Frequently Asked Questions

Botox®
  • Is BOTOX® Safe?
  • I’ve heard that BOTOX® can be taken up by motor nerves and transported into the brain. This sounds pretty scary to me. Is this something I should be concerned about? Does this effect account for BOTOX® side effects?
  • I’ve been going to the same place now for my last few BOTOX® treatments. At first it was really the best BOTOX® I had ever experienced but now it only seems to last a few weeks. Am I becoming immune to BOTOX®?
  • I am very confused about how BOTOX® is priced. Some places offer it by the unit and some places charge by the area. Whats up?
  • I have blepharospasm with difficulty opening my eyes at times. I get Botox® every 4 to 6 months for this problem. Since I am new to the area, I actually fly back to Baltimore to get my treatment. Does Dr. Steinsapir treat blepharospasm?
  • I developed a droopy eyelid after a BOTOX® service a few years ago. I swore off Botox® for a while but I am thinking of doing it again. What are my chances of developing another droopy eyelid?
  • I am an actor and I need to retain the ability to make facial expression. Should I avoid Botox® all together?
  • How much down time should I expect with my Microdroplet™ BOTOX® treatment?
  • What can I do to minimize the risk of bruising?
  • I am on Coumadin® on the order of my doctor because I have a history of atrial fibrillation. Should I stop my Coumadin® before having BOTOX®?
Fillers
  • How much Restylane® do I need under my eyes and how much will the service cost?
  • How come Dr. Steinsapir does not use permanent filler or fat to fill in the dark circle?
  • What does Dr. Steinsapir think of Juvederm®? Why does he prefer Restylane®?
  • What does Dr. Steinsapir think of Perlane®?
  • How long will my treatment last?
  • I had under eye Restylane® treatment at a Medi-Spa a couple of years ago. I was really unhappy with that service and I think that I still have a visible bluish streak in my lower eyelid from the treatment. Is there anything that can be done about this?
  • How much down time should I expect with my under eye Restylane® treatment?
  • What can I do to minimize the risk of bruising?
  • I am on Coumadin® on the order of my doctor because I have a history of atrial fibrillation. Should I stop my Coumadin® before having under eye Restylane®?
Eyelid Surgery
  • I am thinking of having eyelid surgery. How much recovery time should I allow?
  • I am taking a number of herbal products that my acupuncturist has recommended. Will that be a problem for my eyelid surgery?
  • I take Plavix® prescribed by my internist due to a stroke I had 8 months ago. Should I go ahead and stop this ahead of my consultation knowing that I want surgery?
  • I was born with a heavy eyelid on one side. Is this a condition that can be fixed with eyelid surgery?
  • I have heaviness in my upper eyelid fold. Will Dr. Steinsapir accept my health insurance?
  • I saw a surgeon who proposed laser resurfacing my eyelids and told me this is a type of eyelid lift. Do I really need surgery if laser resurfacing will lift the eyelids?
  • I am thinking of having eyelid surgery. How do I know if I am a candidate?
  • I had eyelid surgery in Hong Kong several years ago. They gave me a double fold. At first the results looked good but a year later almost all of the effects were gone. Is this something that Dr. Steinsapir can fix?
  • A few years ago I had eyelid surgery in Newport Beach. Initially, I was very happy with my upper eyelid surgery. However, now I think too much surgery was performed. I once had a much fuller upper eyelid and now my upper eyelids are very hollow and my upper eyelids seems to hang down. Is there anything that can be done?
  • Is it possible to have eyelid surgery awake and in the office?
  • I am thinking about having eyelid surgery. I am nervous to have the surgery. Can it be performed under general anesthesia?
  • I am thinking about having laser eyelid surgery and I want to know what kind of laser does Dr. Steinsapir use to perform eyelid surgery.
  • I am thinking of having eyelid surgery. My plastic surgeon tells me I can combine this with body liposuction and breast implant surgery at the same time. Can Dr. Steinsapir do my eyelid surgery at the time of these other procedures?
Asian Eyelid Surgery
  • What Should I Know about Ptosis and Asian Eyelids?
  • I think I need my Asian Eyelid Surgery fixed.
  • What Should I Know about Asian Eyelid Surgery?
  • Do Asian doctors make the best Asian eyelid surgeons?
Forehead Lift
  • I have been thinking of eyelid surgery but now that I’ve read this discussion of the forehead lift, how do I know if I am a candidate for the endoscopic forehead lift?
  • Twelve years ago I had an open forehead lift. I think it is time for another and I am wondering if I can have an endoscopic forehead lift even though my last procedure was done open?
  • I have had hair grafting. Will the incisions for the endoscopic forehead lift damage my hair grafts?
  • Are there any significant health concerns I should be worried about in having an endoscopic forehead lift?
  • Can I have BOTOX® as an alternative to a forehead lift?
  • How long will an endoscopic forehead lift last?
Face Lift
  • How do I know I am ready for a face lift?
  • I am thinking of having a face lift but I am afraid of the pain. A girl friend of mine had a face lift and she had to stay drugged in a recovery facility for 5 days.
  • I’ve been reading about the deep plane face lift. Does Dr. Steinsapir perform a deep plane face lift?
  • I am considering having a face lift. It is reasonable to have abdominal liposuction at the same time?
  • How does Dr. Steinsapir close the ear? I have a girl friend who had a face lift and her ears have never looked right.
  • When will I be able to resume my workout after my face lift?
  • How do I know if I am a candidate for having my face lift awake in the office procedure suite?
  • I really don’t have a neck cord but I do have more fullness in my lower face and I am wondering if I could benefit from a lower face and neck liposuction rather than a lower face lift?
Midface Surgery
  • How does Dr. Steinsapir decide when to recommend noninvasive procedures and when to recommend surgery for the midface?
  • I have consulted other doctors and none of them seem to use a hand-carved implant. Why is Dr. Steinsapir’s approach so different?
  • I consulted a surgeon who feels that all I need is a fat transfer to my midface and all of the issues will be corrected. Does Dr. Steinsapir offer this approach?
  • I broke my cheekbone several years ago. At the time, I had several surgeries to fix the break. Despite this, the repaired cheek has never been right and my eyelid on that side looks pulled down. Can midface surgery help me?
  • I have bags in my lower eyelids. I have had several consultations and they seem split between eyelid surgery alone or eyelid surgery with a midface lift. I have never thought of filling the midface with Restylane® until seeing Dr. Steinsapir’s website. Why did none of the cosmetic surgeons I have seen recommend this option?
  • I had lower eyelid surgery that seemed to hollow out my lower eyelids and change the shape of my eyes. Another surgeon performed a lateral canthoplasty and did some fat transfer to my lower eyelid but the results have never been to my liking. I am wondering if Dr. Steinsapir’s midface surgery can help me?
Peels
  • I am getting a monthly Jessner’s peel by my aesthetician. How does that differ from the peels that Dr. Steinsapir performs?
  • My cosmetic surgeon tells me that chemical peels are obsolete and has recommended that I get a series of Fraxel® laser treatments instead. What does Dr. Steinsapir think of Fraxel®?
  • My cosmetic surgeon has recommended that I have CO2 laser resurfacing. I am a little nervous about the treatment especially after reading in his brochure that it is normal to have a result that leaves the face lighter than the neck. Is a chemical peel an alternative to CO2 laser resurfacing?
  • I am thinking of having a laser peel. What are these and what are the alternatives?
  • Several years ago, I had laser resurfacing of my lower eyelids. I developed hyperpigmentation of the skin. The doctor who treatment me said that this was normal and would resolve in time but never did. Is there anything that can be done for this issue?
  • I have heard that chemical peels are very uncomfortable. How will I know if I can tolerate a chemical peel?
Liposuction
  • I had a C-section with my last pregnancy. My daughter is now four. I’ve lost my “baby fat,” but I have this roll of fat just above my C-section scar that I can’t seem to loose. I saw a plastic surgeon who told me I needed a tummy tuck but I really don’t want my C-section scar made any bigger and also he told me I’ll have a scar around my belly button. Isn’t there some other option?
  • What does Dr. Steinsapir think of Mesotherapy? Is this a good alternative to liposuction?
  • Is it possible to get all the fat out if liposuction is performed under local anesthesia?
  • I am thinking about having liposuction but I am black and it seems like every needle stick causes my skin to darken around where I get poked. Will this be a problem of me when I have liposuction?
  • I am considering Lap-band® surgery because I am 100 pounds above my desired weight. Will liposuction help me achieve my desired body weight?
  • I am a male bathing suit model. I am 5’10” and weigh 140 pounds. In my pictures I think that I would look better if my love handles were not so obvious. Could liposuction help me achieve my goals?
  • I am in my late thirties and I hate my arms. I seem to be getting those flabby fat deposits in my arms. Can this be improved with liposuction?
  • I previously had liposuction. I don’t think it was done with tumescent because I had general anesthesia. I definitely had an improvement but the surgery left me with some irregularities. In particular, my belly button looks like there is a donut around it. Can anything be done about these irregularities?
  • I had liposuction a few years ago and I think that in a few places the doctor took too much fat. I actually think that in a few places the skin is sitting on my muscle. Is there anything that can be done about this?
Reconstruction
  • Will Dr. Steinsapir accept my insurance?
  • I don’t find Dr. Steinsapir listed as a provider for my health plan. Can I still use my health insurance for reconstructive surgery?
  • I am a school teacher and I am thinking of having reconstructive surgery with Dr. Steinsapir during my winter break. How much notice do I need to give the office?
  • I had a cancer removed from one of my eyelids and a reconstruction at the same time. I am very discouraged by my appearance but my current doctor does not seem to take my concerns seriously. I am grateful that the cancer was successfully removed but I am wondering if anything can be done for my appearance?
Fixing Eyelid Surgery
  • Too much of my upper eyelid folds were removed at the time of upper eyelid surgery leaving my upper eyelid sulcus hollow and the eye skeletonized. What can be done?
  • I think my upper eyelid creases were made too high. Is there anything that can be done to help this?
  • The skin on my upper eyelid platform is wrinkled and loose. I can’t seem to keep makeup on without it smudging. Is there anything that can be done to help this?
  • My upper eyelashes point down. It bothers my vision and makes my eyes look dull. Is there any thing that can be done about this?
  • Since my upper eyelid surgery, the inner corners of my eyes look heavy. What causes this and what can be done?
  • My eyelids seem very heavy since my blepharoplasty. What causes this and what can be done?
  • Since my eyelid surgery my eyes seem very dry and at night I don’t think I close my eyes. What can be done about this?
  • Since my lower eyelid surgery the area under my eyes seems hollow. What causes this and what can be done about it?
  • Since my lower eyelid surgery my lower eyelids look pulled down. What’s up with this?
  • I had lower eyelid surgery and there seems to be residual fullness in the outer third of my lower eyelids. Is it possible that my doctor missed some eyelid fat?
  • I had a fat transfer to my lower eyelid to fix my under eye circles and now I have lumps and my circles are still there. What is going on and what options do I have?
  • Since my midface surgery, the skin in my lower eyelid bunches up when I smile. What is going on and what can I do about this?
Fotofacial®
  • When I lived in the Bay Area Patrick Bitter Jr., M.D. did several Fotofacial® for me. Is Dr. Steinsapir familiar with Dr. Bitter?
  • What exactly is a Fotofacial®?
  • I have veins in my lower eyelid. Will the Fotofacial® address these?
  • I get cold sores. Will this be a problem with my Fotofacial®?
  • I previously had a series of Fotofacials® a few years ago. Would I benefit from more Fotofacials®?

