October 23, 2011

I am having BOTOX treatment complications and my wedding is in two weeks. What do I do?

BOTOX® complications can range from minor problems like bruising, frozen forehead, or swelling, to more severe problems like eyelid ptosis, to the even more rare systemic effects including difficulty swallowing.  Typically, even these more severe problems will resolve themselves over a period of 4 to 6 weeks without intervention.  However, given a very short time frame, it is essential to see a treating physician immediately to determine the best course of action.

Fixing Minor Problems

BOTOX treatments are popular because they are noninvasive and effective in relaxing tense muscles and smoothing wrinkles.  BOTOX is a naturally-occurring purified protein that relaxes muscles but is eventually broken down and expelled from your body completely.  The effects usually last 4 to 6 months.

With botulinum toxin A products (BOTOX, Dysport, Xeomin), adverse issues are usually the result of an unbalanced treatment.  Forehead treatment can be associated with upper eyelid or eyebrow ptosis.  Unbalance forehead treatment can result in issues of asymmetry.  It is possible to improve your treatment results using the appropriate counter treatment along the eyebrow using Dr. Steinsapir’s Microdroplet method.

Eyelid Ptosis

If your BOTOX treatment has caused eyelid ptosis, Dr. Steinsapir recommends finding an oculoplastic surgeon to help you with this particular issue.  Oculoplastic surgeons are trained to assess and treat upper eyelid ptosis. A prescription for Iopidine (aproclonidine ophthalmic solution) can be helpful in this circumstance; this medication is a glaucoma drop that can elevate the eyelid a couple of millimeters. The drops can also be used to assess the severity of the ptosis and predict the likely time frame for the resolution.  Dr. Steinsapir recommends trying the drops twice a day for a week.  If successful in opening the eye, the ptosis will likely resolve in 4-6 weeks and the drops will help improve the eyelid ptosis until resolution takes place.

The likelihood of upper eyelid ptosis is extremely small in the hands of an experienced injector.  Less experienced injectors are more likely to perform a treatment that causes ptosis.  It’s important to carefully research a doctor or nurse’s credentials and their track record for successful injections.  The individual performing your treatment has a profound effect on the risk of side effects.  Upper eyelid ptosis has been reported in as many as 5% of cases. The incidence of upper eyelid ptosis in the hands of experienced injectors is much less.   Dr. Steinsapir has seen only three mild cases of ptosis in his last 3,500 treatments.

Other Options

What if your doctor tells you that there are no treatment options?  Rescheduling an event like a wedding can be impossible.  Consider having a heart to heart with your photographer.  Can they photograph you to minimize the appearance of a droppy eyelid or photoshop your images after the fact?  If so, consider going forward with your plans and let the photographers cure your eyelid position digitally.

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 his expert care.

To learn more about Dr. Steinsapir’s specialized BOTOX treatments, please contact us today.

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

 

June 8, 2010

Help for Ptosis after Blepharoplasty

Eyebrow and eyelid ptosis is the most common reasons people seek revision eyelid surgery after blepharoplasty.  In most cases, this is not an urgent concern or an emergency, although it is still important and can be a source of disappointment following surgery.  These issues are relatively common after eyelid surgery.  Some degree of eyebrow ptosis is normal and occurs in 100% of cases.  It becomes a problem when it in someway reduces the apparent benefits of the surgery.  True upper eyelid ptosis following eyelid surgery is more complex.

Eyelid Ptosis Surgery Before and After Photo

Eyelid Ptosis Surgery Before and After Photo

What causes eyebrow ptosis after eyelid surgery?

