blepharoplasty « Cosmetic, Facial & Eye Plastic Surgery Blog

November 16, 2011

I consulted a plastic surgeon for eyelid surgery who said I needed clearance by my general ophthalmologist. Is that really necessary?

Yes, if your plastic surgeon doesn’t specialize in eyelid surgery and lacks board certification in Ophthalmology. Ask yourself if it makes sense to have eyelid surgery by someone who lacks this specialized knowledge and training. Is this really the right surgeon for you?

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

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

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

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

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October 5, 2011

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

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

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

Immediate post-operative issues

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

Dry eye

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

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

Bruising

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

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

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

Stitches

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

Swelling

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

About Dr. Steinsapir

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

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September 27, 2011

My sutured eyelid surgery only lasted 6 months; is there a way to extend the benefits?

Filed under: anchor blepharoplasty,asian eyelid surgery,blepharoplasty,cosmetic eyelid surgery,double fold surgery,Eyelid Surgery — Tags: asian blepharoplasty, asian eyelid surgery in los angeles, blepharoplasty, corrective eyelid surgery, DST, non-incisional blepharoplasty, partial incision blepharoplasty, sutured eyelid surgery — admin @ 9:35 pm

Sutured upprer eyelid surgery is a specialized methods primarily marketed to young individuals of Asian descent who lack a double upper eyelid. The methods go by a number of names including closed blepharoplasty, suture method blepharoplasty, double suture and twisting (DST) method, threaded eyelid surgery, non-incisional or partial incision blepharoplasty. The method offers the promise of inexpensive, minimal down time, non-incisional eyelid surgery. The only thing that does seem certain about these procedures is that the results are not permanent and for many the effects are gone in less than a year. Having studied the effects of this surgery, it is the opinion of Dr. Steinsapir, a leading eyelid surgeon, it’s better to find a real eyelid surgeon who can perform permanent double-fold blepharoplasty.

How doe sutured eyelid surgery work?

Double fold surgery with a threaded suture works by using stitches to create and maintain an eyelid fold. The crease is created by burying permanent, non-reactive sutures and pinching the undersurface of the eyelid skin to the deep soft tissue of the eyelid. The problems arise when the sutures break over time or start migrating through the skin. The recently developed method called Double Sutured and Twist (DST) technique purports a solution to this problem, however it does not solve the other problems created by this technique.

Problems with sutured eyelid surgery

Sutured double-fold surgery is often performed very quickly. In some parts of the world non-medical providers will do the work. As we have said so many times before on this blog, it is important to find an experienced medical professional to perform any cosmetic procedure, no matter how simple someone advertises it to be.

Sutured double-fold surgery and DST double-fold surgery are not a permanent solution. Not only do the sutures have a record of breaking or migrating, but the fold is often less distinctive than a fold created using an incision technique. Many patients who have undergone sutured double-fold surgery notice that their crease begins to lose definition over time and due to the lack of control this procedure is known for, asymmetry in the lids is also common.

The best double-fold surgery technique

To make a lasting crease, it is necessary to perform a surgery to make a strong attachment between the skin at the crease and the levator aponeurosis, the tendon that raises the upper eyelid. Although this method occasionally fails and the crease loses integrity, for most people, the result of surgery lasts a lifetime.

Although cosmetic surgery textbooks recommend the placement of the crease 2 millimeters to 4 millimeters higher than experience dictates. Physicians who specialize in Asian eyelid surgery are informed by experience; and experience indicates that the incision tends to migrate upward as the eyelid heals. For the best Asian blepharoplasty results, you need a minimally invasive treatment plan that preserves as much natural tissue as possible. A less aggressive, yet highly controlled surgery creates the fastest recovery time, natural improvements, and precise results.

Restoring the eyelid fold

When sutures fail, the defined upper eyelid crease begins to disappear. There can be changes to the fold that are unsatisfactory with asymmetry between the two eyelids. Careful incisional anchor blepharoplasty can be performed to restore the appearance of the eyelids despite prior suture procedures. Since these types of situations can present unique issues, there is no substitute for a personal consultation with an eyelid surgery expert like Dr. Steinsapir.

About Dr. Steinsapir

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August 10, 2011

Is Laser Eyelid Surgery the Best Method of Eyelid Surgery?

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

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

The risks of using lasers

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

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

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

Is it possible to correct laser damage?

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

About Dr. Steinsapir

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June 25, 2011

What should I expect with my upper eyelid surgery?

Filed under: blepharoplasty,Eyelid Surgery,oculoplastic surgery,ptosis,safe cosmetic surgery — Tags: blepharoplasty, corrective eyelid surgery, oculoplastic surgery, upper eyelid surgery — 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

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June 15, 2011

Micro-blepharoplasty

Filed under: blepharoplasty,Eyelid Surgery,oculoplastic surgery,ptosis — Tags: blepharoplasty, corrective eyelid surgery, Cosmetic Surgery, oculoplastic surgery — 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

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May 2, 2011

Can I have my eyes and forehead lift at the same time?