Is BOTOX® Safe?

BOTOX® made by Allergan, Inc., is an incredibly safe product with a 20 year track record. The safety of the FDA approved indications is now well established in millions of treatments. However, all drugs have the potential for side effects when used improperly or properly. Generally the safety of a drug is judged based on its safety record when used in the way detailed and approved by the FDA and the drug’s manufacturer. By this standard, BOTOX® is among the safest drugs in use today. Recently in the news, the FDA has begun to look into the safety of BOTOX® when doctors use it in certain off-label treatments. Off-label means a medical usage for which there is no specific FDA approved indication. Drugs are used for off-label use all the time and this is perfectly legal. However, off-label indications also have the potential for unstudied side effects. Even the small doses of BOTOX® used for cosmetic use can have some pretty significant side effects if improper injection techniques are used. This is why it is critical to work with an experienced injector like Dr. Steinsapir. The most significant problems with BOTOX® are associated with treating small infants with whopping doses to treat rare neuromuscular conditions. This application, which has been in the news is not FDA approved and has no actual relationship to the cosmetic use of BOTOX®. On the other hand, bootleg “BOTOX” has also been in the news and this specifically does relate to cosmetic use of this product. Some greedy doctors got the idea that they could buy research grade Botulinum toxin A never meant for human use for a much better price than buying BOTOX® from Allergan and make extra profit. Well guess what? People got hurt. The good news is that these doctors lost their licenses to practice medicine and many went to prison. The bottom line, go to reputable physicians, avoid situations where there is no physician, and if the price seems too good to be true it probably is—no one is giving real BOTOX® away.

I’ve heard that BOTOX® can be taken up by motor nerves and transported into the brain. This sounds pretty scary to me. Is this something I should be concerned about? Does this effect account for BOTOX® side effects?

The safety of BOTOX® for the FDA approved indications have been very carefully investigated with millions treatments per year with very few side effects. The possible central activity of BOTOX® may be one of the reasons the treatment is so effective—you look good and feel good. The retrograde transport of BOTOX® may account for why BOTOX® is effective for headaches.

I’ve been going to the same place now for my last few BOTOX® treatments. At first it was really the best BOTOX® I had ever experienced but now it only seems to last a few weeks. Am I becoming immune to BOTOX®?

It is really quite unusual to develop immunity to BOTOX®, especially at the dosages that are used cosmetically. So while it is not impossible to become immune, there are more likely explanations for this loss of treatment effectiveness. The most likely cause is that you are not getting as much BOTOX® in the syringe as you did with your initial treatment. Some offices seem to have a strategy of dose creep—give a good size dose initially and then throttling back on subsequent visits. If you have experienced this, it is probably time to find a new office for BOTOX®.

I am very confused about how BOTOX® is priced. Some places offer it by the unit and some places charge by the area. Whats up?

Welcome to retail medicine. Offices seem to intentionally confuse people as a way of getting them into the office. One office we are aware of advertises BOTOX® for $99 per area but if you count up the number of areas needed to treat the forehead and eyebrow, it is about 12 “areas.” Medically speaking, there is no such thing as an “area.” If you did get this service, you would still have no idea how much BOTOX® was administered. The other scam is selling BOTOX® by syringe. However, one syringe (typically one milliliter by volume) can contain as much as 50 units of BOTOX® or as little as no BOTOX® (afraid so). Allergan, Inc. supplies the medication in a dry vial. The doctor decides how to dilute the medication. Ethical offices use dilutions that generally vary from 2 to 4 ml of saline, so that a 1 ml syringe should contain from 25 to 50 units of BOTOX®. BOTOX® sold by the “unit” can also be deceptive as it is very difficult for the consumer to know what they are getting. At a minimum, you should insist on being told the total number of units the office is purporting to treat you with so you have a basis for future comparison. Dr. Steinsapir does not believe in pricing treatment by the unit or by the area. These pricing strategies force the consumer to practice medicine. Rather he prices BOTOX® by the service with most women receiving a treatment of 33 units of BOTOX® which is utilized for the Microdroplet™ BOTOX® service described above. This level of service works well for many men but some men (and also some women) have quite large muscle groups along the eyebrow and they benefit from a higher dose of BOTOX®. Dr. Steinsapir will tell you what he thinks you need to achieve the best possible result from Microdroplet™ BOTOX®.

I have blepharospasm with difficulty opening my eyes at times. I get Botox® every 4 to 6 months for this problem. Since I am new to the area, I actually fly back to Baltimore to get my treatment. Does Dr. Steinsapir treat blepharospasm?

Dr. Steinsapir has been treating blepharospasm since 1988 and trained with Allan Scott M.D., in San Francisco at the Pacific Medical Center. Dr. Scott invented the use of Botulinum A toxin for blepharospasm and first marketed this product as Oculinum®. Dr. Steinsapir does not participate with any insurance including Medicare. Therefore, you would need to privately contract with him for service. An office consultation will determine what dose of BOTOX® will be right for you. As a courtesy, the office will send you a bill that you can submit to your insurance company for reimbursement. However, private contracting for Medicare beneficiaries precludes any billing to Medicare. Inquire with the office for more details.

I developed a droopy eyelid after a BOTOX® service a few years ago. I swore off Botox® for a while but I am thinking of doing it again. What are my chances of developing another droopy eyelid?

A droopy eyelid can occur when BOTOX® drifts deep into the eyelid. This generally is only going to happen if the injector places the needle too deep or pinches up the eyebrow. By avoiding these types of maneuvers, the incidence of dropping an eyelid following a Botox® service is vanishingly small.

I am an actor and I need to retain the ability to make facial expression. Should I avoid Botox® all together?

Dr. Steinsapir treats many working actors. Treatments should be customized to the degree of facial activity needed. Generally the Microdroplet™ BOTOX® treatment is applied less densely in the worry line area to maintain the ability to furrow. The Microdroplet™ BOTOX® treatment along the eyebrows and crows feet is very natural and does not interfere with the activity of the forehead. There is absolutely no reason to have a frozen forehead.

How much down time should I expect with my Microdroplet™ BOTOX® treatment?

Generally there is little bruising from the treatment. The skin can be a little red for an hour or two. We strongly advise you refrain from working out for 24 hours. Most people find that they can return to work right after their treatment.

What can I do to minimize the risk of bruising?

Certain medicines thin the blood, which is to say they promote bruising. Aspirin, Motrin®, its generic form ibuprofen, and all non-steroidal anti-inflammatory agents increase the risk of bruising. Virtually anything herbal may contain natural products that can increase the risk of bruising. Red wine can do the same. Normally these are healthy for us. However, to minimize the risk of having a bruise, it is advisable to avoid these types of products for about 10 days before a treatment. If you are not sure if a product you use on a regular basis promotes bruising, call the office and we can address this issue for you.

I am on Coumadin® on the order of my doctor because I have a history of atrial fibrillation. Should I stop my Coumadin® before having BOTOX®?

