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

October 5, 2011

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

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 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: corrective eyelid surgery, Cosmetic Surgery, eye drops for eye surgery, fixing eyelid surgery, lower eyelid surgery, ophthalmic ointment, upper eyelid surgery — 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

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August 6, 2011

Can I visit the United States for Reconstructive Surgery?

Filed under: blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,Dr. Steinsapir,eyelid cancer reconstruction,eyelid reconstructive surgery,facial cosmetic surgery,fixing eyelid surgery,oculoplastic surgeon,oculoplastic surgery — Tags: corrective eyelid surgery, Cosmetic Surgery, Dr. Steinsapir, facelift in los angeles, los angeles cosmetic surgeon, travel for cosmetic surgery, travel to see Dr. Steinsapir — admin @ 9:32 am

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

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

Consult First

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

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

Take Time to Reflect

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

Make Thoughtful Decisions

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

About Dr. Steinsapir

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

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June 29, 2011

Complications after surgery

Filed under: beverly hills facelift,blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,lower blepharoplasty,midface lift,midface surgery,oculoplastic surgeon — Tags: beverly hills facelift, corrective eyelid surgery, Cosmetic Surgery, facelift, lower eyelid surgery, midface lift complications, midface surgery — admin @ 7:53 am

Complications following a midface lift and eyelid surgery are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason to be concerned. But sometimes, inexperienced surgeons panic in these situations (even long-in-practice, but inexperienced surgeons) and respond with a shoot-from-the-hip, fix-it mentality, and may push you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may feel pressured to have a corrective surgery. There are certainly times where immediate work is appropriate. Before you agree to such a fix, ask yourself if you are still comfortable trusting your surgeon. In his book Blink, Malcom Gladwell describes the process of “thin slicing;” the way our intuition rapidly assesses a situation. That intuition is ignored at our peril. If the hair on the back of your neck is standing up because your surgeon wants to hustle you back to surgery, ask yourself: are you comfortable with what is being proposed? If you are not comfortable, your best course of action is the natural one―dig in your heals. There are occasional situations that are medical emergencies. However, these are truly rare. There is almost always time for a second opinion.

Undergo a consultation

Before taking any action to correct your complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see, and fully understand the physical complications. Occasionally, the description of what is going on and the actual physical complications are not the same. Fixing complications is specialized business. Even if your surgeon does a lot of primary cosmetic surgery, he or she may be relatively unsophisticated when it comes to repairing surgical complications, especially when this work affects the function of the eyelids.

If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon whose recommendations do not make sense to you. Don’t commit to a second surgery unless you have a clear understanding of the following:

What is going on and why these complications are occurring,
What type of surgery your doctor has planned,
Why a surgical solution is necessary,
The risks of a second surgery, and
The probability of success or failure.

The risks of midface and lower eyelid surgery and corrective surgery

Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did something that another surgeon might have done in a similar circumstance. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.

The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. Unfortunately, a hypothesis is a scientific guess―it does not make an established anatomic fact. Lower eyelid surgery through the lower eyelid skin is one example of this. Surgery damages the motor nerves that help support the lower eyelid margin leading to complications that can surprise the unsuspecting surgeon. Naturally, they are not going to say that they are surprised but be assured they would not perform surgery this way if they thought it would cause a problem.

So why do doctors still perform this kind of surgery despite the risks? Despite the inaccurate papers it is possible to dissect in this plane in some cases without significantly altering the nerve supply to the orbicularis oculi muscle. Motor nerve damage to the orbicularis oculi muscle near the upper and lower eyelid margin affects the blink and weakens eye closed. Without this critical blink function, tears do not move across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.

The remedy for midface and lower eyelid surgery complications

To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. By preserving as much of the lower eyelid function and not cutting out additional tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so less work than originally thought may be necessary.

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 28, 2011

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

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

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

Managing Risk

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

Realistic Numbers

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

Being a responsible patient

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

About Dr. Steinsapir

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

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May 10, 2011

Do I need an eye examination before I have eyelid surgery?

Filed under: canthal surgery,cosmetic eyelid surgery,cosmetic surgery and insurance,cosmetic treatment payment,oculoplastic surgeon — Tags: corrective eyelid surgery, Cosmetic Surgery, eye examination, oculoplastic surgery — admin @ 7:43 pm

Cosmetic surgery clients often wonder what type of examinations they need prior to undergoing eyelid surgery. It’s important for your surgeon to give you a physical examination to fully understand your expectations, your anatomy, and any current health issues before any cosmetic surgery procedure. Before eyelid surgery, the same considerations apply. A detailed assessment of your eye and eyelid health should be performed in advance of eyelid surgery. This information is essential for your surgeon to understand your eye health and how it might be affected by eyelid surgery.

Insurance coverage for eyelid surgery

Insurance companies including Medicare have significantly restricted which eyelid procedures they will cover. In the past, coverage was much more generous; now coverage is greatly limited. Even functionally significant issues may be denied. Many of our patients, upon investigating co-pays and deductibles are surprised to learn that, in some cases, they actually save money by paying out-of-pocket for certain eyelid procedures as cosmetic surgery. Every situation is different, but it’s worth researching the charges you will be responsible for if you use applicable health insurance. It can sometimes be less expensive to pay for your procedure out-of-pocket because often, the rates for medically necessary surgery are much higher than the cosmetic rates. This difference can be particularly acute if you have a high-deductible insurance policy and you have not met your deductible limits. If your issue is not medically necessary, convincing your doctor to submit a false insurance claim is a crime. Just because you know someone who had eyelid surgery covered by health insurance, don’t assume you have the same issues.

Finding a highly qualified eyelid surgeon

The best course of action is to seek care from a fellowship-trained oculoplastic surgeon. Oculoplastic surgeons are board-certified ophthalmologists who have completed a two-year fellowship in eyelid and facial plastic surgery. They have the necessary experience and equipment to examine you and document your issues. If your problem requires surgery to help improve you quality of life and likely covered by health insurance, your oculoplastic surgeon will inform you of this. On the contrary, if it is not covered, please respect the surgeon’s opinion. For a list of names of qualified oculoplastic surgeons in your area, visit ASOPRS.org. This is the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery and it features a geographic directory.

Cosmetic eyelid surgery

As with any surgical procedure, elective or otherwise, it’s important to find a surgeon who will perform an appropriate consultation. If you’re undergoing revisional surgery with a new surgeon, one who did not perform the original surgery, bringing pre-surgery photographs and any medical records to your examination will help your new surgeon create a treatment plan that will result in the changes you desire. The new surgeon may ask that you release you prior medical records for review before your visit.

About Dr. Steinsapir

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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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