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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: , , , , , , — admin @ 10:39 am

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

Why won’t my eyes close?

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

What are my treatment options?

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

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

Is this a long-term issue?

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

I chose an experienced surgeon, what happened?

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

About Dr. Steinsapir

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

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

July 27, 2011

Invisible Eyelid Surgery―Be Careful What You Look For

Filed under: blepharoplasty,chemical peel,chemical peel alternatives,chemical peel los angeles,cosmetic eyelid surgery,eyelid fat,Eyelid Surgery,facial laser resurfacing,laser resurfacing alternatives,laser vs. chemical peel — Tags: , , , , , , — admin @ 8:45 am

Throughout Los Angeles and Beverly Hills there is a buzz about a “new and innovative” procedure that promises eyelid surgery without scarring.  The promise of no scars following surgery sounds appealing; who doesn’t want to walk away from surgery with all the benefits of a refreshed look without the evidence of surgery?  But as the old adage goes, “if it sounds too good to be true, it probably is.”

How does invisible eyelid surgery work?

According to the doctor who “invented” this procedure, invisible eyelid surgery involves both “subconjunctival blepharoplasty” (usually called transconjunctival blepharoplasty) and a simultaneous “advanced” laser treatment performed by a dermatologist.  Using a micro-fractional CO2 resurfacing laser to treat lower eyelid skin by “tightening” the area following removal of fat through an incision made on the inside of the lower lid (transconjunctival incision), this procedure touts a younger and refreshed appearance of both the upper and lower lids without cutting surgery.  And all this has a recovery period of about a week and no one will be able to see any evidence that you’ve had surgery!  Now that sounds too good to be true.

Why the skepticism?

When you break down the idea of “invisible eyelid surgery” into its basic parts, all you’re really left with is lower eyelid blepharoplasty and CO2 resurfacing; two procedures that have been offered by cosmetic and oculoplastic surgeons for years.  Invisible eyelid surgery isn’t a new idea as the advertising physician would have you believe.  It’s simply two existing procedures packaged together and given a brand new name!  No surprise this is often how “new” things are invented in Beverly Hills all the time.

The risks of transconjunctival blepharoplasty

The idea behind the transconjunctival blepharoplasty is to remove the lower eyelid fat pads to eliminate puffiness around the lower lid that makes you look tired and aged.  But transconjunctival blepharoplasty is not without some serious risks that, if performed without skill or experience can result in permanent damage.  This approach of permanently removing eyelid fat is an old approach to lower eyelid surgery.  It can be effective for a small number of people.  The more current approach is preservation of this fat using a procedure called an arcus marginalis release.  Simply throwing away the fat can cause a hollow lower eyelid.

The risks of CO2 laser resurfacing

Deep CO2 laser resurfacing has fallen out of fashion because of the negative experience many have had healing from these treatments.  There is a very real risk that your skin will suffer from permanent depigmentation, and that the scarring caused by such treatments will likely affect the texture of your face.  This is because the treatment depth needed to improve deep facial lines makes post laser resurfacing scars, particularly skin texture changes, relatively common.  In fact these types of skin texture changes and skin depigmentation are so common that many surgeons think that this is the expected outcome of the service!

Micro fractional C02 laser is an effort to reduce this damage.  These treatments do provide freshening of the skin but generally are not powerful enough to reduce lower eyelid lines.  Chemcial peels, although they require much more training than a laser treatment are still the preferred methods.  In some cases, the chemical peel was all that was needed for the lower eyelid contour to be much smoother even without lower eyelid surgery!

What kind of eyelid surgery will work for me?

Dr. Steinsapir says this a lot, so it should come as no surprise: the best lower eyelid surgery is customized for the individual and designed to meet his or her particular features, goals, and medical needs.  This means that the lower eyelid surgery ideal for one person may be a specialized type of blepharoplasty while for another it may be a midface lift designed to correct tissue descent and return it to its proper anatomical location in the lower eye area.  Once you and your oculoplastic surgeon determine the best procedure, together, you and your surgeon must customize it even further to fit your features and obtain natural results.  Dr. Steinsapir observes: “people don’t do well with a one size fits all, cookie cutter approach.”