If you are taking a medication prescribed by your doctor specifically to promote anti-coagulation like Coumadin®, Plavix®, or even aspirin; don’t stop these medications without consulting the doctor who prescribed them. If you are serious about treatment, we advise a consultation with Dr. Steinsapir. He will assess your cosmetic needs and help balance them against your health issues. If treatment makes sense, it may be more reasonable to risk a bruise than to stop these medications.

How much Restylane® do I need under my eyes and how much will the service cost?

How much Restylane® you need very much depends on your facial anatomy. The key is a personal assessment by Dr. Steinsapir. At the time of the visit, Dr. Steinsapir will assess you and tell you the necessary volume. Our best advice is to get full correction.

Most patients with average dark circles need about 1 ml of Restylane® under each eye. However, you may need more or less. When financial considerations are an issue, Dr. Steinsapir will work with you to get the most from the treatment you are able to afford. Before you agree to service, we will be able to give you a precise quote once Dr. Steinsapir has personally assessed you.

Our office believes in providing a very high level of boutique care. All patients are seen and all services are performed by Dr. Steinsapir, who believes in natural results. Dr. Steinsapir approaches each patient as an individual. This means a detailed history, careful listening to individual concerns and developing a plan that works for the individual based on their needs.

How come Dr. Steinsapir does not use permanent filler or fat to fill in the dark circle?

One of the most important things to understand about the under eye circle is how thin the eyelid is in this region. On the cheek, there is more flexibility in the choice of fillers because lumps and bumps can and do hide out in the cheek fat. There is not such a margin for error in the lower eyelid. Therefore it is essential to work with a filler that is easily adjusted after the treatment should this be necessary. Permanent fillers lack this flexibility. For example, surgery may be needed if a lump is seen after treatment with your own fat or a filler like Artefill® or silicone oil. Even fillers like Radiesse® and Sculptra® have been reported to produce irregularities visible at the skin surface making them a less than ideal choice for this particular application.

What does Dr. Steinsapir think of Juvederm®? Why does he prefer Restylane®?

Dr. Steinsapir thinks that Juvederm®, which is also a sugar gel filler, is an excellent product. However, you may be aware from Allergan, Inc. (the company that makes Juvederm®) marketing that it is touted as being “smooth.” Indeed, there are slight flow characteristics that differ between Juvederm® and Restylane®. Dr. Steinsapir finds that the relative “thickness” or viscosity of the Restylane® actually makes it easier to work with for the under eye area. It is Dr. Steinsapir’s personal opinion that the higher viscosity of the Restylane® helps keep the material in place in the tissues of the lower eyelid/cheek interface. In fairness, both materials seem to last about as long and both can be adjusted if needed at any time after they have been placed.

What does Dr. Steinsapir think of Perlane®?

Perlane® is distributed by Medicis, Inc., the company responsible for Restylane®. Perlane® is a thicker material than Restylane® and seems to last a few months longer than Restylane®. This time frame seems to be well over a year, which is amazing. The material is fantastic for volumizing the face including the cheeks, eyebrow, chin, and perioral area. Again, these areas have much more fat to work with than the lower eyelid dark circle. Perlane® is commonly used in the top of the cheek to compliment the Restylane® volume used in the dark circle/lower eyelid hollow.

How long will my treatment last?

Restylane® appears to be quite long lasting with many patients reporting treatment benefits over a year. The key to long-term happiness is getting enough volume replacement with the initial treatment.

I had under eye Restylane® treatment at a Medi-Spa a couple of years ago. I was really unhappy with that service and I think that I still have a visible bluish streak in my lower eyelid from the treatment. Is there anything that can be done about this?

This is a testament to how long Restylane® can last. Not all treatments are equal. The material is being used to sculpt your face. You need someone who really understands the anatomy and how to best place the material. You may be surprised to learn that many Medi-Spas are actually illegal businesses. In California, the Medical Board required that a doctor be on the premises and perform a good faith examination before a nurse can treat you. It is not sufficient that a doctor serve in the capacity of “medical director” with no actual physical presence. Just say no if your aesthetician wants to come at you with a needle. The good news is that the bluish streak, which represents very superficial Restylane®, can easily be removed with a tiny nick in the skin or by injection with an enzyme, hyaluronidase, that breaks the product down.

How much down time should I expect with my under eye Restylane® treatment?

If you don’t bruise, there is about 30-40 hours of mild swelling following the treatment. Women and men who use camouflage makeup can usually hide this swelling within hours of treatment. Now let’s talk about bruising. The incidence of bruising is about 20%. The nature of the bruise varies from a little micro-bruise that will disappear in about 2-3 days to a major shiner. The incidence of a black eye is about 2%-a small incidence unless you are the one who gets the black eye. Black eyes can take 2-3 weeks to fully resolve. Think of the procedure as surgery in a syringe.

What can I do to minimize the risk of bruising?

Certain medicines thin the blood, which is to say they promote bruising. Aspirin, Motrin®, its generic form ibuprofen, and virtually all non-steroidal anti-inflammatory agents increase the risk of bruising. Almost anything herbal may contain natural products that can increase the risk of bruising. Red wine can do the same. Normally these are healthy for us. However, to minimize the risk of having a bruise, it is advisable to avoid these types of products for about 10 days before a treatment. If you are not sure if a product you use on a regular basis promotes bruising, call the office and we can address this issue for you.

I am on Coumadin® on the order of my doctor because I have a history of atrial fibrillation. Should I stop my Coumadin® before having under eye Restylane®?

If you are taking a medication prescribed by your doctor specifically to promote anti-coagulation like Coumadin®, Plavix®, or even aspirin; don’t stop these medications without consulting the doctor who prescribed them. If you are serious about treatment, we advise a consultation with Dr. Steinsapir. He will assess your cosmetic needs and help balance them against your health issues. If treatment makes sense, it may be more reasonable to risk a bruise than to stop these medications.

I am thinking of having eyelid surgery. How much recovery time should I allow?

Generally the bruising and swelling that is common after eyelid surgery rapidly diminishes so by 7 to 10 days most people are comfortable returning to work and social activities.

I am taking a number of herbal products that my acupuncturist has recommended. Will that be a problem for my eyelid surgery?

It is critical for eyelid surgery that any product that may interfere with clotting be avoided prior to surgery. Many herbal preparations effect clotting and can cause severe bruising following surgery. This can compromise the surgical outcome. Therefore, we want you to stop these products and other products like aspirin, ibuprofen, and similar products about three weeks prior to surgery. These can be resumed five days after surgery. The office has a relatively comprehensive list of products to avoid.

I take Plavix® prescribed by my internist due to a stroke I had 8 months ago. Should I go ahead and stop this ahead of my consultation knowing that I want surgery?

Please do not stop you Plavix® or any medication prescribed by you doctor without first discussing this with the doctor who prescribed the medication. Dr. Steinsapir will assess your indications for taking a physician prescribed blood-thinning medication. In consultation with your physician, a decision will be made regarding this medication. There are many situations were eyelid surgery or other cosmetic procedures are not worth taking the risk of discontinuing these medications.

I was born with a heavy eyelid on one side. Is this a condition that can be fixed with eyelid surgery?

Dr. Steinsapir is highly qualified to treat eyelid asymmetry. The heavy eyelid is called eyelid ptosis. It can be addressed at the time of cosmetic eyelid surgery or the droopy lid can be addressed without performing other procedures.

I have heaviness in my upper eyelid fold. Will Dr. Steinsapir accept my health insurance?

Dr. Steinsapir does not participate with any health insurance plans. The problem described is usually a cosmetic issue and health insurance does not cover this type of problem.

I saw a surgeon who proposed laser resurfacing my eyelids and told me this is a type of eyelid lift. Do I really need surgery if laser resurfacing will lift the eyelids?

This very much depends on the exact nature of your issues. It is true that tightening the eyelid skin can resolve some of the eyelid heaviness. However, laser resurfacing can’t address the structural issues in the upper eyelid. This includes laxity of the eyelid platform, lash ptosis, eyelid ptosis, and herniated orbital fat. A personal consultation will permit a definitive answer for you.

I have been thinking of eyelid surgery but now that I’ve read this discussion of the forehead lift, how do I know if I am a candidate for the endoscopic forehead lift?

There are a number of considerations that go into making this decision. Many of these involve individual issues. A personal consultation with Dr. Steinsapir will greatly assist in clarifying the best approach for you based on anatomy, personal goals, and other factors. A choice that makes sense for one person may not be right for you. Ultimately surgery must be tailored for the individual.

I had eyelid surgery in Hong Kong several years ago. They gave me a double fold. At first the results looked good but a year later almost all of the effects were gone. Is this something that Dr. Steinsapir can fix?

It is likely that you had double fold surgery with a threaded suture. These procedures are done very quickly and in some parts of the world by non-medical providers. To make a lasting crease, it is generally 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. While this effort occasionally does not hold up, for most the result of surgery lasts a lifetime.

Years ago I had eyelid surgery in Newport Beach. Initially, I was very happy with my upper eyelid surgery. Now I think too much surgery was performed. I once had a much fuller upper eyelid and now my upper eyelids are very hollow and my upper eyelids seem to hang down. Is there anything that can be done?

Some surgeons see their job as removing as much tissue as possible even to the point of making it difficult to close the eyes. In contrast Dr. Steinsapir looks to preserve natural eyelid structure as much as possible. Usually restoring fullness to the upper eyelid is very difficult. However in this case, it sounds like the tendon of the upper eyelids may be disinserted causing a drooping of the upper eyelid. This can be caused by the prior eyelid surgery as the tendon may have been accidentally cut and not repaired leaving the eyelids to slowly sag down over time. On the other hand, the upper eyelid heaviness may just be coincidental and unrelated to the prior eyelid surgery. A consultation with Dr. Steinsapir will resolve these issues and determine what you need to address the eyelids.

