suits or death, most of these problems involve surgeries performed under general anesthesia.  For example, liposuction’s mortality rate when performed under general anesthesia is estimated to be between one in 40,000 cases to one in 5,000.  The actual figure is probably toward the lower end of that range, which means it’s extremely unlikely that you’ll be so unlucky, especially if you choose an experienced and reputable surgeon.  Then, when we look at the mortality rate for liposuction performed under local anesthesia, we find a mortality rate of only one in 300,000 cases.  The lesson to be gleaned here is that while both methods are very safe, the increased dangers of general anesthesia make safe local anesthesia a better option, so why take a chance?

2.    Local anesthesia enables the doctor and patient to communicate and obtain better results.
When the doctor and patient can communicate during the procedure, there is much to be gained.  If you are having eyelid surgery, for example, your surgeon can have you open and close your eyes so he or she can see exactly how your body is responding to the surgery and you can obtain the most precise results possible.  In cases like liposuction, your doctor will ask you to alert him if you begin to feel any mild discomfort.  This ensures that nearby tissues are not traumatized during the procedure.  If they are, you will be okay, but your recovery time will be longer.  When you are conscious, you can listen to your doctor and tell him or her exactly how you feel, which means your results will be more individualized than they would be if you are “out” under general anesthesia.

3.    Local anesthesia allows for faster recovery.
Fewer drugs means that you are less hung-over after surgery, so you return to normal much faster.  Going back to our liposuction example, the compression garments worn for six weeks after general anesthesia are only needed for five to six days after local anesthesia liposuction.  Since you are able to provide feedback to your doctor during surgery, the liposuction is accomplished with much less trauma which means a much faster recovery.

For these reasons, Dr. Steinsapir performs cosmetic procedures under local anesthesia whenever possible.  Cosmetic surgeries under local anesthesia often cost more than they would under general anesthesia because your doctor needs to spend more time working gently and delicately to ensure your absolute comfort.  The increased doctor-patient time does cost money, but this is also the reason why you heal so quickly and receive detailed treatment, along with fewer complications and health risks.

Which procedures can I have under local anesthesia?

This depends on your unique, individual health status and a personal examination.  Usually, those in good health can safely and comfortably receive most of the treatments we provide under local anesthesia.  Nonsurgical treatments like BOTOX, fillers, the chemical peel, and fotofacial of course are routinely administered under local anesthesia.  Cosmetic surgeries like the endoscopic forehead lift, facelift, midface surgery, liposuction, and eyelid surgeries are best performed under local anesthesia or local with intravenous sedation.  It is especially important to receive eyelid surgery under local anesthesia so your doctor can instruct you to open and close your eyes so that he or she can monitor and adjust the effects of the surgery for optimal results.

When is it best to have surgery under general anesthesia?

Generally procedures that are likely to run more than an hour benefit from sedation.  Body wall surgery including tummy tucks and breast surgery should be performed under general anesthesia.  Procedures that are likely to take more that 4 hours are often best performed under general anesthesia but this is something that should be discussed with the individual surgeon.

How do I find a doctor who will treat me under local anesthesia?

As always, we encourage you to be direct with your doctor.  Simply ask your potential cosmetic surgeon if he or she prefers to work under general or local anesthesia, and what he or she thinks will be best for you.  If your doctor prefers general anesthesia for you, find out why.  Is it because of your unique health situation?  Local anesthesia should be the default answer with general anesthesia functioning as an exception.  Yes, this will require your doctor to spend more time treating you, but in the end you will have peace of mind knowing that you’ll receive the safest care, as well as experience the fastest recovery time and the best results.

Dr. Steinsapir specializes in performing procedures that improve the face and body contours under local anesthesia.  He believes the extra time this requires is well worth the safer, superior results and satisfied recipients.  Dr. Steinsapir emphasizes the importance of minimally-invasive, detail-oriented treatments on a comfortable outpatient basis, while maintaining the expertise and safe resources needed for general anesthesia and inpatient treatment for individuals with unique health needs.  If you have any apprehension about anesthesia, Dr. Steinsapir can answer your questions, offer advice, and create solutions during your individualized consultation.  Contact us today to see how we can help.

Cosmetic Anchor Blepharoplasty and Ptosis Repair

Whether anchor blepharoplasty is for you depends on your candidacy for upper eyelid surgery, as we previously discussed – for example, if you have puffy, sunken, asymmetrical, or tired eyes then you may benefit from an upper blepharoplasty and thus an anchor blepharoplasty.  This is an essential part of correcting upper eyelid problems.

Is this a separate procedure from blepharoplasty?

Ideally, no.  Your surgeon should perform the anchor blepharoplasty as part of your regular upper blepharoplasty to correct tension problems along the eyelash line and ensure that your eyes look bright and lively.  However, performing an anchor blepharoplasty is a highly specialized, technical skill, and it takes the most experienced surgeons to execute this procedure.  If you go to a doctor who does not offer this procedure in conjunction with your blepharoplasty, then you may be setting yourself up for disappointment and possible revisional surgeries.  If your eyes have already healed with droopy lashes and loose skin, then it’s time for a consultation.  It’s always a good idea to find out if your original surgeon can help you resolve this issue.  However, the most common reason it was not performed at the time of the original surgery is that the surgeon lacked the skills necessary to incorporate structurally important element into the eyelid surgery.  If he or she can’t, or you lack confidence in their ability, then seek a second opinion.