Filed under: blepharoplasty,brow lift,cosmetic eyelid surgery,Eyelid Surgery,forehead lift,forehead surgery,open vs closed forehead lift — Tags: beverly hills facelift, blepharoplasty, endoscopic forehead lift, forehead lift in los angeles, oculoplastic surgery, upper eyelid surgery — admin @ 8:01 pm

As an experienced oculoplastic and facial cosmetic surgeon, Dr. Steinsapir often combines eyelid surgery with a forehead lift for a comprehensive facial rejuvenation. However, every individual’s needs differ and a consultation and examination by a cosmetic surgeon is necessary to determine the extent of the procedure required. Before you decide on a surgeon to perform any procedure, attend a consultation to learn how the surgeon will address your individual goals and his or her strategy for achieving optimal results.

The benefits of a forehead lift

In some instances, a forehead lift alone can freshen your face and provide you with the youthful appearance you are seeking. The forehead lift elevates the eyebrows, reduces frown lines, and smoothes your forehead. Eyelid surgery deals with the height of the crease, the crease structure, and eyelid and lash ptosis. Although this can freshen your look as well, the forehead lift addresses one of the focal points of your face – one that can make the difference between looking tired and run down and looking youthful and refreshed.

A forehead lift can freshen your appearance

Dr. Steinsapir only performs endoscopic forehead lift, or closed forehead lift, as opposed to the more traditional open forehead lift. The endoscopic forehead lift offers faster healing time and fewer negative effects like scalp numbness, hair loss, or a long scar.

The benefits of a lid lift

Blepharoplasty, also known as eyelid surgery or a lid lift, allows the surgeon to remove excess skin and fatty tissue that create the appearance of droopy, deflated eyelids. As the fat deposits, loose skin, and drooping of the eyelids typically occur because of aging, this procedure can reverse the effects of time to restore a youthful, refreshed, and rested appearance. Upper eyelid surgery, because it is a versatile procedure, can also accomplish other goals, such as creating an upper eyelid crease.

How will the surgeon know which procedure I need?

The primary issue in determining whether you need a lid lift, forehead lift, or both is the type of eyebrow support and shape you need. Some individuals need just a forehead lift. Your surgeon will assess the need to address upper eyelid issues. In some instances people will have both eyebrow ptosis and excess upper eyelid skin and fullness and benefit from both sets of issues being addressed at the same time.

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 multiply revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is board certified in Ophthalmology and 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 Beverly Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care. Please contact us today to learn more about evidence-based treatment options with Dr. Steinsapir for proven results.

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April 17, 2011

What is the difference between blepharoplasty and ptosis surgery?

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

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

Blepharoplasty

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

Ptosis Surgery

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

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

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

About Dr. Steinsapir

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

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February 24, 2011

Blepharoplasty Reconstruction

Filed under: cosmetic eyelid surgery,eyelid reconstructive surgery,lower blepharoplasty — Tags: blepharoplasty, corrective eyelid surgery, Cosmetic Surgery, facial fillers, los angeles cosmetic surgeon, lower blepharoplasty, lower eyelid surgery, oculoplastic surgery, upper eyelid surgery — admin @ 6:31 pm

Blepharoplasty, also known as eyelid surgery or a lidlift, is one of the most common cosmetic surgeries and has a remarkable track record for safety. Because incisions are made along the creases of the upper eyelid, below the lower lashes, or from the inside of the lower lid, scarring is minimal and relatively hidden. Complications can occur, even when surgery is performed by experienced surgeons. Complications that can compromise the outcome of eyelid surgery can include hematoma, infection, or eyelid function problems that result from excessive skin or muscle removal, or motor nerve damage. When the cosmetic or functional result is unacceptable, reconstructive surgery is needed to address these issues.

Potential Concerns

The traditional approach to upper eyelid surgery has been to aggressively remove skin, muscle, and fat. The result of this outdated philosophy is “the surgical look” with a high sulcus and no upper-eyelid fold. While some are happy with the cleaned-up appearance created by this type of surgery, a certain percentage of individuals are unhappy with the alterations caused by their changed appearance. Unfortunately restoring the upper eyelid fold is virtually impossible. Fillers can help soften the appearance, but restoration of the upper eyelid is not feasible as it is with repair of the lower eyelid.

Other upper eyelid issues are more amenable to corrections. One such concern is laxity of the skin in the upper eyelid, below the upper eyelid crease. The skin takes on a crepe appearance. Crepe skin appears thin and dry and doesn’t hold makeup. This can be corrected with a precision anchor blepharoplasty.