Is it possible to have eyelid surgery awake and in the office?

Absolutely. Eyelid surgery is very comfortable with most procedures easily performed and very comfortable under local anesthesia. Dr. Steinsapir maintains a dedicated procedure suite in his office for this purpose.

I am thinking about having eyelid surgery. I am nervous to have the surgery. Can it be performed under general anesthesia?

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 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.

I am thinking about having laser eyelid surgery and I want to know what kind of laser does Dr. Steinsapir use to perform eyelid surgery?

Dr. Steinsapir has an incisional CO2 laser but he routinely does not use the laser to perform eyelid surgery. The most critical aspect of eyelid surgery has nothing to do with which incisional instrument was used to perform the procedure: cautery needle, scalpel, or laser. The most critical aspect of eyelid surgery is the proper design of the procedure and this in turn is dependent on a proper work up and diagnosis. Dr. Steinsapir specifically avoids using the laser for surgery because the laser devitalized the edge of the wound for approximately a half millimeter on each side. This means that sutures need to be in for a prolonged period of time leading to inclusions cysts and wound separation.

I am thinking of having eyelid surgery. My plastic surgeon tells me I can combine this with body liposuction and breast implant surgery at the same time. Can Dr. Steinsapir do my eyelid surgery at the time of these other procedures?

Dr. Steinsapir likes to remind his patients that cosmetic surgery should not be life threatening. He is not sure that it is so reasonable to have breast surgery and liposuction at the same time. This combination has an unreasonably high mortality rate (i.e. too many people die from this combination of surgeries). It is far safer to have less surgery at one time. Dr. Steinsapir advises against having the blue plate special. In the long run, saving a few dollars by combining all this surgeries at the same time is just not in your best interests.

Ptosis and the Asian Eyelid

Eyelid ptosis is a relatively common concern for which effective treatment is available. The key is in finding a specialist who understands the condition, has a great deal of experience in treating ptosis with successful results, and will custom-design the treatment to fit your unique features to give results that look natural for you. When you have Asian eyes, all of the above is true, and you must also make certain that your potential oculoplastic surgeon appreciates the unique qualities of your eyes that make you you. Asian eyelids are as diverse as any other descriptive characteristic for eyelids, so be certain that your physician recognizes the importance of approaching your treatment not through a standard plan, but with your individual circumstances in mind.

Asian eyelid surgery is a specialized type of eyelid surgery that, like other cosmetic eye procedures, is truly an art form. How is it an art? Consider how the best eye plastic surgeon must not only have education, training, and experience; he or she must also have the keen ability to perceive subtle characteristics that make your eyes and entire facial structure distinctive, the talent to design a treatment plan that addresses these features, and the skill to provide natural results and a fast healing time. When one considers the complexity of cosmetic eyelid surgery, it is no wonder why it’s essential you seek a surgeon who individualizes your treatment.

What Should I Know about Ptosis and Asian Eyelids?

For whatever reason you seek treatment for Asian eyelid ptosis, first know that there is science-based treatment available that can improve your condition. Please also understand that your treatment must be individualized for you as we discussed above. The best cosmetic surgeon for you will be one who is a leader in Asian cosmetic eye surgery with a solid reputation and proven results. Ptosis can affect anyone, and effective treatment must correct existing problems by enhancing the natural qualities of your eyelid contour. In other words, correcting ptosis of the Asian eyelid is in no way about “westernizing” the eye, so talk to your doctor about his or her treatment philosophy to find someone who can establish the right results for you.

How Is Ptosis Treated?

With ptosis what we observe is a heavy or drooping eyelid. This can cause aesthetic problems like asymmetry and even cause challenges with communication when people are focused on your eyelid ptosis rather than what you are saying. It can also impede your peripheral vision and cause dissatisfaction with your appearance.

Any good treatment will be customized for your condition, goals, medical history, and unique features. This may include eyelid surgery to remove excess upper eyelid skin, which corrects the imbalance of forehead activation needed to elevate this extra tissue. You may be a candidate for a forehead lift that helps to brighten your eyes’ appearance and balance out your whole face. Anchor blepharoplasty is another type of upper eyelid surgery that can correct ptosis of the eyelashes. The right and best option for you can only be determined at a personal consultation with a leading oculofacial surgeon.

I think I need my Asian Eyelid Surgery fixed

A well designed and skillfully performed Asian eyelid surgery can transform your look and give you new found confidence. Unfortunately, there are a few cases when individuals are disappointed in their results—usually due to a lack of expertise and understanding of the best treatment methods. If you have had Asian eyelid surgery in the past but are dissatisfied with your results, there is hope in specialized treatment. First, let’s consider your situation, what your current needs are, and your best options for moving forward.

What causes unsatisfactory results in Asian eyelid surgery?

There are many types of Asian eyelid surgery that greatly improve your appearance, including Asian blepharoplasty, Asian canthoplasty, and double eyelid surgery. They key to getting the best results with these procedures is much the same as getting the best results with any eyelid surgery: you need a specialized eye plastic surgeon who is experienced in treating concerns similar to yours, and who customizes each treatment based on your individual needs.

Eyelid surgery should always strive for results that appear natural for your features. The goal is to enhance your eyelid contours to bring out your best look. To this end, each treatment must be carefully planned and carried out, followed by after-care monitoring with an attentive physician. However, if your doctor is not a leader in oculofacial surgery for Asian eyes then he or she may not have the specialized training and experience needed to give you a natural look.

Disappointing results usually come from shortcuts, lack of experience, and misunderstandings about the goals of surgery. A shortcut could mean that you do not look for a specialist in eye plastic surgery or try to find the cheapest option. A lack of experience can happen when you choose a physician without a comprehensive background in treating Asian eyelid concerns with great outcomes. A misunderstanding could be when you or your doctor does not recognize the importance of conservative surgery for natural results. Overaggressive surgery can result in a “surgical look” that is not right for you. You can usually avoid these situations if you take the time to research and gain confidence in your cosmetic surgeon’s qualifications and abilities.

Still, there is a risk with every surgery that you should be aware of, and revisional surgery is occasionally indicated. By taking preventative measures—like seeking the best oculoplastic surgeon who customizes minimally invasive treatments for your needs, you can expect to have an empowering treatment experience.

How do I know when I need revisional surgery?

If you have already had an eyelid surgery such as blepharoplasty, give yourself time to heal. It is natural to experience some anxiety regarding whether you will like your results, but remember that worrying doesn’t help. If you are confident in your doctor, you have good reason to expect the best.

If you have any complications during healing, talk to your original surgeon. Post-operative concerns are often the result of lack of follow-up communication. Do not assume that your surgeon does not wish to hear from you or is too busy for what you perceive as a minor concern. Please don’t wait. Call your surgeon. Be seen and have your concerns addressed.

Significant complications are unusual, and a more common concern is that you don’t see the improvements you were hoping for after healing or you feel you are taking longer to heal than expected. This isn’t considered a complication, but it is something to address with your surgeon. If you do not like the results you see and your original surgeon does not feel anything further can be done, it is time to seek a second opinion.

Who can fix Asian eyelid surgery?

In most cases, we recommend talking with your original surgeon who will likely be happy to address your concerns. However, if your surgeon is not a specialist in Asian eyelid surgery, if the original results indicate a lack of specialized skill, if your relationship has deteriorated, or if you lack confidence in your surgeon’s ability to meet your needs, it is valid to seek a second opinion.

Obtain advice from a cosmetic eye surgeon who understands that every Asian eye is unique, and thus addresses you on an individual basis. Your doctor should understand that there is no one standard approach to Asian eyes because everyone presents with a different situation and goals. Just as your original surgery should be customized, any revisional surgery should be carefully planned for your individual needs.

Dr. Steinsapir is an expert in both Asian eyelid surgery and in fixing prior eyelid surgery. He practices individually tailored, minimally invasive solutions for fastest healing and natural results. This is also his approach with revisional eyelid surgery. If you are concerned about a former surgery, Dr. Steinsapir has a great deal of experience in assessing these situations and in many cases is able to achieve an improved result with revisional surgery. Please contact us today to learn more about how to achieve the results you always wanted.

What Should I Know about Asian Eyelid Surgery?

Cosmetic eyelid surgery is a broad field of study, but if we could tell you just one thing about Asian eyelid surgery, we’d say this: surgery for Asian eyelids is as varied as any eyelid surgery, so for best results your oculoplastic surgeon will need to customize your surgery for your particular goals, facial structure, and needs.

There is no one standard approach for Asian blepharoplasty, Asian canthoplasty, double fold surgery, and other kinds of eyelid surgery. There is a wide diversity in human eyes, and to not understand that every Asian eyelid is unique is just ignorant. They key to definitive results is to find one of the best cosmetic surgeons with specialty and experience in eyelid surgery and obtain a custom-tailored treatment plan.

A few people misunderstand the purpose of surgeries like Asian double eyelid surgery and are under the misconception that it is about “westernizing” the eye. This should not be the case at all; instead, treatment is about enhancing the natural eyelid structure to meet your aesthetic goals.