The right doctor can easily correct problems with a properly designed anchor blepharoplasty.  Since precision is key to obtaining a great outcome, you should find a surgeon who has performed this procedure numerous times and recognizes its importance.

How long should I wait after surgery to receive a corrective anchor blepharoplasty?

Allow yourself several months to heal before seeking revisional surgery, assuming you’ll still want it when you are close to your final results.  Certainly keep communication open with your doctor so he or she can address your concerns and keep a close eye on your recovery, and it is also fine to seek a second opinion to decide on the best time for another eyelid procedure.  Unless it’s an emergency as we discussed in our last post, you should finish healing before undergoing more procedures in the same area.  This will enable your doctor to correct your eyelid tension with the fewest possible variables that may affect the outcome of your surgery.

I’m ready to talk to a professional about my concerns.

Consulting with an oculoplastic surgeon is the single most helpful action you can take when deciding whether anchor blepharoplasty is right for you.  You’ve done a bit of research, and now you need an examination by an experienced doctor who can accurately diagnose your problem and recommend the best treatment course, or no treatment when none is necessary.  If you haven’t yet had a blepharoplasty, be sure to ask your potential doctor about an anchor blepharoplasty so you love your results the first time.  If you need revision, a consultation will help you determine if an anchor blepharoplasty is ideal for your individual needs.

Dr. Steinsapir considers anchor blepharoplasty a normal part of upper eyelid surgery.  For evidence of his skill and attention to detail, we welcome you to browse his before and after blepharoplasty photos, where you will notice the alert position of the eyelishes and properly tensioned eyelid platform skin.  Dr. Steinsapir is a top eye plastic surgeon in Los Angeles who holds an impressive list of publications, qualifications, trainings, and certifications, including the multiple fellowships he has completed and his professorship at UCLA.  Contact us today to schedule your personal, individualized consultation with Dr. Steinsapir and learn how he can resolve your upper eyelid concerns.

The relative strength of BOTOX to Dysport is thought to be about 2 to 4, so they cannot be used in similar doses.  Further, Dysport diffuses more widely than BOTOX, meaning that treating one section of the face with Dysport will have a wider effect than treating the same portion with BOTOX.  This is not necessarily better or worse – what it means is that BOTOX and Dysport have different applications.  We don’t have meaningful evidence that Dysport lasts longer than BOTOX.  However, Dysport seems to kick in faster and some people really like this difference. These two products share important similarities, but we must be cautious in differentiating them as well.

Is Dysport Better than BOTOX?

It’s too soon to tell because Dysport only just became available in the United States in mid-2009.  So far Dysport and BOTOX seem to be comparable products with important differences outlined above, and Dysport has not demonstrated any clear advantages.   We already know BOTOX to be an extremely beneficial product that is here to stay, and we also know that Medicis (the maker of Dysport, Restylane, and Perlane) has consistently created effective products.  This said, BOTOX is still the market leader and Dysport will need to prove itself and withstand the test of time.

Some people are holding their breath in hopes that BOTOX and Dysport prices will compete until prices drop considerably.  Although there is some competition, we advise you to go ahead and take a deep breath and not expect a drastic change.  Introducing a new drug or product to the market is a costly endeavor that requires extensive research, production, and testing.  Add to this the cost of an experienced doctor who specializes in these procedures, and we see that cosmetic procedures from the better providers are never going to be significantly less expensive.  The advanced and technical nature of the medical field means that good medicine will always come at a premium, if administered safely and as recommended.  Since Dysport and BOTOX are not bioequivalent products, the competition between these products is even less direct than some imagine.  If you have been waiting for the price of BOTOX to drop sharply, you may be disappointed.  BOTOX is still worth as much as it was before, and Medicis still needs to recover the cost of bringing Dysport to the market.  Additionally, it is rumored that the price of BOTOX is scheduled to go up in 2010.

Dysport is turning out to be a great product, just as we expected.  Doctors are now gaining experience with Dysport and perfecting its use. So…

Should I Be Treated with BOTOX Or Dysport?

Your treatment will depend on the results of your private consultation.  Choose a doctor with extensive experience in treating the face with botulinum toxin A products for the best results.  Very subtle differences in treatment make the difference between good and extraordinary results, and experience guides doctors in making treatment decisions.  While any new product has the disadvantage of a short track record, a doctor with a demonstrable high skill level will know how to best apply the new product and when it’s preferable to use the leading brand.

Dr. Steinsapir trained with the inventor of BOTOX and has performed thousands of BOTOX treatments for over two decades.  In this time he has helped BOTOX recipients achieve remarkable results and has pioneered the patent pending Microdroplet^TM BOTOX treatment.  As a professional considered among the top BOTOX practitioners, he can help you get the best results from a traditional BOTOX treatment or the new Dysport treatment.  Contact us today for an individualized consultation to find out the most appropriate treatment for your unique concerns.