January « 2010 « LidLift Blog – Cosmetic, Facial & Eyelid Plastic Surgery

January 31, 2010

What is the Best Chemical Peel?

There are a number of effective, safe chemical peels available that can do wonders in restoring your face to a healthier, more youthful appearance. These peels can be applied in a variety of strengths, concentrations, and combinations depending on your skin type and the extent of damage your skin has incurred over the years. Your cosmetic surgeon can determine the best one for you by examining your skin type, condition, and goals. This way you can agree on the best chemical peel that will rejuvenate your skin without damaging it.

Chemical Peel Before and After Photo

When Do I Need a Chemical Peel?

Your doctor will go over this with you at your consultation. Some general indications are:

•   acne with or without scaring
•   dark spots that have developed over time
•   aging skin from sun exposure
•   intrinsic skin aging
•   fine lines
•   creases and deep furrows
•   loss of skin elasticity
•   scaly dry skin with irregular brown spots
•   premalignant lesions
•   an overall yellowish hue to the skin due to chronic sun damage

Some patients may benefit from other procedures, like a facelift or facial filler, which can only be determined by an experienced surgeon at an individual consultation.

Which Chemical Peel Should I Get?

This depends on factors like the condition of your skin and what kinds of problems it has, your treatment goals, your skin color as classified by the clinical Fitzpatrick scale (which factors in how easily you sunburn), and other individual conditions. To give you an idea of available chemical peels, here are some that are effective depending on the personal circumstances:

Alpha Hydroxy Agents

This peel is usually delivered in a series of treatments to improve mild brown spots and freshen the skin tone. We derive alpha hydroxy acids (AHA) from fruit and dairy products, most commonly using glycolic acid to smooth the skin. If your skin is suffering from discoloration and darkening from damage, skin bleachers combine synergistically with AHA to lighten the skin nicely. Repeated treatments yield new collagen and elastin, which is thought to reduce skin sagging. AHA can be used in an acne facial peel to improve your complexion, too. Very low concentrations of about 2-15% are available over-the-counter, which generally are not concentrated enough to cause dramatic improvement on their own, but can be used as an effective at-home treatment in conjunction with stronger treatments from a cosmetic physician.

Jessner’s Solution

This balance of resorcinol, salicylic acid, and lactic acid is a mild treatment that can be combined with TCA to treat the skin more deeply. When combined with TCA, which by itself is a mild to moderate peeling agent, Jessner’s Solution is a mild peel with increased skin effects. Generally, those being treated with Jessner’s peel alone need frequent treatments (perhaps monthly) and would likely benefit from a stronger peel performed two or three times per year, which would create similar or better results.

Trichloroacetic Acid

Depending on your needs, your doctor can apply trichloroacetic acid (TCA) in any number of strengths to achieve your desired results. Depending on the concentration strength, your doctor may administer a regional anesthesia and oral or intravenous sedation to ensure your complete comfort. After TCA treatment, your skin will be fresher and smoother. Generally the maximum concentration of TCA used is 35%. TCA solutions of 50% are less predictable and can sometimes result in scaring. The better option is to opt for an effective but less concentrated treatment that will provide predictable benefits without unwanted scars or use phenol which will safely peel deeper into the skin. The exception to this is the so-called Cross method using 95% TCA for acne scar pits.

Phenol

This peel, when made into an 89% solution, creates a medium-deep chemical peel used to peel the face. Phenol formula is remarkably effective at addressing problem lines, improving all but the deepest ones. The tightening of the facial skin achieved with this treatment can, in some cases, rival facelift results without the need for surgery. This peel can address sun damage, sun-spots, pre-malignant actinic keratosis, which left untreated can progress to in-situ squamous cell carcinomas. Since this agent is both strong and effective, your doctor must be cautious in its application. Conservative applications are best because, when overdone, phenol can contribute to scaring, but in lower quantities it is a reliable, powerful treatment. Very few patients require treatment of this depth on their whole face. Instead, your doctor should use phenol to treat only small areas of the face where problems are most severe. It may take 10 to 12 days to heal from a phenol peel while your skin rejuvenates. Because the skin can stay red up to four to six months, some patients wear coverup and love their results, while many men find that this subtle hue readily blends into their complexion without concern.

Are Fruit Peels Safer Than Chemical Peels?

It’s important to understand that fruit peels are chemical peels, but milder and usually less effective than the chemical peels outlined above. The word “chemical” scares a lot of people, but it’s important to understand that everything is a chemical, scientifically speaking, and chemical peels have a safe track record. Fruit peels are generally made of mild alpha hydroxy acids and citric acids extracted from fruits. Some may think it’s better simply because they hear the word “fruit” instead of “chemical,” but this peel is superficial with minimal benefits.

Should I Get the New Melange Peel?

This peel, which you receive at an office and then leave on for several hours at home, does receive a lot of internet hype. There have been fantastic claims made about the Melange Peel. It is important to separate marketing hyperbole from reality: while you can expect mild improvement in skin tone, the real issue is do you get real value for what you have been asked to pay?

Expert Treatment

Chemical peels are not something a doctor can learn in a weekend seminar, but something a doctor must perfect by treating hundreds of faces. The peel is an art form and your physician will assess the best peel or combination of peels for your unique situation. Find a board certified surgeon with actual fellowship training in cosmetic surgery who has a long history performing facial peels for satisfied patients.

Dr. Steinsapir demonstrates his face peel expertise through years of experience, and his chemical peel before and after photos demonstrate his skill as both a cosmetic surgeon and an artist. Call us today to schedule your consultation and find out which peel is most suitable to your needs.