How Can I Find the Best Asian Eyelid Surgeon?

The best eye plastic surgeons will never say that Asian eyelid surgery is the same as every other eyelid surgery, nor will they say that there is one technique to successful Asian eyelid surgery. Instead, the most qualified surgeon will let you know what kind of medical plan will be ideal for your unique facial structure, eyelid contour, and treatment goals. Your doctor will strive for results that are right for you.

Your doctor should have extensive experience treating a wide range of concerns for diverse eyes. Furthermore, choose a doctor who has a history of providing natural results and can show you before-and-after Asian eyelid surgery photos that demonstrate versatile skills. Study these photos to make sure that your potential surgeon individualizes every treatment.

Make sure that your doctor has a strong educational and fellowship background, as well as years of experience specializing in cosmetic eyelid surgeries like eyelid lift surgery, blepharoplasty, eyelid reconstruction, eyelid correction surgery, and medical eyelid surgery for conditions like eyelid ptosis and basal cell carcinoma of the eyelid. An expert in treating aesthetic facial concerns will be able to ensure that your eyelid surgery works optimally with the rest of your features.

The Top Eyelid Surgeons Can Help

People travel worldwide to seek treatment with Dr. Steinsapir, an oculofacial surgeon in Los Angeles and Beverly Hills who treats a variety of eyelid concerns with exceptional individualized results. His education at UCLA and The University of Chicago along with multiple fellowships formed the basis for his forward-thinking, evidence-based, minimally invasive practice—now widely acclaimed by researches, leading physicians, and satisfied recipients. With years of practical experience in designing treatment plans that work, Dr. Steinsapir adds to his expertise a friendly and trustworthy personality.

Do Asian doctors make the best Asian eyelid surgeons?

If you are seeking Asian eyelid surgery, seek treatment with the best. This seems like a no-brainer that is of course true of most any medical procedure, and yet some people still seek specialized treatments from nonspecialists. The key to obtaining definitive, optimized results is to do your homework and consult with the most experienced, respected, and qualified specialists. Be completely honest about your needs, goals, and medical history, and ask as many questions as you need in order to feel good about your decision and confident in your doctor’s abilities. When you seek Asian eyelid surgery in Los Angeles or elsewhere, we recommend you consult with a cosmetic surgeon who has a specialized strength in this area.

Finding the Best Asian Eyelid Surgeon

Many wonder if Asian doctors make the best Asian eyelid surgeons. This seems like a natural question to ask, even if it is not the most logical upon closer examination. A surgeon is as good as his or her training, skill, experience, ethical values, education, leadership, medical understanding, and a myriad of other dynamic factors that come together to make a capable and reputable physician. Every physician has particular areas of strength and specialization, so of course you will not choose the same surgeon to operate on your heart, brain, or eyelid. You of course will choose the specialist. So, in short, the best Asian eyelid surgeon is a specialist. There are many Asian doctors who are excellent at performing procedures like Asian blepharoplasty and double fold surgery, and this is because they have studied and specialized in Asian eyelid surgery.

Nobody is born with an innate knowledge of medicine. Yes, becoming the best oculoplastic surgeon does require developed talent and artistic vision, while it also requires years of study, focus, training, and experience. These factors depend on the individual surgeon. It is therefore wise to evaluate potential surgeons not based on their own photo or ethnicity, but on their credentials, expertise, and clinical experience.

A Unique Approach

Asian eyelid surgery should not be approached in a cookie-cutter fashion, but then again, neither should any eyelid surgery. While it is important that your doctor has experience and training in treating the distinctive features of Asian eyelids, it’s also important that both you and your doctor understand that there is no one standard approach to Asian eyelid surgery. When everyone has unique eyes and distinctive features, how could there be one method that works for everyone? There is a wide range of characteristics among Asian eyelids that vary based on the individual. The approach should therefore emphasize results that enhance the natural features, rather than aiming to “westernize” the eye. This common misconception is rarely the goal of Asian eyelid surgery.

The most qualified Asian eyelid or blepharoplasty surgeons for giving you natural results will be someone who specializes in oculoplastic surgery for Asian features and has treated a variety of eyelid shapes and concerns by custom-tailoring each procedure to the individual.

Consult with an Expert

To find the doctor best suited for your needs, seek someone with extensive oculofacial cosmetic surgery experience and training who has also demonstrated an exceptional ability to treat a variety of eyelid concerns. This should include a solid understanding of how to maintain the natural beauty of Asian eyelids and a recognition that every eyelid is different and cannot be improved by simply following assembly line instructions.

I have been thinking of eyelid surgery but now that I’ve read this discussion of the forehead lift, how do I know if I am a candidate for the endoscopic forehead lift?

There are a number of considerations that go into making this decision. Many of these involve individual issues. A personal consultation with Dr. Steinsapir will greatly assist in clarifying the best approach for you based on anatomy, personal goals, and other factors. A choice that makes sense for one person may not be right for you. Ultimately surgery must be tailored for the individual.

Twelve years ago I had an open forehead lift. I think it is time for another and I am wondering if I can have an endoscopic forehead lift even though my last procedure was done open?

Endoscopic forehead lift can be effectively performed even after a prior open forehead lift.

I have had hair grafting. Will the incisions for the endoscopic forehead lift damage my hair grafts?

It is possible that the small incisions, which are made behind the hairline, could cause loss of a small number of grafts. Generally this loss is not noticeable and concerns about this should be balanced against the benefits from the forehead lift.

Are there any significant health concerns I should be worried about in having an endoscopic forehead lift?

The endoscopic forehead lift is generally a very well tolerated surgery. As the surgery can be performed under intravenous sedation anesthesia, endotracheal intubation anesthesia is avoid. The placement of the breathing tube is the most stressful aspect of surgery. Risks of this stress are increased in individuals with multiple cardiovascular risk factors including high blood pressure, known heart disease, etc. Therefore, we perform a thorough assessment of your health status prior to surgery and when indicated, may also have you assessed by your primary medical doctor prior to surgery.

Can I have BOTOX® as an alternative to a forehead lift?

BOTOX® can be an excellent alternative to a forehead lift. By utilizing the Microdroplet™ method of BOTOX® it is possible to create elevation at the eyebrow. However, the effect is not as dramatic as actual surgery and effects last 4-6 months. Many considering actual surgery need a result that is more powerful than what can be achieved with BOTOX®. This should be discussed with Dr. Steinsapir at the time of your consultation as an alternative to surgery.

How long will an endoscopic forehead lift last?

Like all surgeries, never quite as long as one would hope for. It is important to understand that the endoscopic forehead lift, like all cosmetic surgery procedures, does not stop the clock. Aging and the effects of sun and gravity continue. Generally the results of surgery including the endoscopic forehead lift are long lasting. One can reasonably expect results that last 5 to 10 years for surgery.

How do I know I am ready for a face lift?

The key feature that prompts most face lifts is the presence of a neck cord, that band of skin and muscle under the chin in the mid-line. If this is not present, almost every other facial concern can be addressed minimally invasive methods avoiding surgery.

I am thinking of having a face lift but I am afraid of the pain. A girl friend of mine had a face lift and she had to stay drugged in a recovery facility for 5 days.

We do seem to like our drugs in Los Angeles. It is the style of some surgeons to keep their patients heavily medicated after surgery. This may be so they don’t have to spend a lot of time speaking with them. Dr. Steinsapir’s face lift patients generally stay overnight at the UCLA surgery center before being discharged home. A prescription of Vicodin®, or its equivalent, is provided but many face lift patients find that this medication was never needed. Keep in mind that many of Dr. Steinsapir’s patients have their face lift awake under local anesthesia in the office procedure suite. This would be impossible if the procedure was inherently uncomfortable.

I’ve been reading about the deep plane face lift. Does Dr. Steinsapir perform a deep plane face lift?

Dr. Steinsapir very much believes that the punishment should fit the crime. Plastic surgeons tend to be a macho bunch. The deep plane face lift carries with it a risk of injury of facial nerve injury even in the best of hands. This is because the nerves are exposed in performing the dissection. It is not possible to have a great face lift result if part of your face does not move correctly after surgery due to a facial nerve injury. This small risk might be justifiable if the deep plane face lift led to a much better result or a more long lasting procedure. The operative word here is might. The reality is that after six months it is impossible for experts to tell what technique was used in a particular face lift. So it makes no sense to perform high-risk maneuvers under the facial flaps. So if you feel you need a deep plane face lift Dr. Steinsapir is not your guy. However, be careful what you look for.

I am considering having a face lift. It is reasonable to have abdominal liposuction at the same time?

Dr. Steinsapir does not think so. A detailed, properly tailored face lift takes 3 to 4 hours to perform. To add liposuction to this procedure requires that both procedures be performed under general anesthesia. This substantially increases the risks of surgery. Dr. Steinsapir strongly advises against this type of “blue plate special.” It is far safer to separate these types of procedures in time. This reduces the risk of toxicity from the combination of anesthesia. Patients are sometimes coerced into having these combination procedures with the argument that the first hour of anesthesia is the most expensive and reduced facility fees for multiple surgeries. Our best advice is don’t try to save money this way. There are some logical combination surgeries like lower face lift and lower eyelid surgery, or lower face lift and endoscopic forehead lift. These types of options can be discussed at the time of your consultation with Dr. Steinsapir.

