Revision Eyelid Surgery Beverly Hills
Eyelid surgery is one of the most popular cosmetic enhancement procedures, and when performed correctly, it can dramatically rejuvenate and refresh one’s facial appearance. However, there are many potential complications that can ensue during or after eyelid surgery, and when something goes awry during surgery on this delicate region of the face, the consequences can be devastating. Even “adequate,” but less than perfect results can be a profound disappointment.
Eyelid surgery revision (revisional eyelid surgery) is a secondary procedure that is performed to correct or improve any complications that may have arisen after the original surgery, and/or to address the patient’s dissatisfaction with the cosmetic results of the previous surgery. Revisional eyelid surgery is even more complex than the primary procedure, which is why it is essential to look past the hype and empty promises and base your revisional surgeon selection on irrefutable qualifications, such as: board certification, training, experience, and demonstrable proof of past successful eye/eyelid surgeries (i.e. case studies, before-and-after photos).
REVISIONAL SURGERY EXPERTISE
Dr. Kenneth Steinsapir is one of the foremost eyelid surgeons in the world, is board certified in Ophthalmology, and has completed numerous prestigious fellowships, including three years of Orbital and Eyelid fellowships at the Jules Stein Eye Institute at the David Geffen School of Medicine at UCLA. He is widely respected for his clinical research, and has published over thirty scientific papers and eight book chapters. He lectures regionally, nationally, and internationally, and has a private practice located in Beverly Hills, CA, where he is in high demand by discerning individuals from Los Angeles, Beverly Hills, Southern California, and abroad. Very few doctors can match the level of skill and expertise he possesses when it comes to improving upon the results of prior eyelid surgery, and he is known amongst his peers as performing some of the best blepharoplasty Beverly Hills has to offer.
At Dr. Steinsapir’s eyelid surgery Beverly Hills boutique practice, he performs several consultations a day with patients who have concerns about the results of a previous eyelid surgery. A patient’s original eyelid surgery may have been many years ago, or very recently. Some patients may have been initially satisfied with the results of their surgery, but have noticed their results fading over time and desire a surgical ‘refresher.’ Others may have immediately realized that there was a problem with the first eyelid surgery and allowed their original surgeon to attempt to correct the issue before finally seeking out Dr. Steinsapir’s expertise. A small number of individuals seek a consultation with Dr. Steinsapir’s because they are having an immediate problem after a recent eye surgery and feel that their issue warrants a second opinion.
Dr. Steinsapir welcomes second opinion consultations, and understands that many issues stem from a lack of open communication between surgeon and patient. A call from Dr. Steinsapir can be helpful to reestablish lines of communication and strengthen the doctor-patient relationship, allowing the patient to continue with their original surgeon and to feel secure that they are receiving appropriate care. More often than not, however, the breakdown in doctor-patient communication requires a transfer of care, particularly when the issues are beyond the capabilities of the original surgeon to manage. Dr Steinsapir is available to intervene in urgent and emergency situations when the need arises.
Dr. Steinsapir always strives to perform surgery in the least invasive manner possible, and has innovated conservative surgical methods that help to preserve the integrity of the eyelids and spare the fragile eyelid tissue whenever possible. By combining this approach with advanced techniques and custom-tailored treatment plans, dramatic (yet very natural) eyelid surgery results are possible with minimal post-operative downtime.
before & afters
POTENTIAL EYELID SURGERY COMPLICATIONS
The initial phase of the recovery period after any eyelid surgery can be a time of great anxiety for many patients. Post-operative eyelid surgery issues are often a result of insufficient post-operative follow-up and a lack of doctor-patient communication. No matter how technically superb the surgeon, lack of attention to post-operative eye comfort can undermine patient confidence and heighten the patient’s anxiety. Unfortunately, specialists lacking ophthalmological training often underestimate the impact of these easily addressed issues.