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January 27, 2010

Can I have cosmetic surgery under local anesthesia?

Filed under: Cosmetic Facial Fillers, Cosmetic Surgery, Liposuction Beverly Hills, safe cosmetic surgery — Tags: beverly hills, cosmetic liposuction, cosmetic surgery under local anesthesia, is botox dangerous, los angeles cosmetic surgeon, safe cosmetic surgery — admin @ 12:51 pm

You may be surprised to learn that many procedures like eyelid surgery, liposuction, facelifts, and others can be safely performed under local anesthesia with or without intravenous sedation. Whenever possible, it’s usually best to choose local anesthesia instead of general anesthesia for several reasons:

1. Local anesthesia is safer.
While cosmetic procedures today are overall considered extremely safe, it’s noteworthy to point out that in the rare cases of malpractice suits or death, most of these problems involve surgeries performed under general anesthesia. For example, liposuction’s mortality rate when performed under general anesthesia is estimated to be between one in 40,000 cases to one in 5,000. The actual figure is probably toward the lower end of that range, which means it’s extremely unlikely that you’ll be so unlucky, especially if you choose an experienced and reputable surgeon. Then, when we look at the mortality rate for liposuction performed under local anesthesia, we find a mortality rate of only one in 300,000 cases. The lesson to be gleaned here is that while both methods are very safe, the increased dangers of general anesthesia make safe local anesthesia a better option, so why take a chance?

2. Local anesthesia enables the doctor and patient to communicate and obtain better results.
When the doctor and patient can communicate during the procedure, there is much to be gained. If you are having eyelid surgery, for example, your surgeon can have you open and close your eyes so he or she can see exactly how your body is responding to the surgery and you can obtain the most precise results possible. In cases like liposuction, your doctor will ask you to alert him if you begin to feel any mild discomfort. This ensures that nearby tissues are not traumatized during the procedure. If they are, you will be okay, but your recovery time will be longer. When you are conscious, you can listen to your doctor and tell him or her exactly how you feel, which means your results will be more individualized than they would be if you are “out” under general anesthesia.

3. Local anesthesia allows for faster recovery.
Fewer drugs means that you are less hung-over after surgery, so you return to normal much faster. Going back to our liposuction example, the compression garments worn for six weeks after general anesthesia are only needed for five to six days after local anesthesia liposuction. Since you are able to provide feedback to your doctor during surgery, the liposuction is accomplished with much less trauma which means a much faster recovery.

For these reasons, Dr. Steinsapir performs cosmetic procedures under local anesthesia whenever possible. Cosmetic surgeries under local anesthesia often cost more than they would under general anesthesia because your doctor needs to spend more time working gently and delicately to ensure your absolute comfort. The increased doctor-patient time does cost money, but this is also the reason why you heal so quickly and receive detailed treatment, along with fewer complications and health risks.

Which procedures can I have under local anesthesia?

This depends on your unique, individual health status and a personal examination. Usually, those in good health can safely and comfortably receive most of the treatments we provide under local anesthesia. Nonsurgical treatments like BOTOX, fillers, the chemical peel, and fotofacial of course are routinely administered under local anesthesia. Cosmetic surgeries like the endoscopic forehead lift, facelift, midface surgery, liposuction, and eyelid surgeries are best performed under local anesthesia or local with intravenous sedation. It is especially important to receive eyelid surgery under local anesthesia so your doctor can instruct you to open and close your eyes so that he or she can monitor and adjust the effects of the surgery for optimal results.

When is it best to have surgery under general anesthesia?

Generally procedures that are likely to run more than an hour benefit from sedation. Body wall surgery including tummy tucks and breast surgery should be performed under general anesthesia. Procedures that are likely to take more that 4 hours are often best performed under general anesthesia but this is something that should be discussed with the individual surgeon.

How do I find a doctor who will treat me under local anesthesia?

As always, we encourage you to be direct with your doctor. Simply ask your potential cosmetic surgeon if he or she prefers to work under general or local anesthesia, and what he or she thinks will be best for you. If your doctor prefers general anesthesia for you, find out why. Is it because of your unique health situation? Local anesthesia should be the default answer with general anesthesia functioning as an exception. Yes, this will require your doctor to spend more time treating you, but in the end you will have peace of mind knowing that you’ll receive the safest care, as well as experience the fastest recovery time and the best results.

Dr. Steinsapir specializes in performing procedures that improve the face and body contours under local anesthesia. He believes the extra time this requires is well worth the safer, superior results and satisfied recipients. Dr. Steinsapir emphasizes the importance of minimally-invasive, detail-oriented treatments on a comfortable outpatient basis, while maintaining the expertise and safe resources needed for general anesthesia and inpatient treatment for individuals with unique health needs. If you have any apprehension about anesthesia, Dr. Steinsapir can answer your questions, offer advice, and create solutions during your individualized consultation. Contact us today to see how we can help.

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January 21, 2010

How often should I get BOTOX and Restylane?

Filed under: Botox Los Angeles, Cosmetic Facial Fillers, Under Eye Restylane — Tags: Botox Los Angeles, how often should I get botox, restylane los angeles, Under Eye Restylane — admin @ 9:40 am

BOTOX and Restylane are both great solutions for those who wish to improve their facial appearance without undergoing surgery or invasive procedures. We know them both to be safe, comfortable procedures that are effective but not permanent. If you are thinking about receiving treatment, you are probably wondering how often you’ll need it. This is a great question that we will address in a moment, but first, please slow down and realize that you don’t have to decide right now how often you’d like to be treated or even definitively opt for any follow-up treatments. We will give you some general guidelines, but exactly how often you’ll need treatment depends on individual circumstances and personal preferences.