How does Dr. Steinsapir close the ear? I have a girl friend who had a face lift and her ears have never looked right.

Dr. Steinsapir spends a good percentage of his face lift tailoring the face lift closure. Some of the alterations in the appearance of the ear after a face lift are the results of sloppy technique. Dr. Steinsapir believes that it is well worth taking whatever time is needed to tailor the face lift closure. These myriad details and choices account for why Dr. Steinsapir’s face lift results are so beautiful and natural.

When will I be able to resume my workout after my face lift?

Generally Dr. Steinsapir will allow you to go for a walk two days after your face lift with certain restrictions. Most face lift patients are back to work in 7 to 10 days. By three weeks, it is generally possible to resume your regular work out.

How do I know if I am a candidate for having my face lift awake in the office procedure suite?

You should be in excellent health and comfortable and relaxed when having service with your dentist. Many patients will have had prior BOTOX® and Restylane® treatments with Dr. Steinsapir. This gives Dr. Steinsapir a very sound basis for deciding who will do well with an office-based face lift under local anesthesia.

I really don’t have a neck cord but I do have more fullness in my lower face and I am wondering if I could benefit from a lower face and neck liposuction rather than a lower face lift?

It is remarkable how beneficial a lower face and neck liposuction can be. All face lifts involve some degree of liposuction or in some cases fat injury that effectively results in the same type of improvement. Lower face and neck liposuctions are truly minimally invasive procedures, can be comfortably performed in the office under local anesthesia, and most people return to work in just a few days. We encourage you to come into the office and have a personal consultation with Dr. Steinsapir to learn if a lower face and neck liposuction will be right for you.

How does Dr. Steinsapir decide when to recommend noninvasive procedures and when to recommend surgery for the midface?

Generally, midface surgery is significantly more expensive that using facial fillers. When there is a profound deficiency in bone projection or loss of soft tissue due to prior surgery, Dr. Steinsapir favors a surgical approach. Otherwise, the noninvasive methods are preferred even if they only last a year or so before retreatment is necessary.

I have consulted other doctors and none of them seem to use a hand-carved implant. Why is Dr. Steinsapir’s approach so different?

Dr. Steinsapir is a pioneer of midface surgery. It is important to understand that his extensive training and experience permit him to offer solutions that other surgeons lack the experience to perform. This is why Dr. Steinsapir is often called upon to fix the midface work of other surgeons.

I consulted a surgeon who feels that all I need is a fat transfer to my midface and all of the issues will be corrected. Does Dr. Steinsapir offer this approach?

To address your particular concerns, a personal consultation with Dr. Steinsapir would be necessary. In general however, fat transfer to the under eye area has been relatively disappointing. The arcus marginalis release rotates a small volume of fat into the deepest portion of the under eye circle which is helpful. However, when the groove is profound, the arcus marginalis release will not provide a satisfactory degree of improvement. It is precisely these situations where the fat transfer has the greatest risk of post-procedure lumps and irregularities.

I broke my cheekbone several years ago. At the time, I had several surgeries to fix the break. Despite this, the repaired cheek has never been right and my eyelid on that side looks pulled down. Can midface surgery help me?

This is a situation where midface lift can make an enormous difference. A personal consultation with Dr. Steinsapir will help determine what types of additional procedures you will need to get the best possible result.

I have bags in my lower eyelids. I have had several consultations and they seem split between eyelid surgery alone or eyelid surgery with a midface lift. I have never thought of filling the midface with Restylane® until seeing Dr. Steinsapir’s website. Why did none of the cosmetic surgeons I have seen recommend this option?

First, a personal consultation with Dr. Steinsapir will be very helpful because everyone is different. However, generally, Dr. Steinsapir will recommend the least invasive method he feels will achieve your goals. Recognize that the Deepfill™ developed by Dr. Steinsapir is a sculpting technique that requires a very detailed knowledge of midface anatomy to produce an ideal result. Not every cosmetic surgeon will be comfortable with this approach.

I had lower eyelid surgery that seemed to hollow out my lower eyelids and change the shape of my eyes. Another surgeon performed a lateral canthoplasty and did some fat transfer to my lower eyelid but the results have never been to my liking. I am wondering if Dr. Steinsapir’s midface surgery can help me?

At the risk of being repetitive, a personal consultation with Dr. Steinsapir would definitely answer this question. We generally recommend that you bring old photographs of yourself prior to the original surgery so Dr. Steinsapir can better understand your appearance prior to surgery. Dr. Steinsapir has been very successful in helping many people with exactly your set of issues so we encourage you to make an appointment for you personal consultation.

I am getting a monthly Jessner’s peel by my aesthetician. How does that differ from the peels that Dr. Steinsapir performs?

The Jessner’s peel is a very mild peel. Even the low concentration trichloroacetic acid peels such as the 10 and 15% concentration reach deeper into the skin. It is likely that a 15% TCA peel performed two or three times a year would produce the same results or even more dramatic results than you currently achieve with the Jessner’s peel that you find necessary to repeat on a monthly basis.

My cosmetic surgeon tells me that chemical peels are obsolete and has recommended that I get a series of Fraxel® laser treatments instead. What does Dr. Steinsapir think of Fraxel®?

Fraxel® is fractional CO2 laser resurfacing. In general, these are relatively mild treatments designed to be well tolerated and with no down time. Because they are mild, the degree of improvement is limited. It will freshen the complexion but does not create a lot of tightening. The equivalent treatment with a chemical peel might be a 20% TCA peel of the face. The good news is that you are unlikely to be harmed by this type of treatment but you may also not feel that you got your monies worth depending on what you were charged. In defense of the fees charged for Fraxel®, the device is very expensive and this is reflected in what is charged for the service. By the way, peels are not obsolete, it is just that very few surgeons are trained to perform chemical peels like Dr. Steinsapir.

My cosmetic surgeon has recommended that I have CO2 laser resurfacing. I am a little nervous about the treatment especially after reading in his brochure that it is normal to have a result that leaves the face lighter than the neck. Is a chemical peel an alternative to CO2 laser resurfacing?

Dr. Steinsapir believes that CO2 laser resurfacing is a failed technology. It offered a lot of promise when it was first introduced. It is possible to have a good results with CO2 laser but only if the treatment is performed on a person with the right complexion. In general, the thermal injury created by CO2 laser injures the melanocytes of the skin and results in hypopigmentation. There are also often textural abnormalities in the skin after a CO2 laser treatment. The solution is avoiding the CO2 laser and having a customized full-face chemical peel. Call the office to schedule a personal consultation with Dr. Steinsapir and learn if a chemical peel is right for you.

I am thinking of having a laser peel. What are these and what are the alternatives?

Generally, a laser peel is performed with an erbium laser, which is used in a single pass. This ablates off only a few layers of skin and is usually comfortable with a topical numbing cream. However, the treatment is very superficial and therefore the results are very mild. How mild? The treatment can be equivalent to a microdermabrasion, which is very mild indeed. Therefore the service should be very inexpensive or it will not be worth the price paid.

Several years ago, I had laser resurfacing of my lower eyelids. I developed hyperpigmentation of the skin. The doctor who treatment me said that this was normal and would resolve in time but never did. Is there anything that can be done for this issue?

A consultation with Dr. Steinsapir will prove to be very helpful in fully answering this question. However, in general, there are a number of treatments for post-laser hyperpigmenation. Dr. Steinsapir has successfully treated this condition with both fotofacial® and chemical peels. So we encourage you to come in for a personal consultation to learn what can be done.

I have heard that chemical peels are very uncomfortable. How will I know if I can tolerate a chemical peel?

The key with having a comfortable chemical peel is in preparation. Dr. Steinsapir has developed an entire system for making a comfortable full-face chemical peel. The result is an incredibly effective treatment that is surprisingly comfortable. You might be shocked to learn that most of our patients find they only need extra-strength Tylenol® after their chemical peel.

I had a C-section with my last pregnancy. My daughter is now four. I’ve lost my “baby fat,” but I have this roll of fat just above my C-section scar that I can’t seem to loose. I saw a plastic surgeon who told me I needed a tummy tuck but I really don’t want my C-section scar made any bigger and also he told me I’ll have a scar around my belly button. Isn’t there some other option?

What you’re describing occurs when the obstetrician sweeps up the belly fat to flatten the area above the pubis before making the C-section incision. This traps fat above the incision. That is what accounts for that bulge above the C- section scar that no one likes. Tumescent liposuction is very effective at reducing this bulge. Tumescent liposuction will stimulate some skin contraction. The procedure can be done in the office under local anesthesia with minimal down time. While liposuction will not resolve all the issues, it will make a significant difference without the necessity of a tummy tuck. For many women this is a great alternative to having an incision from one hip to the other and 10 weeks of recovery.

What does Dr. Steinsapir think of Mesotherapy? Is this a good alternative to liposuction?