Dr. Steinsapir is acutely aware of the importance of eye comfort after surgery, and takes every measure necessary to make the patient as comfortable as possible. For this reason, Dr. Steinsapir closely follows his patients after surgery, and sees patients as often as is necessary to maintain their comfort and manage any concerns that arise, including offering 24-hour accessibility so that any urgent concerns may be promptly addressed.
Common post-operative eyelid surgery issues can be thought of in two broad categories: immediate and long term. An immediate problem may arise moments after surgery, or up to six months later. Long-term issues are present six months or more after surgery—the six month time frame is useful because leading up to the six month window, a number of concerns related to upper eyelid crease height, difficulty closing the eye, mild lower eyelid retraction, or alterations in eyelid shape often resolve on their own. When these problems persist more than six months after surgery, it is Dr. Steinsapir’s experience that corrective surgery may be necessary to improve the situation.
Potential immediate post-operative concerns include:
- Dry Eye: the eyelids are like the windshield wipers of the eye, and post-surgical swelling of the eyelids can cause drying and irritation. This type of swelling can typically affect eye comfort for approximately ten days before swelling settles down enough for the eyelid to again move tears efficiently on the eye surface.
- Motor Nerve Damage: Eyelid surgery cuts small motor and sensory nerves to the eyelid. This can weaken the muscle that closes the eye (orbicularis oculi muscle), and the blink mechanism may be temporarily or permanently affected, causing long-term eye surface drying and dry eye symptoms (i.e. irritation, sensation of burning, grittiness, redness). Fortunately, many of these closure issues resolve over time, and can be treated with first-line approaches, such as: artificial tears, bland ophthalmic ointment, plugging the tear drainage system, and/or taping the eyes closed. Should symptoms persist, surgery to improve eyelid closure may be required. In contrast to motor nerve damage, sensory nerve injuries are generally short lived and are more likely to heal completely without additional surgery.
- Hemorrhage: occurs as a result of blood vessels that are cut or damaged during the eye surgery, or from straining, coughing, or other activities following surgery that disrupt normal clot formation and may lead to the formation of large bruises. This bruising prolongs healing, and in more extreme cases, can disrupt the surgical result and even affect vision.
- Retro-orbital hemorrhage: although some degree of post-operative bruising is normal, on rare occasions, a much more significant bruise can occur, potentially causing blindness. While these cases are very rare (about one in 300,000 cases), this concern is why you will be instructed to avoiding blood thinning medications and herbal products prior to surgery, and why Dr. Steinsapir may turn you down for surgery if you are required to be on a blood thinner after a heart valve replacement or recent stroke.
- Superficial Bruising: although superficial bruising may not threaten the patient’s vision, severe bruises may cause swelling that can stretch a healing eyelid, potentially producing heaviness in the upper eyelid that requires surgical correction should it persist after 6 months. Similarly, in the lower eyelid, bruising stimulates the formation of extra collagen and scar tissue that can lead to permanent eyelid malposition, again necessitating revisional surgery.
- Infection: infection after eyelid surgery is much less common than bruising. To reduce this risk further, antibiotics are often prescribed routinely after surgery to prevent this issue from arising. If an infection does develop after surgery, a change in the type of antibiotics may be warranted. Additional treatment options may include consultation with an infectious disease expert and intravenous antibiotics may rarely be necessary. Once the infection has cleared, if there is any loss of eyelid function or unanticipated scarring, this might warrant revisional surgery to address these concerns. When reconstruction is needed in these circumstances, it is often reasonable to wait a full year before undergoing secondary surgery, as the tissue may eventually relax sufficiently enough to avoid revisional surgery.
- Wound Dehiscence: This is the medical term to describe stitches that have come apart before the skin edges are healed together, causing the raw edges of skin to separate and the wound to gape open. This unsightly complication commonly occurs in the upper eyelid, where the incision to remove excess skin is made. Although it is tempting to sew the raw edges back together immediately, there may be a low-grade infection causing the wound separation. For this reason, the best course of action is often simply to observe the area and keep it moist with extra antibiotic ointment. Perhaps the most surprising thing about wound dehiscence is how well it heals on its own. It has been Dr. Steinsapir’s experience that given time to fully heal, the body pulls the skin edges back together and no further intervention is required.