Microdroplet Botox and undereye Restylane before and after photo

Restylane, the preferred undereye filler for delicate areas like the undereye hollow, is long-lasting and typically retains great results for one to two years. BOTOX results generally last about four months and some benefits are still apparent after five months. These are guidelines, not rules; results will vary based on your individual anatomy, treatment plan, and your own perception.

Ultimately, it’s up to you.

Dr. Steinsapir recommends a simple mirror test to his patients. No, we don’t mean the one you may have heard of that instructs you to smile and look for lines (some lines, as previously discussed, are both natural and desirable). This test is as follows: if you don’t notice anything issues in the mirror, then you don’t need further BOTOX or Restylane treatments at this time. But if what you see starts to bother you – maybe you’re brushing your teeth and notice that you’re less satisfied with your appearance – then it’s time for retreatment. This means that some patients come in to receive BOTOX treatment every two and a half months, because they don’t want to see a single effect wear off, while others come in merely once a year because they only just noticed an appearance they would like to treat again. We encourage you to find your comfort level and what makes sense for your personal goals.

I want precise guidance in scheduling my next treatment.

Perhaps you’re an actor, model, or just a busy mom; perhaps there’s another reason why you want objective advice about when to receive your next treatment. Your doctor can help you decide how often you should receive treatment. Objectively, it will probably be about once every four months for BOTOX, and once every year for Restylane. Your doctor is a great resource for objective advice. Your friends and loved ones may prefer to compliment you rather than give you honest feedback when you ask how your treatment is holding up. If how others perceive you is a very important part of your treatment, discuss this with your doctor.

You can always modify your treatment plan later.

So relax! If you are anxious about your first consultation or treatment because you worry that you might be “getting into more than you bargained for,” remember that you don’t have to sign away your life at a consultation, and a reputable, ethical practitioner won’t pressure you into signing up for some “blue plate special.” BOTOX and Restylane are low-risk cosmetic treatments not only because of how rare complications are, but also because the results aren’t permanent. Yes, they are effective, but you have no reason to worry that these services will “make you age faster.” Few drugs are as well studied as BOTOX and the hyaluronic acid fillers like Restylane. You may want to view your first treatment as a trial; if you like it, as most people do, then you can continue with treatments according to your needs as discussed with your physician. If you don’t, then leave it at that.

A consultation, not a commitment.

It’s always wise to consult with a trustworthy doctor before committing to any treatment plan. First, you need to find out if the procedure you have in mind is actually appropriate to your needs. Then you of course must make sure you feel at ease with your potential cosmetic physician. The reliable yet flexible nature of BOTOX and Restylane make these ideal products for anyone hesitant to make a permanent change, and they are also great for those seeking long-term treatments they can count on.

Dr. Steinsapir believes in natural Restylane and BOTOX results and in providing caring, honest feedback that is tailored toward your needs. This means that you will never be pressured into more than you need or want. At your individualized consultation, Dr. Steinsapir will ask about your goals and other personal circumstances to help you come up with the best course of action. Remember to keep communication open with whomever you choose as your doctor to ensure that your needs are met at the times that are right for you. Dr. Steinsapir meets with you personally for your consultation and, when you’re ready, personally performs your service, not a nurse or a technician.

Dr. Steinsapir is a leading practitioner of BOTOX and Restylane treatments. He trained alongside the inventor of BOTOX and has since been helping Los Angeles BOTOX recipients achieve satisfying results. He invented Microdroplet BOTOX and Deepfill Restylane methods. Call us today for a consultation to learn how BOTOX and Restylane treatments can meet your needs through an individualized program.

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January 19, 2010

Should I have an open or endoscopic forehead lift?

Filed under: Cosmetic Surgery, Dr. Steinsapir, brow lift, forehead surgery — Tags: endoscopic forehead lift, forehead lift, forehead lift in los angeles, open forehead lift, open forehead lift risks — admin @ 10:22 am

It’s astounding that some surgeons insist on performing the open forehead lift after it was essentially replaced by the endoscopic forehead lift in the early 1990s. The closed forehead lift, or endoscopic forehead lift, is just as effective if not more so than the traditional yet outdated open forehead lift, with added benefits: faster healing time, no long term numbness of the scalp, no hair loss, and no scar arching over the head from one ear to another. The open forehead lift, also known as the coronal forehead lift, is undoubtedly oversurgical – the effects can be unnaturally excessive and it leaves a long, unsightly scar often accompanied by permanent numbness.

Before and After: Forehead Lift by Dr. Steinsapir

Endoscopic Forehead Lift Before and After

Some excuse this scar because it can be “hidden” under the hair, but the problem here is that the human eye and brain are amazingly capable of discerning the unnatural patterns of hair growth that result from this surgery. Even with a carefully designed, beveled incision through the hairline’s edge that allows hair to grow through the scar, the eye perceives something amiss. The hair is not as dense here, and for those opting for micrografted hair in this area, be warned that the uncontrolled compression and lack of random placement is easy for the eye to notice. Lacking the relevant technical experience, others may not be able to describe what they are seeing, but they will think to themselves that something isn’t quite right about your hairline. Those in favor of open forehead surgery argue that it is superior because it doesn’t push back the hairline. However, it is nearly always better to push the hairline back a tiny five milimeters than to have an altered hairline and huge scar that even the best of surgeons cannot render natural in appearance.

The results of an endoscopic forehead lift last just as long as the open forehead lift, with the added advantages of faster healing, no hair lass, an extremely low risk of numbness, and no visible scarring.

What’s the difference between an open and closed forehead lift?