About Dr. Steinsapir

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

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

June 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: , , , , , , — 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

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

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

June 20, 2011

Eyelid Surgery and Permanent Eye Makeup

Filed under: blepharoplasty,brow lift,canthal surgery,cosmetic eyelid surgery,Eyelid Surgery,forehead lift — Tags: , , , , — admin @ 8:13 pm

Permanent eye makeup is a tattoo that is applied to the eyelid margin to simulate eye liner, or along the eyebrow to fill-in or darken the brows.  These services are very popular, but if you are considering permanent eye makeup and are also considering eyelid surgery, Dr. Steinsapir recommends that you have a surgical consultation before receiving permanent makeup.  Permanent eye makeup is a tattoo, and therefore is relatively permanent; “relatively” permanent because over time the tattoo will lose color and after a few years you may need the color reinforced.  Generally eyelid surgery will have an effect on the shape of the eyelids and on eyebrow position.  For this reason, if you are considering doing both services, have the permanent makeup after you have healed from eyelid surgery.

I already have permanent makeup, can I have eyelid surgery?

If you already have permanent makeup, this won’t prevent you from having eyelid surgery.  Generally the permanent makeup is placed within the eyelashes and eyelid surgery typically does not require an incision along the lashes.  Occasionally, the permanent lower eyelid makeup extends beyond the lower eyelid lashes.  The portion of the eye line that extends beyond the lower eyelid lashes may be affected by lower eyelid surgery, but a skilled surgeon can work around this issue and many lower eyelid procedures do not require a lower eyelid incision.

I have permanent eyebrow makeup, can I have a facelift?

Permanent makeup for the eyebrow generally fills-in or darkens your existing eyebrows.  As a result, a forehead lift that moves the eyebrow will also cause your permanent eyebrow makeup to move.  Occasionally, a woman has plucked her thin eyebrow hairs and penciled in a brow at a higher location.  Before considering having this eyebrow location marked permanently with a tattoo, Dr. Steinsapir recommends a cosmetic consultation.  In some cases, an endoscopic forehead lift may correct the location of your eyebrows and improve your appearance and make your eyebrows appear more natural.  For this reason, before you have your eyebrows tattooed in a higher location, consider having a surgical consultation for an endoscopic forehead lift.

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.

February 24, 2011

Blepharoplasty Reconstruction

Filed under: cosmetic eyelid surgery,eyelid reconstructive surgery,lower blepharoplasty — Tags: , , , , , , , , — 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.

February 2, 2011

What are the best lower eyelid options for Asians?

Filed under: asian eyelid surgery,blepharoplasty,Cosmetic Surgery,Eyelid Surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , — admin @ 2:02 am

In every instance of lower eyelid surgery for Asian eyes, the best option is simple yet not easy: the best lower eyelid surgery is one that is custom-designed and skillfully delivered based on your unique circumstances, treatment goals, and individual features.  While it is tempting to seek out a solution that works every time for every person, the nature of facial aesthetics makes it impossible for any standardized medical approach to meet everybody’s needs.  A cookie-cutter or assembly-line approach to eyelid surgery and other kinds of facial cosmetic surgery tends to yield results that don’t look natural to your features and instead represent the “surgical look.”

Lower eyelid surgery before and after photo

Lower eyelid surgery before and after photo

Asking  questions like “What is the best Asian eyelid surgery?” is like asking what shoe size is best to wear.  Of course there are many sizes of feet just as there is great diversity in Asian eyelid features, so your best option must be fit precisely for you alone.  This means that even if your friend had amazing Asian eyelid surgery results, you may benefit from a completely different oculoplastic surgery.  The key to finding the right Asian eyelid surgery for you—be it Asian blepharoplasty, Asian canthoplasty, or another specialized eyelid surgery—lies in finding an exceptional oculoplastic surgeon with specialized training and experience in Asian eyelid surgery and whose treatment philosophy is to custom-design a minimally-invasive treatment that enhances your natural qualities.

A Variety of Helpful Cosmetic Options

In your search for the right lower eyelid surgery for you, you’ll come across many options that you should carefully and considerately discuss with a top cosmetic surgeon.  Lower eyelid surgery options include blepharoplasty, canthoplasty, eyelid reconstruction, midface options, and treatment of dark circles under the eyes.  Even these specific procedures do not follow a standard blueprint for every eyelid; rather, optimal results are always due to custom-tailoring of the treatment to meet the unique circumstances and enhance your eyelid contour in a way that makes sense for you.