There are a couple of reasons why you may be experiencing ptosis.  After a blepharoplasty, the forehead and eyebrows may relax.  The reason is simple.  Generally before surgery, the eyelid fold which is operated on during blepharoplasty rests on the eyelid.  This sends a signal to the forehead and eyebrow lifting muscles to cinch up, lifting the eyelid fold so it does not weigh so heavily on the actual eyelid.  When surgery trims this eyelid fold, there is less tissue weighing on the eyelid.  The signal to lift the forehead and eyebrow decreases and the eyebrow falls, lowering what remains of the eyelid fold.  For most, this difference is small and just not an issue.  In fact, the relaxation of the forehead and eyebrow muscles is possibly the most significant benefit of upper eyelid surgery.  However, for some individuals, the fall in the eyebrow can bring too much of this fold down.  They may feel that they got very little benefit from the eyelid surgery.  Sometimes the answer is removing more upper eyelid skin.  However, sometimes the answer may be a different approach altogether like a forehead lift.

Actual upper eyelid ptosis is another reason why the eye might be heavy after eyelid surgery.  The tendon that lifts the upper eyelid is held in place by loose fibrous tissues that become looser in time as we blink our eyelids.  In some cases this causes an the tendon to slip out of place resulting in a drop in the eyelid position.  In a rare case, the tendon may be loosened by direct damage from surgery.  However, it is probably much more common for eyelid swelling after surgery to simply weigh the eyelid down and cause this delicately held tendon to slip.  As the swelling resolves, some of the heaviness resolves.  However, after about 6 months or a year, if there is no further improvement, surgery may be needed to tighten the upper eyelid tendon.  This surgery is called upper eyelid ptosis surgery.

How can I fix my ptosis?

There are different solutions to this problem, and the right one for you will be determined through a personal consultation that includes a discussion of your goals and a physical exam to identify the core issues that are causing your problem.  There are a few approaches, which include:
•    Removal of excess skin in the upper eyelid to reduce the forehead activation needed to elevate the excess eyelid skin.  This offers an appearance that doesn’t seem surgical.
•    If you need your eyes to appear brighter, you may need a forehead lift in conjunction with eyelid surgery to address all of your facial dynamics.  This stabilizes the face.  It’s important to note that not everyone who needs blepharoplasty also needs a forehead lift, and not everyone with brow heaviness needs a forehead lift.

What if my eyelashes point down?

This is a different kind of ptosis called eyelash ptosis, and it can happen in relation to poor levator fixation of the upper eyelid platform skin.  Eyelid revision surgery by an expert can improve the support for the eyelashes by creating a balanced tension that rotates the eyelashes upward.  This procedure can usually be performed in the office under local anesthesia, and recovery time is similar to standard upper blepharoplasty: 10 to 14 days before you are ready for social situations.

Finding the Best Doctor

As a specialized oculoplastic surgeon in Beverly Hills and Los Angeles, Dr. Steinsapir meticulously evaluates the current and potential eyelid ptosis in each potential candidate for eyelid surgery and creates treatment plans that specifically address these realities.  In this way he can bring you the best results possible and avoid problems.  In the case that your results are disappointing, which all ethical physicians must admit is a possibility, Dr. Steinsapir understands how to find a solution to resolve or improve the situation in each unique case.  The reality that not every surgery goes perfectly is why Dr. Steinsapir plans ahead, leading the trend toward minimally invasive surgeries that give natural-looking benefits while allowing for revisional surgeries should the need arise.

If you are experiencing blepharoptosis or another unsatisfactory outcome, your original surgeon will likely be happy to help you achieve the results you desire.  However, if your cosmetic surgeon does not specialize in eyelid surgery or fixing eyelid surgery, or if you are not confident in your patient-doctor relationship, it’s reasonable to seek a second opinion.

When you need to fix eyelid surgery with the best cosmetic surgeon in Los Angeles, consider making Dr. Steinsapir a part of your treatment experience.  At a no-risk consultation, you can seek an opinion based on years of education, practical experience, and insight regarding the best way to move forward.  In many cases, Dr. Steinsapir can help restore your relationship with your original surgeon.  If your needs exceed the expertise and specialization of your first doctor, then Dr. Steinsapir can help you find the best treatment option for you and offer honest advice.

Take the first step in resolving your ptosis concerns.  Call today to learn more about Dr. Steinsapir’s background in fixing eyelid surgery.