In short, the open forehead lift places the hairline slightly lower but creates an unnatural-looking hairline. The endoscopic or closed forehead lift places the hairline subtlely higher while retaining a natural pattern in the hairline. The endoscopic forehead lift offers faster healing time and far fewer complications because it is a minimally invasive technique, whereas the open forehead lift can be categorized as oversurgical. Recovery from the endoscopic forehead lift is 5 times faster than the open forehead lift. The endoscopic forehead lift presents a larger learning curve for surgeons and takes longer to perform until mastered, so some have been resistant to transitioning to this superior method.

How long does a forehead lift last?

As with any cosmetic surgery, an endoscopic forehead lift will set back your aging clock, restoring and extending a youthful appearance, but it cannot completely stop the clock, and gravity and sun exposure will continue to affect you. You can expect your results to be long lasting and benefit you for five to ten years after surgery. Even when the effects start to diminish, you can be guaranteed that you’d look much worse had you never undergone this procedure. Thus an endoscopic forehead lift can be seen as twofold in purpose: it immediately improves the aesthetic appearance of your face, and it prevents you from looking excessively aged in the future.

Am I a candidate for an endoscopic forehead lift?

As we always say, only a personal consultation can tell you for sure, but some good indications of requiring a forehead lift are heavy brows, deep-set or hidden eyes, and wrinkled or sagging forehead skin. In some cases Microdroplet™ BOTOX® treatment or eyelid surgery may be more appropriate, as each of these procedures can affect similar areas. This really depends on the severity of your issue and other individual circumstances. The only way to know for sure is to obtain an individualized consultation from a highly qualified cosmetic surgeon who will examine you and then talk with you about your goals and concerns.

If you had a forehead lift years ago and the effects have worn off, you can receive another if a consultation with a qualified doctor demonstrates that one is necessary. Even if your last forehead lift was coronal, you may still benefit from a closed forehead lift today.

We cannot overemphasize the fact that what is best for one person may not be best for you. While reading reliable information is certainly beneficial, it can never replace the advice obtained from a face-to-face appointment with an actual doctor.

How can I find a doctor who performs endoscopic forehead lifts?

You must directly ask potential surgeons if they perform endoscopic forehead lifts. Also be sure to inquire as to which they perform – open or closed forehead lifts. If they routinely administer the open forehead lift, you should be suspicious. There are a very few exceptional situations for which the open procedure is most appropriate, but the best surgeon will tell you that these cases are rare and that he or she provides many more closed than open forehead lifts. Find a surgeon who recognizes the superiority of the effective, minimally invasive closed forehead lift.

Dr. Steinsapir is such a doctor who understands the importance of administering an endoscopic forehead lift instead of a coronal one. He constantly seeks solutions that involve minimal down time, maximum comfort, and the most natural results for his patients. Dr. Steinsapir’s forward-thinking leadership is not new – in fact, he has been a lead performer of the small incision endoscopic forehead lift since 1990. People from Beverly Hills, Los Angeles, and all over the world routinely travel to his practice to receive the best cosmetic eyelid and forehead treatments available. Contact us today to schedule a consultation and have your questions and concerns addressed with honesty, care, and expertise.

Should I have an open or endoscopic forehead lift?

The results of an endoscopic forehead lift last just as long as the open forhead lift, with the added advantages of faster healing, no hair lass, an extremely low risk of numbness, and no visible scarring.

What’s the difference between an open and closed forhead lift?

How long does a forehead lift last?

Am I a candidate for an endoscopic forehead lift?

As we always say, only a personal consultation can tell you for sure, but some good indications of requiring a forehead lift are heavy brows, deepset or hidden eyes, and wrinkled or sagging forehead skin. In some cases Microdroplet™ BOTOX® treatment or eyelid surgery may be more appropriate, as each of these prodedures can affect similar areas. This really depends on the severity of your issue and other individual circumstances. The only way to know for sure is to obtain an individualized consultation from a highly qualified cosmetic surgeon who will examine you and then talk with you about your goals and concerns.

How can I find a doctor who performs endoscopic forehead lifts?

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January 17, 2010

Anchor Blepharoplasty: Is It for Me?

Filed under: Eyelid Surgery — Tags: anchor blepharoplasty, beverly hills, corrective eyelid surgery, los angeles, upper eyelid surgery — admin @ 9:18 am

Anchor blepharoplasty addresses, loose, crepey skin on the upper eyelid platform by tightening the skin between the upper lashes and upper eyelid crease. This platform may become loose and sag, giving an unsightly appearance of tired eyes with sagging eyelashes, a form of ptosis. For women, having skin in this condition makes it very difficult for the eyelid to hold makeup, creating a problem that is difficult to artificially enhance. For both women and men, it can make the eyes look dull. The discreet nature of the incisions used in an anchor blepharoplasty means that this procedure will not contribute to visible external scarring, nor will it impede your healing process. This safe treatment should be part of every upper blepharoplasty to ensure that the lashes are properly supported.

Cosmetic Anchor Blepharoplasty and Ptosis Repair

Whether anchor blepharoplasty is for you depends on your candidacy for upper eyelid surgery, as we previously discussed – for example, if you have puffy, sunken, asymmetrical, or tired eyes then you may benefit from an upper blepharoplasty and thus an anchor blepharoplasty. This is an essential part of correcting upper eyelid problems.

Is this a separate procedure from blepharoplasty?