The Right Oculoplastic Surgeon for You

Asian eyelid surgery is a specialized subtype of cosmetic eye surgery, and your doctor absolutely needs to have proven experience and success in helping individuals with Asian eyes to achieve the natural results they desire.  This ability in a doctor is accompanied by the understanding that you have unique eyes, and your treatment plan must reflect this uniqueness.  The goal should never be to “westernize” the eyelid, but to design a minimally invasive treatment approach combined with a high level of skill to obtain results that fit you like a fine-tailored suit.

Consider how Dr. Steinsapir’s extensive experience and education in specialized eye plastic surgery can help you to obtain the best Asian eyelid surgery results.  Dr. Steinsapir is both an oculofacial and cosmetic surgeon with board certification in the field of ophthalmology and a tradition of excellence.  Take a look at his eyelid surgery before and after photos, and consider how his education at UCLA and the University of Chicago as well as multiple fellowships and focused practice can help you finally get the natural improvement you seek.  Please contact us today to learn more at your no-risk consultation.

January 20, 2011

Fixing Lower Eyelid Surgery

Filed under: best cosmetic surgeons,Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,fixing eyelid surgery,lower blepharoplasty — Tags: , , , , — admin @ 1:34 am

Eyelid surgery is a great option for many people seeking to improve their looks and their interactions with others.  You can usually anticipate that your lower eyelid surgery will be a positive experience that improves your appearance and your confidence, but there are still occasions when an individual may need to seek revisional eyelid surgery with a top oculoplastic surgeon, especially if the original operating surgeon was not chosen with the greatest care.  If you are concerned about the outcome of a past eyelid surgery and want to know how to address any issue you perceive, here are a few items to consider as you move forward toward attaining your treatment goals.

Have you had time to heal?

After an eyelid surgery, you might experience some apprehension as you anticipate your results and wonder if you made the right decision.  Most individuals find that they are very happy with their eyelid surgery results, so before you start to fret make sure you’ve allowed yourself healing time to see improvement.  In a very few, rare cases an individual needs to seek immediate medical attention for eyelid surgery complications, but this is not common.

If your concerns are aesthetic, it’s generally advisable to wait six to twelve months after a lower eyelid surgery such as lower blepharoplasty to seek revisional treatments.  This is because it’s important to allow all the tissues to fully heal and observe your final results before modifying the outcome with additional surgery.  Especially in cases when an overaggressive surgery leads to the need for corrective surgery, your corrective surgery should preserve your tissue as much as possible to improve your look rather than making the problem worse.  This is why a conservative approach after ample healing time is most effective.

Since you begin to see the results of your eyelid surgery earlier than the time for corrective surgery, you should be openly expressing any concerns that arise with your original surgeon on an ongoing basis.  If you feel you could benefit from a second opinion with a specialist in eye plastic surgery and its correction, this can also help you to calm your worry and consider your options.

Who can help?

In many cases, individuals worry needlessly about an overall great surgery because they haven’t let themselves heal or are nervous enough to imagine problems that aren’t there.  On the other hand, with any medical procedure you run a risk that it will not go exactly as you had hoped, and eyelid surgery is no exception.  If you want to learn more about whether you might need your lower eyelid surgery fixed, you can be glad that expert help is available.

First you should consult with your original surgeon wherever possible.  Your surgeon who performed your first eyelid surgery should be eager to help you address any concerns you have and find the best solution together.  However, sometimes part of the problem may be that your surgeon lacks the specialized skill in conservative eyelid surgery that is needed for precise and natural results, and in these cases consider consulting with an additional doctor for a new viewpoint based on experience and expertise.

It takes extensive training, experience, skill, and specialization to be able to perform the best eyelid surgery, and additionally there are very few doctors with focus on skillfully correcting eyelid surgery.  We invite you to consult with Dr. Steinsapir, who makes eyelid surgery as well as corrective eyelid surgery based on years of education, training, and experience a major focus of his practice in Los Angeles and Beverly Hills.  Dr. Steinsapir works from a philosophy that natural results are achieved through conservative surgery that enhances your eyelid’s natural contour.  This approach helps to prevent the need for corrective surgery to begin with.  If you are already concerned about a prior eyelid surgery, or if you are seeking lower eyelid surgery and want to minimize your risk of needing corrective surgery later, contact us today and consider how a fresh opinion from Dr. Steinsapir can help set you on the right track for to achieve your goals.