Mesotherapy involves the injection of solutions containing, among other things, the bile salt deoxycholate and phosphatidylcholine. These treatments are marketed under the names Lipo-dissolve, Lipodissolve, LipoShape, and Lipostabil. Other chemicals that may be in mesotherapy solutions may include: Aminophylline, Dimethylethanolamine, Glutathione, Hyaluronidase, Isoproterenol, L-arginine, Lidocaine Pentoxifylline, and Yohimbine. What you may not know is that mesotherapy is an untested, and unproven treatment with a lot of documented unpleasant side effects. Whenever a doctor (or whoever) picks up a syringe and injects fat with a mesotherapy solution, they are essentially conducting an uncontrolled experiment. Mesotherapy solutions are not FDA approved. The labs that concoct these solutions are unlicensed. In many cases, doctors buy the raw materials and mix them up in their office. There are numerous reports of infections due to the less than ideal conditions in which these preparations are made. These treatments particularly deoxycholate and phosphatidylcholine do destroy fat cells but they also damage blood vessels and produce scaring. Ultimately with a better understanding of these agents and preparation under sterile conditions, there may be a role for these agents in reducing a small fat deposit. However, at this time, Mesotherapy does not live up to the hype and represents an unreasonable danger to the public. Mesotherapy is not a replacement for liposuction.

Is it possible to get all the fat out if liposuction is performed under local anesthesia?

It is important to understand that liposuction performed under general or local anesthesia is a sculpting technique. It is absolutely not about sucking all the fat out. The goal is shaping the body. Believe it or not, fat on the body is golden. It is needed to cushion the skin off of the underlying muscle. Where all the fat is removed between the skin and muscle, the skin becomes stuck down to the muscle and this is not an attractive result.

I am thinking about having liposuction but I am black and it seems like every needle stick causes my skin to darken around where I get poked. Will this be a problem of me when I have liposuction?

It certainly can be an issue. All skin types, including the darkest skin types, can develop what is called post-inflammatory hyperpigmentation where the skin is traumatized, including the needle tracks used to infiltrate the fat with dilute local anesthetic. Not everyone has this reaction. Generally the hyperpigmentation fades over a period of months but some people retain residual discoloration of the skin. It is appropriate to talk with the doctor regarding your concerns.

I am considering Lap-band® surgery because I am 100 pounds above my desired weight. Will liposuction help me achieve my desired body weight?

Absolutely not. Liposuction is truly a sculpting surgery not a weight reduction technique. This does not mean that only skinny people benefit from liposuction. Heavier individuals with stable weight can benefit from liposuction if it is the purpose of sculpting or shaping a localized area of fat. A personal consultation with Dr. Steinsapir will help determine if liposuction is right for you.

I am a male bathing suit model. I am 5’10” and weigh 140 pounds. In my pictures I think that I would look better if my love handles were not so obvious. Could liposuction help me achieve my goals?

Most likely the answer is yes. Even a relatively small fat deposit can be sculpted with tumescent liposuction. You probably already work out like crazy and control your diet. Liposuction is the perfect means to address this type of concern.

I am in my late thirties and I hate my arms. I seem to be getting those flabby fat deposits in my arms. Can this be improved with liposuction?

Absolutely. However, liposuction should be used to sculpt the fat deposits. If too much fat is removed, then the skin becomes deflated and this can make the area look worse. Generally the goal is a 20-30% improvement.

I previously had liposuction. I don’t think it was done with tumescent because I had general anesthesia. I definitely had an improvement but the surgery left me with some irregularities. In particular, my belly button looks like there is a donut around it. Can anything be done about these irregularities?

In general, these issues are the result of either too much or too little fat being removed at the time of the original liposuction. The donut you are describing is a common contour defect following liposuction and can be resolved or significantly improved with revisional liposuction. Even though your original liposuction was performed under general anesthesia, you are likely to do well having this addressed with tumescent liposuction under local anesthesia.

I had liposuction a few years ago and I think that in a few places the doctor took too much fat. I actually think that in a few places the skin is sitting on my muscle. Is there anything that can be done about this?

A personal consultation with Dr. Steinsapir will be very helpful so he can specifically examine your concerns and answer your question. However, in general, these areas can be grafted with your own fat as a fat transfer, which will significantly improve these types of divots.

Will Dr. Steinsapir accept my insurance?

Dr. Steinsapir does not accept insurance including, but not limited to, Medicare, Medi-Cal, and Medicaide. You are directly responsible for Dr. Steinsapir’s surgeon’s fee. Depending on the details of your coverage, you insurance may cover a portion of the fees charged by the hospital for surgery.

I don’t find Dr. Steinsapir listed as a provider for my health plan. Can I still use my health insurance for reconstructive surgery?

Dr. Steinsapir does not participate as a network provider for any health plan. You health insurance may cover some of the cost for surgery at UCLA for the hospital, anesthesia, and pathology fees. The office is happy to answer specific questions regarding insurance coverage.

I am a school teacher and I am thinking of having reconstructive surgery with Dr. Steinsapir during my winter break. How much notice do I need to give the office?

Generally, the office is scheduling non-emergency surgeries 6-9 months ahead. Occasionally, cancellations occur making it sometimes possible to have surgery on shorter notice. However, we encourage you to plan ahead, especially for busy times of the year like the winter break when it seems that everyone wants elective surgery.

I had a cancer removed from one of my eyelids and a reconstruction at the same time. I am very discouraged by my appearance but my current doctor does not seem to take my concerns seriously. I am grateful that the cancer was successfully removed but I am wondering if anything can be done for my appearance?

This is a common situation. Your doctor may simply feel that your reconstruction was the best that could be done under the circumstances. We find that a fresh set of eyes is sometimes very helpful. A personal consultation with Dr. Steinsapir will reaffirm your current doctors management or provide you with a new direction to improve your appearance following cancer reconstruction. Most patients find this a very helpful and informative visit.

Too much of my upper eyelid folds were removed at the time of upper eyelid surgery leaving my upper eyelid sulcus hollow and the eye skeletonized. What can be done?

It was once taught to eyelid surgeons that it is impossible to take too much upper eyelid skin with the blepharoplasty. However, this is not the case. It is essential to consider the position of the eyebrows in assessing how much spare skin exists in the upper eyelid. A conservative approach is to position the eyebrow anatomically, and then determine how much excess skin exists in the upper eyelids. When too much skin and underlying tissue are removed from the upper eyelid, the upper eyelid fold is compromised. This results in a hollow space below the eyebrow where the upper eyelid fold once existed. The upper eyelid fold is an important anatomic feature. Failure to conserve the upper eyelid fold, as part of the upper blepharoplasty, is a major cause for an over operated appearance. It is also important to understand that it is virtually impossible to create more upper eyelid fold with secondary surgery.

I think my upper eyelid creases were made too high. Is there anything that can be done to help this?

The surgeon sets the height of the upper eyelid crease. Unfortunately, many surgeons fail to understand that they are making their incision too high above the eyelashes, often 10 or more millimeters above the eyelashes. As the incision heals, it tends to creep up another one or two millimeters. This means that ultimately the upper eyelid crease will heal at 11-14 millimeters above the eyelashes. This creates a very high crease and contributes to the hollow appearance in the upper eyelid. Before we criticize other surgeons, please understand that many text books of plastic surgery and journal articles on this subject also pass on the erroneous information that the surgical crease should be made this high. Dr. Steinsapir advocates making creases much lower and typically marks the upper eyelid incision about 6.5 to 7.5 millimeters above an eyelid margin. It is relatively straightforward to raise a crease but very difficult (almost impossible) to predictably lower an upper eyelid crease. The best cure is avoiding the surgeon who plans on placing the blepharoplasty crease incision too high. You can discern this by looking at the before and after pictures. If every one of the after pictures demonstrates that the upper eyelid fold is gone, you should seriously consider finding a different office.

The skin on my upper eyelid platform is wrinkled and loose. I can’t seem to keep makeup on without it smudging. Is there anything that can be done to help this?

When upper blepharoplasty is performed, simply removing extra skin is not enough to create a great result. Beautiful blepharoplasty results require what Dr. Steinsapir calls a structured blepharoplasty. For the eyelid platform skin this means making the eyelid crease at just the right height and anchoring the eyelid platform skin to the levator tendon, which raises the upper eyelid. This places the upper eyelid skin on a slight stretch resulting in a smooth platform for makeup. Crepe-like upper eyelid skin can be addressed after unsatisfactory upper blepharoplasty by a carefully planned re-excision of the excess skin left on the eyelid platform. With the eyelid open, the upper eyelid skin is anchored to the levator tendon to create a long lasting adhesion to the eyelid elevator. Recovery is usually shorter than standard upper blepharoplasty. Generally, this type of revisional procedure can be performed in an office procedure setting with local anesthesia.

My upper eyelashes point down. It bothers my vision and makes my eyes look dull. Is there any thing that can be done about this?

This condition is called eyelash ptosis and it is related to poor levator fixation of the upper eyelid platform skin. Again, a structured blepharoplasty will address lash ptosis. When this is not performed, it can be corrected with a revisional procedure. Typically a carefully planned re-excision of the upper eyelid platform is carried out so that the platform skin will be on slight stretch when the platform is reattached to the levator tendon. This puts slight traction on the skin of the eyelid platform and this gently rotates the eyelashes upward to a more youthful position. Recovery is usually shorter than standard upper blepharoplasty. Generally, this type of revisional procedure can be performed in an office procedure setting with local anesthesia.

Since my upper eyelid surgery, the inner corners of my eyes look heavy. What causes this and what can be done?