Ideally, no. Your surgeon should perform the anchor blepharoplasty as part of your regular upper blepharoplasty to correct tension problems along the eyelash line and ensure that your eyes look bright and lively. However, performing an anchor blepharoplasty is a highly specialized, technical skill, and it takes the most experienced surgeons to execute this procedure. If you go to a doctor who does not offer this procedure in conjunction with your blepharoplasty, then you may be setting yourself up for disappointment and possible revisional surgeries. If your eyes have already healed with droopy lashes and loose skin, then it’s time for a consultation. It’s always a good idea to find out if your original surgeon can help you resolve this issue. However, the most common reason it was not performed at the time of the original surgery is that the surgeon lacked the skills necessary to incorporate structurally important element into the eyelid surgery. If he or she can’t, or you lack confidence in their ability, then seek a second opinion.

The right doctor can easily correct problems with a properly designed anchor blepharoplasty. Since precision is key to obtaining a great outcome, you should find a surgeon who has performed this procedure numerous times and recognizes its importance.

How long should I wait after surgery to receive a corrective anchor blepharoplasty?

Allow yourself several months to heal before seeking revisional surgery, assuming you’ll still want it when you are close to your final results. Certainly keep communication open with your doctor so he or she can address your concerns and keep a close eye on your recovery, and it is also fine to seek a second opinion to decide on the best time for another eyelid procedure. Unless it’s an emergency as we discussed in our last post, you should finish healing before undergoing more procedures in the same area. This will enable your doctor to correct your eyelid tension with the fewest possible variables that may affect the outcome of your surgery.

I’m ready to talk to a professional about my concerns.

Consulting with an oculoplastic surgeon is the single most helpful action you can take when deciding whether anchor blepharoplasty is right for you. You’ve done a bit of research, and now you need an examination by an experienced doctor who can accurately diagnose your problem and recommend the best treatment course, or no treatment when none is necessary. If you haven’t yet had a blepharoplasty, be sure to ask your potential doctor about an anchor blepharoplasty so you love your results the first time. If you need revision, a consultation will help you determine if an anchor blepharoplasty is ideal for your individual needs.

Dr. Steinsapir considers anchor blepharoplasty a normal part of upper eyelid surgery. For evidence of his skill and attention to detail, we welcome you to browse his before and after blepharoplasty photos, where you will notice the alert position of the eyelishes and properly tensioned eyelid platform skin. Dr. Steinsapir is a top eye plastic surgeon in Los Angeles who holds an impressive list of publications, qualifications, trainings, and certifications, including the multiple fellowships he has completed and his professorship at UCLA. Contact us today to schedule your personal, individualized consultation with Dr. Steinsapir and learn how he can resolve your upper eyelid concerns.

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January 11, 2010

“I’ve had eyelid surgery and I need help ASAP!”

Filed under: Cosmetic Surgery, Dr. Steinsapir, Eyelid Surgery, Uncategorized — Tags: bad eyelid surgery, eyelid surgery corrections, fixing eyelid surgery — admin @ 10:42 am

If you’ve done your research and chosen a reputable doctor who specializes in oculofacial plastic surgery, chances are you will achieve satisfying results. While it is accurate that you needn’t fear surgery performed by a top-rated practitioner, it is also true that sometimes there are complications, and if you are the unlucky one experiencing complications, you need help soon.

The best doctors know not only how to give you great surgery results – they also know how to correct complications should they arise. Occasionally complications may arise from surgery, which require correction beyond the skill of the original surgeon, or the doctor-patient relationship may break down, and this is when you need to seek a second opinion. Fortunately, these circumstances are unusual.

What are the signs of needing immediate help?

Many people are naturally worried about how their surgery will heal when in reality things will be just fine. This is the case with most anxious patients, as we discussed in a recent post. However, everyone must admit that sometimes something can go wrong, as with any medical procedure and even in any professional field. It is important to understand that these are the times when you need your surgeon the most. Do not wait for your next appointment. Call your surgeon. If you feel you are having a true emergency, go to an emergency room or call 911. Someone can call your surgeon later to let he/she know what is going on. It is far better to be seen for something that turns out not to be serious than to miss something important. An expert physician must understand how to respond in such unusual situations, and fortunately such doctors are available. The key is handling the situation gracefully, swiftly, and effectively.

The following conditions after eyelid surgery are not normal:

1. Bleeding. Generally any bleeding should cause concern. While it does not take much blood to look like a lot, it is not normal to have any visible bleeding after surgery. It can be caused by a number of reasons, most commonly activity after surgery. If you are experiencing this, call your surgeon, discuss the situation and follow their directions.
2. An expanding bruise in the eyelids. This is generally a sign that you are bleeding inside the eyelid where surgery was performed. Again this is rare but needs prompt attention. Call your surgeon immediately. If you have any trouble reaching the surgeon, go to an emergency room especially if there is pain and changes in vision.
3. Pain that is not relived by the pain medications prescribed for use after surgery. The most common reason this might happen is deciding that you really don’t need to take the pain medicine after surgery. Then hours later, everything wears off and not surprisingly you hurt. At this point, it can literally take two hours for oral pain medicine to return you to a pain free state. While the truth is that many patients truly are comfortable after surgery without medications but not ever one. This is perhaps one of the more common reasons for patients to call after surgery. However, there are situations after surgery where pain breaks through even on the prescribed medications or days after surgery when there should not be any pain. Pain is a very important sign. It might represent a lack of pain medicine right after surgery, an expanding bruise, or days later, the earliest symptoms of an infection. Share your concerns with your surgeon and pick up the phone.
4. Loss of vision. Bleeding behind the eyes can cause permanent loss of vision. This is uncommon, estimated to occur 1 in 300,000 eyelid cases. Prompt steps can save the vision. But immediate attention in necessary. Call your surgeon immediately or 911.
5. New onset pain, swelling, and redness in the area of surgery two or more days after surgery. These can be signs of an early infection. Again, don’t wait for your next visit. Call your surgeon to discuss the situation.