October 19, 2010

What is the difference between canthoplasty and canthopexy?

Filed under: canthal surgery,cosmetic eyelid surgery,Cosmetic Surgery,eyelid fat,Eyelid Surgery — Tags: , , , , , — admin @ 12:28 pm

For those seeking improvement of the overall face, and more specifically their eyes, don’t neglect the significance of the canthus or canthal angle.  The inner and outer canthal angles are the corner of the eyes, and problems with the canthus can lead to a number of aesthetic concerns, like baggy eyelids, drooping eyelids, and eyelid asymmetry.  Effective treatment of the canthus can help you to look brighter, younger, and more open to social interactions.

Treatment Options for the Canthal Angle

There are different approaches to correcting problems with the canthus, and the treatment you get should be individualized for your needs.  Only a highly skilled surgeon who specializes in oculofacial plastic surgery and has the technical skill and artistic eye should perform this procedure, as the revisions must be made with precise control of the contour’s shape and position.

Canthopexy Basics

The canthopexy is a shortcut procedure in which a supportive suture is used to cinch the lower eyelid, reinforcing the eyelid’s position.  There are also more elaborate ways to accomplish this such as with a coronocanthopexy.  The aim here is to tighten the outer corner of the eyelid (more technically called the lateral canthal tendon) without actually taking it apart surgically.  The problem with these procedures is that they do not provide the posterior vector of support that is needed to correct many lower eyelid issues.

Given the concerns with this procedure, why do some still use this shortcut?  The main reason is that many surgeons who do cosmetic eyelid surgery are not fellowship trained in eyelid surgery.  They actually lack the training and experience to perform this technical procedure.

Canthoplasty: Definitive Treatment for the Eyelid Corner

The canthoplasty, on the other hand, is the definitive procedure for reforming the outer corner of the eyelids.  This procedure is often used as part of other eyelid surgeries and is a better option for tightening the lower eyelid.  Here the lateral canthal angle is used as a point of entry to perform other procedures from behind the eyelid so that scarring is not visible, and the angle too is corrected surgically.  At this time your doctor can precisely control how tight the eyelid will be as well as where the lateral canthal angle is positioned.  A qualified eye plastic surgeon will be able to perform this procedure readily, while a generalist typically doesn’t possess the kind of specialized knowledge needed to create a symmetric, aesthetically pleasing outcome.

Correcting Prior Canthal Surgery

With the proliferation of surgeons attempting canthal surgery without the appropriate training, skill and experience, there is a recent epidemic of unsatisfactory results from these shortcut procedures.  The good news is that virtually all of these can be improved with revisonal surgery by an experienced eyelid specialist like Dr. Steinsapir.

Seek Treatment with the Best

If you are seeking canthal surgery or would just like to learn more about whether it may be a good solution for your concerns, we invite you to a no-risk consultation with Dr. Steinsapir, a cosmetic eyelid surgeon in Los Angeles.  Dr. Steinsapir is a caring physician who attended medical school at UCLA, trained in ophthalmology at The University of Chicago, then completed a two-year fellowship in orbital surgery at the UCLA’s renowned Jules Stein Eye Institute, where he also completed a one-year fellowship in oculofacial plastic surgery.  Following this is also did a cosmetic surgery fellowship in Rancho Mirage.  He is now a leader in the field of eyelid surgery, providing minimally invasive solutions with the goal of achieving a balanced, natural result.  Please contact us today to learn more.

October 1, 2010

Can I go blind from eyelid surgery?

Filed under: blepharoplasty,cosmetic eyelid surgery,Eyelid Surgery,safe cosmetic surgery — Tags: , , , , — admin @ 12:33 pm

Cosmetic eyelid surgery is an important resource for enhancing your appearance.  If you are nervous about the possibility of eyelid surgery complications, the best thing you can do is get the honest facts directly from a cosmetic surgeon.  Yes, all surgeries carry with them a level of risk, but on a positive note, severe complications like blindness are rare in eyelid surgery, and oculoplastic surgeons, who are specifically trained as both an ophthalmologist and an oculofacial surgeon, take steps to further reduce the risk of this specific complication.