The indiscriminate removal of skin, muscle, and fat can have more serious complications than just the “surgical look.” Over-aggressive cosmetic surgery can, result in damage to the muscles that allow the eyelid to close, shortening the upper eyelid and preventing the eye from closing. The lower lid can also become retracted, pulling the lower lid downward. Often, individuals come to Dr. Steinsapir with unique issues that require unique surgical solutions. While there are complications that can’t be fully corrected, many of these issues can be improved functionally and cosmetically by a very limited number of specialized eyelid surgeons who offer these types of reconstructions. The process starts with a detailed personal consultation.

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.

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March 8, 2010

Is Mesotherapy Good For Lower Eyelid Bags?

Filed under: blepharoplasty,eyelid fat,Eyelid Surgery,lower blepharoplasty,mesotherapy,under eye fat — Tags: blepharoplasty, fatty eyelids, lower blepharoplasty, lower eyelid surgery, mesotherapy, removing fat under eyes — admin @ 10:14 pm

Two common problems in the undereye area are the absence of fat and the presence of excessive fat. Too little fat gives the eyes a hollow, sunken appearance, while too much fat makes them look puffy and swollen. Because the appearance of the eyes makes a big difference in how we read facial expressions, correcting excess fat under your eyes can greatly improve your appearance. While searching for solutions through cosmetic eye procedures, you may hear about a procedure called mesotherapy, which is being actively marketed by a few less ethical practitioners today.

What Is Mesotherapy?

Mesotherapy is a procedure in which a solution is injected into the body with the hope of reducing fat. The solution includes chemicals like aminophylline, dimethylethanolamine, glutathione, hyaluronidase, isoproterenol, L-arginine, lidocaine pentoxifylline, yohimbine, and the bile salt deoxycholate and phosphatidylcholine.

Mesotheraphy is marketed under many catchy names like Lipodissolve, LipoShape, and Lipostabil. Unfortunately, this procedure sounds appealing but is actually untested and unproven, making it a very real danger to those seeking treatment.

Is Mesotherapy FDA-Approved?

Mesotherapy has not been tested enough to demonstrate if it is safe, and we have documented some unpleasant side effects. Mesotherapy remains an unproven treatment that not only doesn’t live up to its hype, but also presents a serious threat to anyone trying to sort through eyelid surgery options. Mesotherapy dangers include scarring, damage to blood vessels, and pain.

For these reasons, the FDA has not approved mesotherapy. The FDA will not endorse mesotherapy for human use unless further research can resolve its side effects and prove it safe and effective. It is unlikely that mesotherapy will ever receive FDA approval. It can destroy fat cells, but it also causes significant inflammation.

You may be wondering what this means for removal of fat under eyes, since this represents a small yet significant fat deposit. If mesotherapy someday be approved for under the eyes, then why not use it now? In answer, you especially shouldn’t use mesotherapy under the eyes now or anytime soon. The area under the eyes is especially sensitive to aging and treatment. Because the skin here is so thin and delicate, it’s very hard to disguise problems in this area. There are a narrower range of treatments that are proven to work here, primarily because the fragile skin here cannot compensate for even small mistakes or irregularities. You don’t want to damage an already-sensitive area by experimenting with an unapproved and unsafe treatment. And that’s exactly what someone performing mesotherapy is doing; they are conducting an uncontrolled experiment on you with chemicals not approved by the FDA. Most doctors will not administer mesotherapy for ethical reasons, but there are a few people hoping to make a quick profit who will try to tell you that mesotherapy is safe. Here’s the bottom line: if the FDA hasn’t approved it, they don’t have science on their side.

Here’s another word of caution: those who administer mesotherapy do not respect the recommendations of the FDA, so you are at increased risk for infection because these same practitioners may also disregard safe preparation procedures. The chemicals are concocted in an unlicenced lab, which gives you no assurance that they were mixed under ideal conditions.

Alternative Treatments for Undereye Bags

Overall, mesotherapy is not a suitable alternative to liposuction and it is certainly no alternative to lower eyelid blepharoplasty. If you are seeking treatment for your undereye bags in particular, a personal consultation may reveal that blepharoplasty or lower eyelid surgery is a much better option for removing fat under eyes. These are flexible procedures that enable a qualified, experienced oculoplastic surgeon to present different treatment options to you and customize a procedure to help this sensitive area. The eyelids and surrounding areas are incredibly complex, and our brains are programmed to pick up on very subtle irregularies, assymmetries, and problems in these areas, cuing us in on how a person is feeling and determining how attractive we view them as. This is why only a proven, time-tested treatment should be administered by a highly experienced doctor who can treat you with the precision necessary to avoid mistakes while improving this area.

Find a Doctor Who Cares

Dr. Steinsapir specializes in cosmetic eye procedures in Beverly Hills and Los Angeles. His approach is to work with a patient to determine their goals and then customize a minimally-invasive treatment plan that makes sense and, most importantly, works. Dr. Steinsapir has completed numerous fellowships and teaches at the prestigious Jules Stein Institute at UCLA. Please contact us today to find out how Dr. Steinsapir can customize your safe treatment program today.

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