Important but less urgent concerns

It’s normal to experience some bruising and swelling during the healing process, but in rare instances this can be severe to affect the outcome. Severe bruising can lead to excessive swelling, which can stretch the eyelid as it heals and alter the final results. Your doctor can help you understand what sort of bruising is expected and what is excessive.

If your eyes look droopy or heavy after surgery, you are experiencing one of the more common complications of surgery called ptosis or blepharoptosis that occurs when the upper eyelid tendon slips. This can happen if it is cut during surgery, but can sometimes happen on its own, and the effect is intensified by severe swelling. It is very common for the upper eyelids to be heavy after surgery due to swelling. This does not mean that your surgery is a failure. Most commonly this heaviness does resolve over a several week period allowing the lid to return to its proper height with no intervention. In some cases, it may take quite a while for the swelling to resolve. For this reason it is generally a good idea to simply give the eyelid time to heal. Should the heaviness fail to resolve in a 6 to 12 months time frame, corrective surgery is appropriate. Although you may only notice heaviness in one eye, reconstructive surgery on both eyes may be necessary. The eye plastic surgeon will closely evaluate you for a subtle ptosis of the other eye to determine the best method of correcting the eyelids.

Some cosmetic surgery textbooks instruct students of medicine to place the upper eyelid crease too high, and through no fault of their own some new professionals may erroneously follow this advice that they only could have known to avoid through increased experience. It is generally easy to raise a crease, but one made too high can be difficult to lower, and requires the most careful and most experienced of care to resolve through further surgery. It’s best to avoid this situation by finding a doctor who understands that the crease is commonly placed to high, but if you’re reading this now because it’s already too late and you’re unhappy with your surgery, then it’s a good idea to seek the opinion of another doctor who can discuss with you the best action to take next.

Other complications that may arise are having loose skin that does not hold makeup, or having eyelashes that droop downward. These issues can be resolved by properly tensioning the skin and adjusting how much skin is present. This procedure is called anchor blepharoplasty and can be performed under local anesthesia in the office setting. Sometimes, the eyebrows seem to fall after upper eyelid surgery. When you are told about the possibility before surgery, this is an expected effect. The result may be satisfactory or a forehead lift may be needed to reposition the eyebrows. It is post-operative surprises that can erode confidence in your surgeon. An experienced surgery anticipates these types of issues and informs you about them ahead of time. He or she can help you decide if a forehead treatment instead of or in conjunction with additional eyelid surgery is necessary.

It is far easier to correct an underdone cosmetic surgery than undo an overaggressive surgery. One does not need to be made drum tight to have a great surgical result. Think about it, when was the last time you saw a model look like they had stuck their head in a wind tunnel? By optimizing the surgical plan it is possible to have extremely natural results that give no indication that they were achieved by cosmetic surgery.

If your friends and loved ones think you look worse, or you just aren’t happy with your results, or you lack confidence in your current physician, you should seek a second opinion from someone who specializes in correcting previous surgeries. At best the doctor can assure you that things are going fine or repair your relationship with your former surgeon. If early action must be taken to correct a problem, a consultation with another doctor can help you decide what to do. You will get a better feel for what you need when you find a concerned, caring doctor who really makes sense and has demonstrated exceptional ability at resolving issues similar to yours like leading oculofacial plastic surgeon, Dr. Kenneth Steinsapir.

You need a second opinion

Dr. Steinsapir regularly consults with individuals who have experienced unsatisfactory surgery nationwide and from around the world. He can help. In some cases, he can help restore communication with the previous physician. In other cases, you may find you need to move on to an oculofacial plastic surgery skilled in correcting your problem. Dr. Steinsapir specializes in fixing eyelid surgery. Lidlift.com contains a wealth of information about correcting eyelid surgery with before and after photos to demonstrate his skills. Eyelid surgery should be a great experience. If it hasn’t been one for you, we are sorry. The good news is, there is help available from a compassionate, respected, and highly qualified surgeon. Take action today to obtain the help you need. Contact us now for more information.

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January 6, 2010

Can I Use Off-Label Silicone Oil As a Facial Filler?

Filed under: Cosmetic Facial Fillers — Tags: safe facial fillers, silicone oil dangers — admin @ 8:24 pm

The more important question is, should you use off-label silicone oil as a facial filler? You can certainly find someone, somewhere, willing to inject you with any substance for pay, but there is only one U.S. FDA-approved use of silicone oil injected into the human body, and that is to repair complex retinal detachments. This is a medically necessary case that prevents the recipient from going blind.

Technically, since physicians may use FDA-approved products for non-approved uses, you can legally receive silicone oil treatments as a facial filler; but that doesn’t make it a good idea. According to the 1997 amendment to the Federal Food, Drug & Cosmetic Act 6, “Nothing in (FD&C Act) shall be construed to limit or interfere with the authority of a health care practitioner to prescribe or administer any legally marketed device to a patient for any condition or disease within a legitimate health care practitioner-patient relationship.” In other words, since silicone oil is legally and rightly marketed to correct retinal detachments, a doctor can apply his or her best professional judgment to use silicone oil along with any other legally marketed product if he or she believes it can help you. This is called off-label use. This important amendment allows doctors the flexibility needed to provide the best care possible, and as such, ethical doctors are extremely careful and thoughtful when using a product for a non-approved purpose.