A Rare but Possible Reality

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 that, 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.  This is one reason to seek out an oculoplastic surgeon with board certification in ophthalmology as your assurance that they are more likely to recognize problems with the eyes than a non-ophthalmologist plastic surgeon.

If someone tells you that they have never encountered or heard of blindness after eyelid surgery, then they probably have not seen enough cases, or simply lack adequate training in eyelid surgery.  A specialist will keep abreast of these issues and should be trained in how to reduce the risks of this complication and provide treatment problems arise.

Truly, this risk is extremely small but not zero.  Still, you should understand the possible risks and seek a doctor who is completely honest about your potential surgery.  Your cosmetic surgeon should review with you not only the eyelid surgery benefits, your individual treatment plan, and your recovery and aftercare needs, but also the risks involved in any procedure.  There is no surgery that is risk-free, which is why your doctor will ask you to review and sign forms saying that you understand both the risks and benefits involved.  Be sure to read this before signing it!  You have the right to know and the responsibility to educate yourself.

How Can Blindness Occur?

The small risk of blindness associated with blepharoplasty is primarily related to uncontrolled bleeding behind the eyelid after surgery.  This process is known as a retrobulbar hemorrhage, and, as already stated, it is extremely rare.  In the few cases that this happens, what we see is a pool of blood that is expanding in the confined space around the eye.  This can raise the pressure enough to affect the circulation of blood to retina, and it can result in loss of vision.

There are different numbers floating around in regards to just how often blindness from cosmetic eyelid surgery occurs.  We have heard someone say that this happens 1 out of 10,000 cases, but this figure seems exaggerated.  If you do the math, that means that just last year around 20 people had blepharoplasty complications that included blindness.  However, if there truly were that many cases, it would have been all over the news.  We have also heard some say that this happens to 1 out of 300,000 cases, which is the opposite extreme estimation.  Somewhere in between these two figures is probably more accurate.  In other words, blindness from blepharoplasty is a rare event.

Making the Low Risk Even Lower

Your reputable oculoplastic surgeon will ask about your medical history to ascertain your risk level and special considerations.  He or she will also give you a physical examination and instructions on how to care for yourself before and after surgery.  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 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.

Your doctor will also take some technical precautions that are medically advised during surgery to decrease the risk of post-operative hemorrhage.  During the first part of your recovery, you will need to taking easy, avoid bending over, and immediately call your surgeon should you experience any pain, bleeding, or impaired vision after surgery.  Don’t worry about memorizing all this right now; it is simply meant to be educational, and when you see your actual 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 You Can Do

Is there a risk associated with eyelid surgery?  Yes, there is a risk with any surgery.  But is this a major risk you should seriously worry about?  In most cases, no.  To further minimize your risk, find an experienced cosmetic surgeon who specializes in minimally invasive eyelid procedures.  Be completely open and honest about your medical history and any past or present conditions you may have, and what medications you take—this is your responsibility!  Ask as many questions as you need to feel comfortable.  Finally, relax a little.  All that worry and stress isn’t helping!

Seeking Safe Treatment from an Expert

Seek treatment from a specialist in oculoplastic surgery who understands how to care for the eye, your most precious facial structure.  Dr. Steinsapir is one such expert in treating eyelid concerns with impressive eyelid surgery results.  He has training in ophthalmology, cosmetic surgery, and oculofacial surgery gained from his education at UCLA, The University of Chicago, and multiple fellowships, making Dr. Steinsapir one of the best cosmetic surgeons in Los Angeles and the world.  In fact, people travel internationally for his exceptional eyelid treatments that emphasize a natural outcome and overall balanced facial appearance.  Contact us today to find out how you can improve your eyelid and facial appearance with a doctor in whom you can feel confident.

September 10, 2010

Can I have eyelid surgery if I smoke?

Filed under: blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,double fold surgery,eyelid cancer reconstruction,eyelid reconstructive surgery,Eyelid Surgery,irregular eyelids — Tags: , , , , , — admin @ 11:35 am

The short answer is, yes, you can have eyelid surgery if you smoke.  Should you smoke?  For your health, you absolutely should not smoke, but you probably already know that.  However, the reality is that quitting is difficult, while many smokers can benefit from eyelid surgery.  With no direct conflict between smoking and eyelid surgery, in most cases we can safely perform cosmetic surgery a smoker’s eyelids.  Decisions about eyelid surgery of course should be considered on a case-by-case basis, but if you are a good candidate for beneficial eyelid surgery and no other medical concerns that complicate your circumstances, then smoking alone should not prevent you from seeking help.