- Chemosis: tissue swelling of the conjunctiva (the white of the eye). Mild chemosis will resolve on its own, while more severe chemosis requires aggressive lubrication with an ophthalmic ointment, occlusion with plastic wrap to prevent drying, and (if necessary) surgical intervention. Severe chemosis is very rare and is almost never seen with standard blepharoplasty—it is more commonly associated with procedures to tighten the lower eyelid (i.e. canthopexy and canthoplasty), more extensive midface procedures, or a pre-existing negative vector eyelid.
- Double Vision: this rare complication is most often caused by the local anesthetic used to perform the surgery. In most cases, double vision resolves on its own within 1-2 hours; however, double vision that persists beyond the first day should be carefully measured and observed, as this may be a sign of injury to an adjacent eye muscle.
- Scarring: scarring that may accompany post-surgical bruising typically improves over a period of months. In extremely rare cases, scars that do not ultimately heal in an acceptable fashion may benefit from revisional surgery.
Potential long-term post-eye surgery issues include:
- Patient Dissatisfaction: One of the most common long-term post-operative issues is patient dissatisfaction with the results of the original surgery. This displeasure may stem from ineffective surgical techniques, or from the patient’s personal perception that their results are not as dramatic as they had hoped for. It is important to understand that a surgical result deemed aesthetically unsatisfactory because it is not dramatic enough, or did not garner sufficient positive responses from friends and family, is not considered a complication of surgery. However, patient dissatisfaction is still a valid concern and a common motivating factor for revisional surgery. Circumstances that give rise to a disappointing surgical outcome due to an insufficient effect include:
- Forehead relaxation and eyebrow sagging resulting from upper blepharoplasty
- Insufficient removal of upper eyelid skin
- Insufficient removal of lower eyelid skin or fat
- Removal of too much upper or lower eyelid skin
- Persistent lower eyelid lines after lower eyelid surgery
- Extra muscle or skin trapped on the upper eyelid platform
- Poorly designed upper eyelid creases
- Visible lower eyelid blepharoplasty scar
- Failed lateral canthal surgery
Corrective surgery to remove additional tissue is far more straightforward than a revisional procedure to address the results of overly aggressive surgery, where tissue needs to be put back into the eyelid. Again, the aforementioned concerns are not technically considered surgical complications, yet in each case additional surgery may be needed to achieve the desired outcome and truly satisfy the patient.
During your initial consultation, Dr. Steinsapir will perform a comprehensive examination and will listen carefully to your post-operative eyelid surgery concerns. He will then create a personalized treatment plan that is carefully designed to ensure the safe and effective correction of any concerns that have arisen, and to bring your aesthetic and/or functional goals to fruition.
CONTACT DR. STEINSAPIR
Dr. Steinsapir is a UCLA- and University of Chicago-trained surgeon who has performed separate fellowships in both Cosmetic Surgery and Oculofacial Microsurgery and is board certified in Ophthalmology. Many individuals travel nationally and internationally to undergo revisional eyelid surgery and other facial rejuvenation procedures with Dr. Steinsapir. To learn how revisional eyelid surgery can help you improve upon the results of a previous surgery and achieve your desired facial improvements, please don’t hesitate to contact our office.
You may also continue to explore Dr. Steinsapir’s website (www.Lidlift.com), where you will find supplementary information pertaining to various types of eyelid surgery, before-and-after eyelid surgery case studies, and answers to frequently asked questions about these procedures. Your revisional eyelid surgery can serve as a key stepping stone along the path to become the best possible version of yourself, and you can take the first step by calling to schedule your personal consultation with Dr. Steinsapir today.