Injecting silicone oil into the face and other parts of the body like the buttocks is not a case of careful and thoughtful use. Unfortunately a few non-physicians and even physicians continue to use silicone oils this way, and the FDA has aggressively pursued them. There are lay injectors who travel to hair salons and other unsupervised settings to “treat” those who are ignorant of its proper application and associated complications.

But What If Silicone Oil Is the Only Filler I Can Afford?

First, it is a misnomer to call silicone oil a filler because this is not an approved use. It is instead a bogus treatment that gives good fillers an unjustified bad reputation. When it comes to financing cosmetic procedures, here is the bottom line: if you can’t afford safe, quality treatment from an actual physician (not an assistant, technician, traveling person with unspecified qualifications, the black market, or your own hand), then you are better off without any treatment. Silicone oil injections have too many associated complications, including migration and permanent disfigurement, and a number of people have died from these treatments including, recently, a woman in Florida who died from receiving silicone oil injections in her buttocks. Many black market procedures use industrial silicone oil, which is absolutely not intended for the human body in any circumstance. Black market providers are dishonest by definition, so it is foolish to trust them if they assure you their silicone oil is medical grade – of course they will lie to make a sale, especially if they are outside the walls of a licensed medical office.

Instead of automatically assuming you cannot afford legitimate, trustworthy, FDA-approved fillers, consult a bona fide, fellowship trained cosmetic surgeon to learn about the cost and payment options for a safe, dependable filler. Silicone oil injections are cheap for a reason. Anyone who tells you they are a good cosmetic option is misleading you and omitting the facts. Perhaps they actually believe it what they are doing—they are deluding themselves. If they insist that this is an approved treatment, they are again misleading you, as silicone oil injections are only approved for treatment of retinal detachments. The FDA explicitly discourages their use as a cosmetic filler.

If you are certain you cannot afford treatment, then how will you afford to correct complications, should they arise? The complications are very common. You may know someone who is happy with his or her silicone oil treatment, but this doesn’t mean it’s safe or that you will experience your friend’s luck.

Finding a Safe Alternative

The good news is that several other fillers on the market work better than silicone oil anyway, and a cosmetic surgeon in Los Angeles like Dr. Steinsapir who specializes in noninvasive filling techniques can help you find an appropriate solution. As a physician who cares, Dr. Steinsapir does not believe it is ethical to inject silicone oil as a cosmetic filler. Contact us today for a personal consultation during which Dr. Steinsapir can tell you which facial filler or other treatment is best for you. Dr. Steinsapir only uses the highest quality products with proven effectiveness and FDA sanctioning and never treats anyone with an unsafe product and instead uses reliable, safe fillers like Restylane, Perlane and others. The best filler for you depends on your individual concerns. Contact us now if you have additional questions about silicone injections and how to find a more suitable option for your unique needs.

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January 4, 2010

What’s the Difference between Dysport and BOTOX?

Filed under: Cosmetic Facial Fillers — Tags: beverly hills, Botox, dysport, los angeles, non-surgical facelift — admin @ 8:38 pm

Both Dysport® and BOTOX® are botulinum toxin A products that relax overactive muscles to improve facial aesthetics. But just because these products share a category does not mean they are equivalent. In fact, it’s important to note that they are not equivalent and the FDA does not consider them to be so. To be considered a generic drug that is the bioequivalent of a name brand drug, the generic product and name brand must share a dose and therapeutic effect by 90%. This means that doctors do not have to adjust dose or treatment when switching between the brand name drug and the generic version. This is not the case with Dysport and BOTOX.

The relative strength of BOTOX to Dysport is thought to be about 2 to 4, so they cannot be used in similar doses. Further, Dysport diffuses more widely than BOTOX, meaning that treating one section of the face with Dysport will have a wider effect than treating the same portion with BOTOX. This is not necessarily better or worse – what it means is that BOTOX and Dysport have different applications. We don’t have meaningful evidence that Dysport lasts longer than BOTOX. However, Dysport seems to kick in faster and some people really like this difference. These two products share important similarities, but we must be cautious in differentiating them as well.

Is Dysport Better than BOTOX?

It’s too soon to tell because Dysport only just became available in the United States in mid-2009. So far Dysport and BOTOX seem to be comparable products with important differences outlined above, and Dysport has not demonstrated any clear advantages. We already know BOTOX to be an extremely beneficial product that is here to stay, and we also know that Medicis (the maker of Dysport, Restylane, and Perlane) has consistently created effective products. This said, BOTOX is still the market leader and Dysport will need to prove itself and withstand the test of time.

Some people are holding their breath in hopes that BOTOX and Dysport prices will compete until prices drop considerably. Although there is some competition, we advise you to go ahead and take a deep breath and not expect a drastic change. Introducing a new drug or product to the market is a costly endeavor that requires extensive research, production, and testing. Add to this the cost of an experienced doctor who specializes in these procedures, and we see that cosmetic procedures from the better providers are never going to be significantly less expensive. The advanced and technical nature of the medical field means that good medicine will always come at a premium, if administered safely and as recommended. Since Dysport and BOTOX are not bioequivalent products, the competition between these products is even less direct than some imagine. If you have been waiting for the price of BOTOX to drop sharply, you may be disappointed. BOTOX is still worth as much as it was before, and Medicis still needs to recover the cost of bringing Dysport to the market. Additionally, it is rumored that the price of BOTOX is scheduled to go up in 2010.

Dysport is turning out to be a great product, just as we expected. Doctors are now gaining experience with Dysport and perfecting its use. So…

Should I Be Treated with BOTOX Or Dysport?