This may be a little confusing given that we recently discussed why a facelift and smoking should not go together.  This is not a contradiction, but a function of the way different tissue areas respond to surgery.  The eyelids have much better circulation than the healing sites of a facelift, and thus they are better able to tolerate the surgery than the facial skin.

This news will come as a relief to smokers who must have surgery for health problems like basal cell carcinoma of the eyelid or severe eyelid ptosis that compromises vision.  Smokers who can benefit from the confidence of an improved aesthetic can also be glad at this news.

As a smoker, why can I have some surgeries but not others?

Why shouldn’t smokers have optional facelift surgery when they can have eyelid surgery?  You should already know that smoking is horrible for your health, and one of the problems is that smoking compromises the healing capacity of the skin. The skin undermining necessary for the facelift can challenge the healing capacity of skin that is compromised by smoking.  In contrast, many eyelid surgery procedures can be performed without challenging this healing capacity.

A Word on Quitting at the Right Time

While it’s okay for most smokers to receive eyelid surgeries like blepharoplasty, canthoplasty, and double eyelid surgery, and while we also support your desire to quit, it’s important to know that you should not quit too close to your treatment.  This is not meant as an endorsement of smoking; we of course want you to quit smoking for your own good.  However, it takes time for the lungs to recover, so when you decide to quit, you should not do so right before the eyelid surgery.

When you quit smoking, your lungs go through a healing process and it will take some time for them to recover.  Your lungs need to be in good shape during your surgery, but your vascular recovery will take some time, as will lung recovery.  Your lungs will require a full eight to twelve weeks to begin their recovery; before then, you’ll have a lot of mucus in your lungs as your body repairs them, and this is not a good time for you to have a surgery.  If you want to both quit and seek eyelid surgery, talk to your oculoplastic surgeon about the timing of these two helpful steps.  He or she can help you determine how long before or after your surgery it is appropriate to quit smoking.  As most eyelid surgery is elective, meaning you can choose when to have eyelid surgery, the answer to this situation is simply schedule your eyelid surgery so you give your lungs the appropriate time to recover in advance of the elective surgery.

How Eyelid Surgery and Quitting Smoking Can Expand Your Options

Eyelid surgery can improve your confidence, aesthetic message, and the way people interact with you.  This newfound confidence and other benefits will broaden your ability to engage in life.

Quitting smoking empowers you by improving your health, helping you to look better and live longer, and boosting your self-esteem by overcoming an destructive addiction.  Even if you are a light smoker or new smoker, the damaging impacts of smoking lead us to encourage you to quit.  By quitting smoking you will be taking one of the most positive steps you can take for your health and the health of your loved ones.  Quitting smoking is one of the best things you can do for yourself.  Yes, it is more important than any cosmetic surgery we can perform for you.  We urge you to find a way to quit that works for you.

If you’ve decided to quit smoking, congratulations!  We wholeheartedly support you.  Quitting is not easy (otherwise nobody would smoke), but there are resources available to help you quit.  Your internist, family doctor, or gynecologist can often assist you with medical resources for smoking cessation. The State of California has a website of resources to assist and encourage you: www.tobaccofreeca.com

Consult with an Expert in Cosmetic Treatment

We advise you to consult with a cosmetic surgeon who specializes in eyelid surgery and complimentary treatments with natural, balanced results that are tailored to your individual needs.  Dr. Steinsapir is such a cosmetic surgeon in Los Angeles who is esteemed as one of the top cosmetic surgeons in California and beyond.  He specializes in minimally invasive eyelid surgery and other cosmetic procedures that offer fast healing time and can be customized to your unique situation.  If you are a smoker with eyelid concerns, we invite you to a no-risk consultation with Dr. Steinsapir today.  He can discuss both your short-term and long-term treatment options, and help you find an aesthetic solution to meet your goals.  Please contact us to learn more about Dr. Steinsapir’s quality treatment plans.

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