When upper eyelid surgery is performed, it is inevitable that the eyebrows will relax downward to some degree. Dr. Steinsapir carefully evaluates potential candidates for eyelid surgery during the consultation. He is specifically looking to assess the degree of brow ptosis present. When it is significant, there is usually compensatory activity of the forehead lifting muscles. When blepharoplasty is performed alone, relaxation in the position of the eyebrows after blepharoplasty can crowd the upper eyelid space and this is sometimes described as the inner corners of the upper eyelid as looking heavy or full. The solution is to perform a forehead lift or a forehead lift in combination with upper blepharoplasty to stabilize this situation. Not every one with a degree of brow heaviness needs a forehead lift. Often the upper blepharoplasty can be performed alone with great results. However, when the heaviness of the forehead is bothersome after eyelid surgery, the fix is a forehead lift.

My eyelids seem very heavy since my blepharoplasty. What causes this and what can be done?

This is actually quite common. It is the result of slippage or disinsertion of the upper eyelid tendon. This tendon connects the upper eyelid edge with a muscle that raises the upper eyelid. This results in a condition that is referred to as ptosis or blepharoptosis. It can be caused if the tendon is cut during surgery but it can also slip on its own and this can be made much worse with the swelling of the eyelid that occurs with the blepharoplasty. Correcting this first entails determining if one or both of the eyelids is drooping. One may be worse than the other but if both sides are not fixed at the same time, the side that was not repaired will end up looking heavy. The exact procedure needed to fix the droopy lid is determined by how heavy the eyelid is and its response to the instillation of neosynepherine eye drops. Based on the effect of this test and several other measurements Dr. Steinsapir will determine the most appropriate surgery for correcting the ptosis.

Since my eyelid surgery my eyes seem very dry and at night I don’t think I close my eyes. What can be done about this?

Dry eye commonly occurs in adults even without eyelid surgery. Typically, an existing dry eye condition returns to its presurgical status after about 6 weeks. It takes about this long because persistent swelling of the eyelid tissues after surgery can make dry eye symptoms worse. However, overaggressive surgery can produce long-term damage to the function of the eyelids worsening the dry eye symptoms. If too much upper eyelid skin was removed, the eyes may not fully close at night causing dry spots to develop on the cornea accounting for the increase symptoms. Depending of the design of the blepharoplasty, the nerves that supply the muscle that helps 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 mean during the blink. This is a problem because the eyelids move tears on the eye surface around. The net result is surface drying and symptoms. The first line approach to treating these issues is to increase the frequency of eye drops and, when indicated, ophthalmic ointment at bedtime. When needed, the tear drains in the eyelids can be closed temporarily with plugs to see if symptoms improve. When these measures fail, consideration may be given to reconstructive surgery. The nature of what is needed is very much directed by the severity of the symptoms and the degree of drying seen on the surface of the cornea. A range of options is available. However 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.

Since my lower eyelid surgery the area under my eyes seems hollow. What causes this and what can be done about it?

Lower eyelid surgery is performed to address skin wrinkling and lower eyelid fullness due to orbital fat that over time bulges forward into the lower eyelid. By carefully sculpting lower eyelid fat, a balance can be struck leaving enough volume in the lower eyelid to eliminate the bulge but prevent deflating the lower eyelid which can contribute to the under eye circle. The under-eye circle is actually the result of a gradual fall in the cheek fat over time. There are several options at the time lower blepharoplasty is initially considered. For the right patient, a conservative lower blepharoplasty done transconjunctival (behind the lower eyelid) can be a fabulous choice. This is particularly good for a relatively young person with thick lower eyelid skin but lower eyelid fullness. Over the past few years, we recognize that it can be helpful to conserve the lower eyelid fat by positioning it into the top of the cheek to help fill in the under eye circle. Chemical peels can firm the skin of the lower eyelid masking the circle. Restylane® can be used to fill in the under eye circle. Where appropriate a vertical midface lift over an orbital rim implant can also address the under-eye circle. Many of these approaches can be used to address the under eye circle that becomes more obvious once the lower eyelid fat creating the bulge has been removed. Because the treatment is relatively easy and can last a year or more, many patients faced with this issue elected to have Deepfill™ Restylane® to fill the under eye circle. A personal consultation with Dr. Steinsapir is the best way to learn what is the best approach for you situation.

Since my lower eyelid surgery my lower eyelids look pulled down. What’s up with this?

The gentle almond shaped curve of the lower eyelid is created by a delicate balance of forces including the ligaments of the lower eyelid, the force generated by the orbicularis oculi muscle, the prominence of the eye itself, the projection of the cheek, and the weight of the cheek. Essentially, the lower eyelid position defies gravity. It is little wonder that lower eyelid surgery can permanently alter this balance and cause the lower eyelid to become pulled down after surgery. Surgery also causes scar tissue to form in the lower eyelid, weakens the ligaments of the lower eyelid, and damages the muscle that helps hold the lower eyelid against the eye. Fixing these issues is challenging because of the careful analysis needed to determine the best options for a given individual. Restoring the lower eyelid contour requires that all of the contributing factors be taken under consideration. It is not unusual to address only one side at a time surgically because the correction often requires that placement of graft material to support the lower eyelid. To obtain the best possible result, the eyelids are sewn closed for about a week. When necessary, this type of reconstruction can be combined with orbital rim augmentation and vertical elevation of the cheek to further support the lower eyelid. This approach has the power to address lower eyelid contour problems that have not responded to multiple prior approaches.

I had lower eyelid surgery and there seems to be residual fullness in the outer third of my lower eyelids. Is it possible that my doctor missed some eyelid fat?

There are three fat pockets described for the lower eyelids. The two central pockets are easily accessed during lower eyelid surgery. The outer fat pocket is less easily accessed during eyelid surgery. The experienced eyelid surgeon anticipates this and with a little effort, the needed fat sculpting can be accomplished. Residual lower eyelid fullness responds well to revisional lower eyelid surgery.

I had a fat transfer to my lower eyelid to fix my under eye circles and now I have lumps and my circles are still there. What is going on and what options do I have?

The under eye circle is a very common issue caused by a fall in the top of the cheek fat which in youth blends with fullness from the lower eyelid to create cheek fullness up to the lower eyelid crease. Transferring fat to the face has become an increasingly popular treatment. Generally, this treatment is very good at restoring volume in the face. The treatment is generally very good when the transferred fat is placed in locations that possess a reasonable layer of fat to hide any irregularities created by the volume of the transferred fat. The lower eyelid in the area of the lower eyelid circle contains almost no fat compared to the adjacent cheek. This means that there is no place for the volume of the fat transfer to hide. This results in visible lumps and bumps. Correcting these has proven to be very difficult. The fat tends to be found in planes that do not correspond to standard surgical approaches. Melting the fat with steroids can lead to unpredictable fat loss. The best approach is to remove the worst of the visible fat deposits and filling around the others with the hyaluronic acid fillers like Restylane®. This approach evens out the lower eyelid irregularities and in some cases this can be effectively performed without the need to surgically remove the fat.

Since my midface surgery, the skin in my lower eyelid bunches up when I smile. What is going on and what can I do about this?

The midface anatomy is highly complex. Several of the midface tissue planes act as glide planes. Certain midface and lower eyelid treatments seem to change the nature of how these tissues glide over each other. CO2 laser resurfacing can be associated with aggressive contraction of the glide planes of the lower eyelid resulting in bunching of the lower eyelid skin with smiling. Interestingly, this type of effect is not typically seen with a chemical peel that produces a comparable degree of tightening. This type of skin heaping can be seen following midface lifting which may stimulate an inflammatory response in these same glide planes. The best cure of this issue is to avoid overly aggressive skin and midface lift procedures.

When I lived in the Bay Area Patrick Bitter Jr., M.D. did several Fotofacial® for me. Is Dr. Steinsapir familiar with Dr. Bitter?

Dr. Bitter invented the Fotofacial®. Dr. Steinsapir originally learned from Dr. Bitter how to perform Fotofacial® and Dr. Steinsapir is listed on the official Fotofacial® website.

What exactly is a Fotofacial®?

It is a facial skin treatment based on intense pulse light. There are a variety of machines that produce intense pulsed light. Dr. Steinsapir uses the Lumenis Vasculight® HR, one of the most sophisticated machines developed for the purpose of performing intense pulsed light treatments. Applying a treatment crystal in a hand piece to the face treats the facial skin. The machine triggers a bright flash of light that is filtered by the crystal. The light produced targets colored marks in the skin including collagen, brown spots, and red spots. Treatment takes about 15 minutes and a numbing creaming makes the treatment comfortable. Typically a series of 5 or 6 sessions is performed at 3-week intervals. You pay as you go. The treatment improves sunspots, flushing, blood vessels, and tighten pores. Over the course of 5 or 6 treatments mild facial tightening is evident.

I have veins in my lower eyelid. Will the Fotofacial® address these?

Generally, the Fotofacial® can close small red blood vessels. However, larger veins need a different type of treatment. Typically, a YAG laser is used that can close veins up to 3 millimeters.

I get cold sores. Will this be a problem with my Fotofacial®?

Dr. Steinsapir routinely prescribes Valtrex® to use for a few days around the Fotofacial® treatment.

I previously had a series of Fotofacials® a few years ago. Would I benefit from more Fotofacials®?

The answer in general is yes. However, a personal consultation will be needed to determine exactly what you will need. Typically, skin redness benefits from retreatment after 6 to 12 months although only one or two sessions may be required. Sun damage takes longer to occur after treatment but this very much depends on how well you have been protecting your face from sun damage since your last treatment series.

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