Your treatment will depend on the results of your private consultation. Choose a doctor with extensive experience in treating the face with botulinum toxin A products for the best results. Very subtle differences in treatment make the difference between good and extraordinary results, and experience guides doctors in making treatment decisions. While any new product has the disadvantage of a short track record, a doctor with a demonstrable high skill level will know how to best apply the new product and when it’s preferable to use the leading brand.

Dr. Steinsapir trained with the inventor of BOTOX and has performed thousands of BOTOX treatments for over two decades. In this time he has helped BOTOX recipients achieve remarkable results and has pioneered the patent pending Microdroplet^TM BOTOX treatment. As a professional considered among the top BOTOX practitioners, he can help you get the best results from a traditional BOTOX treatment or the new Dysport treatment. Contact us today for an individualized consultation to find out the most appropriate treatment for your unique concerns.

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January 3, 2010

I’m Dissatisfied With my Blepharoplasty Results. What Should I Do?

Filed under: Cosmetic Surgery, Eyelid Surgery — Tags: beverly hills, blepharoplasty surgery, eyelid surgery concerns, los angeles — admin @ 8:11 pm

The first thing you should do if you’re worrying about the results of a blepharoplasty is take a deep breath and ask yourself if you’ve had enough time to heal. It is common for people to feel anxious for the first few weeks after surgery and wonder if they made the right decision. This can lead to excessive worrying which is often unnecessary.

If performed by a skilled and experienced surgeon, eyelid surgery almost always leads to satisfactory results, but it does take several weeks to heal and for the swelling to go away. Most people who worry that their blepharoplasty was a mistake do so before their eyes have had time to heal and before the final results can be seen.

Your surgery should be socially passable after about two weeks, while you may personally be aware of some swelling for two or even three months. After this, you are in the advanced stages of healing, and final results can be seen after six to twelve months.

Three Reasons to Express Concern

There are three general answers to this question. First, your surgeon will be happy to address all your concerns as they arise and will urge you to keep communication open. Usually your concerns can be eased by an explanation of the normal, natural healing process. Before and after surgery, you should openly and honestly discuss your questions with your surgeon to get a good idea of what to expect from the surgery. In this regard, it is appropriate to bring up all your concerns with your surgeon as they arise, noting that it’s important to trust his or her explanations about the healing process, especially if your experiences align with what you’re told to expect. You need time for the tissues to heal and swelling to go down before you can see the full benefits of your blepharoplasty. In the meantime, keep communication open. First and foremost, do not be afraid to tell your doctor what’s on your mind, even if your concern is nothing to worry about, which is most likely. Remember that you have a responsibility to educate yourself and keep your doctor informed about your condition. If you hide the truth from a doctor, how can you expect to be helped? We always encourage you to talk about your experiences and ask questions, even if you suspect your concerns are unwarranted.

These next two instances reflect time when there may be some cause for concern. The second time you should express concern is if you are experiencing excessively dry eyes or trouble closing your eyes, which may not be cause for alarm, but it’s important to tell your doctor about these symptoms. It’s common after any eye surgery, including cataract surgery, to experience dry eyes, which usually return to normal within six weeks. If your eyes are uncomfortably dry, you can treat them with artificial tear drops available at the pharmacy. Talk to your doctor about this to keep the both of you informed. In extremely rare cases, over-aggressive surgery may make it difficult to completely open or close the eye if too much tissue has been removed, in which case revisional surgery may be needed soon.

You can see the final results of your blepharoplasty after six to twelve months. After this time is the third instance when it is appropriate to express concern. Now that you have finished or almost finished healing, you can reasonably think about the outcome of your surgery. Do you like it? Is it what you’d hoped for? What do your closest friends think of the outcome? If you are dissatisfied with the results or hope for more improvement, it is now appropriate to bring these concerns to your doctor.

I’m considering reconstructive surgery. What now?

It’s not obvious to everyone, but the first thing you should do is contact the surgeon who performed the original surgery. A lack of 100% satisfaction does not mean that your doctor can’t address your needs or isn’t skilled enough to solve your problem. There may have been a miscommunication, a rare outcome, or you may be misinterpreting your results. There is probably no one more invested in ensuring that you’re happy with the outcome than the surgeon who originally performed the procedure. Your operative surgeon will be highly motivated to improve your results. This is a mutually beneficial option.

Occasionally, eyelid surgery patients experience a breakdown in the doctor-patient relationship. This can happen in any relationship and, like in any other kind of relationship, the degradation may not always be resolvable or one you are willing to repair. If this is the case, it’s entirely reasonable to seek a second opinion. He or she will be able to continue your follow-up care, monitor your progress, and perform reconstructive surgery if necessary. When appropriate, this new doctor may also facilitate communication with your original surgeon, in some cases restoring a diminished professional relationship back to one of mutual confidence and functionality.

When you are not confident returning to your formal surgeon for whatever reason, seek a fellowship-trained oculoplastic surgeon and member of the American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). These doctors have the most comprehensive training in eyelid surgery and complication management.

The Difference of a Second Opinion

A second opinion can work wonders in resolving problems with an old surgeon or establishing confidence in a new surgeon who can completely resolve the issues lingering from prior surgery. It’s important to recognize that doctor-patient relationship breakdowns are rare and can usually be resolved. However, if you are experiencing a lack of confidence, a second opinion consultation is appropriate. Dr. Steinsapir is happy to provide second opinion consultations. Dr. Steinsapir’s philosophy is to keep communication clear and ongoing while providing close follow-up post surgery to monitor the healing progress. Occasionally, individuals wish to transfer care and not communicate with their original surgeon. This of course is your right. Simply communicate your desire at the time of your consultation with Dr. Steinsapir. Contact us today to find out how Dr. Steinsapir can address your concerns and improve your blepharoplasty experience.

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