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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: , , , , — 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  The closed forehead lift, or endoscopic forehead lift, is just as effective if not more so than the traditional yet outdated open forehead lift, with added benefits:  faster healing time, no long term numbness of the scalp, no hair loss, and no scar arching over the head from one ear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?

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.

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 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?

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, 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.

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.

January 11, 2010

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

Filed under: Cosmetic Surgery, Dr. Steinsapir, Eyelid Surgery, Uncategorized — Tags: , , — 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.

December 11, 2009

Restylane: The Preferred Minimally-Invasive, Non-Surgical Facial Filler

Filed under: Dr. Steinsapir, Eyelid Surgery, Restylane Injections, Under Eye Restylane — Tags: , , , , , , — admin @ 5:00 pm

Dr. Steinsapir regularly uses Restylane in his Los Angeles practice to correct dark circles under the eyes because it has demonstrated time and time again to be more reliable and produce better results than other fillers in most cases.  Restylane is usually a better choice than permanent under-eye filler because the skin and eyelid are very thin in this region.

Under Eye Circles Before and After

Under Eye Circles Before and After

Restylane is easily adjusted after treatment should an adjustment become necessary and it can be done in a non-invasive manner without surgery.  In the rare case that Restylane does not settle right, it can be easily adjusted with just a tiny injection of hyaluronidase, a safe enzyme that breaks down and softens Restylane.

It is unlikely there will be a complication because Restylane’s thickness keeps it from forming lumps the way other fillers sometimes do in the most sensitive areas.  If irregularities do occur, they can be adjusted using the hyaluronidase.  The thickness of Restylane keeps the filler in place in the lower eyelid and upper cheek regions so your results will be long lasting and remain natural looking.  After treatment, Restylane is very effective and usually lasts one to two years.  Because the procedure only requires office based injections and can yields ideal results, many people choose to have periodic Restylane treatments rather than surgery.  What’s best for you will depend on your particular needs based on an evaluation by an experienced doctor.

Bruising

Most people, about 80%, do not experience bruising after a Restylane treatment; the other 20% experience some degree of bruising.  Most of them have mild bruising, but a very few (one or two in a hundred) will form a black eye.  The black eye takes two to three weeks to completely resolve, and this is a cosmetic concern without health dangers.  Considering that Restylane will last over a year, the recovery process is very mild and comfortable even for these few.  The few Restylane recipients who experience bruising usually feel that the short-lived bruise was worth the long-term results.  It’s a good idea to obtain treatment at least three weeks before big events like vacations and weddings just to be completely certain that your pictures will turn out great.

To minimize your risk of bruising, your doctor will ask you to stop taking certain medications that thin the blood, such as aspirin.  If you are taking anything prescribed by a doctor, we strongly advise that you consult with the physician who prescribed it before discontinuing the medication.  If your doctor suggests that you continue the medication, this does not mean that you aren’t a good Restylane candidate.  If you are willing to be at a slightly elevated risk for bruising, Restylane can fill in the hollows under your eyes very effectively.  Your regular doctor and your cosmetic specialist can help you decide the best route to take.

What If I’m Pregnant or Breastfeeding?

There is no foreseeable complication that could be caused by Restylane, a naturally occurring sugar gel.  It has proven itself to be very safe.  The problem with using it to treat pregnant and nursing women is simply that we have no clinical information regarding the safety of this product in pregnancy and during lactation.  Could Restylane cause a problem for your baby?  This is unlikely.  The sugar gel in Restylane occurs naturally in the body.  Many medications and treatments are not advised for pregnant and breastfeeding mothers simply because they have not been tested, and probably will never be – this does not mean that they’re not safe.  It simply means that ethical practitioners recommend that you don’t take any chances when it comes to untested situations.  We recommend you wait until you wean your baby before undergoing cosmetic procedures.   Fortunately, babies do not nurse forever, so you won’t have to wait too long for the long-lasting benefits of Restylane.

My Eyes Are Sensitive.  Can I Still Benefit from Restylane?

This may sound paradoxical, but depending on the sensitivity you may be especially qualified for Restylane.  If you have allergies, the likelihood of a reaction is extremely small but not quite zero (there is always some risk of a reaction to any medical procedure that introduces something new into the body) and can best be assessed by an oculoplastic surgeon.  If your eyes are sensitive to things like hay fever, for example, and they become irritated or red easily, this aggravation may accentuate the hollows under your eyes.  If you know you are prone to this appearance, a filler like Restylane will be very helpful, because during times of sensitivity, your eyes will look much better with treatment than without it.

Recovery Time

Many of Dr. Steinsapir’s patients resume their normal activities just after leaving the office.  If you don’t bruise, there will be about thirty to forty hours during which you experience minimal swelling.  Many patients, both men and women, can hide this swelling right away with a camouflage makeup that matches their skin color.  If your lower eyelid skin quality is poor and you often collect a small bag of puffiness under the eye, the doctor may counsel you regarding the need to consider a procedure like a chemical peel or surgery prior to getting regular filler treatments so that you don’t experience prolonged recovery after each filler service.  This can be discussed when you have your initial consultation.

Can I Combine Restylane with Another Procedure?

Yes.  Restylane can be safely combined with many procedures.  Discuss your concerns with your physician.  He or she will advise you about which procedures compliment Restylane treatments.  Your doctor may advise you to come in on another day for certain procedures that are especially sensitive to changes in the treatment area, but there are many cases when Restylane can be appropriately combined with another procedure at once.  Restylane is a simple outpatient service that can be done while you’re fully awake in the office after numbing cream has been applied to the treatment area.

Consult with a Doctor Who Cares

Dr. Steinsapir invented and published the Deepfill™ method for placing Restylane®. Deepfill™  method is used by thousands of doctors around the world to inject Restylane® safely in the under eye area.  This method adds precision and certainty to the placement filler in this location making this minimally invasive method a true alternative to lower eyelid surgery for many people.  Dr. Steinsapir is one of very few cosmetic surgeons who dedicate a major focus of his practice to treating dark circles and under eye hollows, making him particularly experienced and qualified as a specialist.

Contact us today for a personalized consultation with a caring physician who individualizes each treatment based on your specific concerns.

December 9, 2009

Am I A Candidate For Asian Double Eyelid Surgery?

Filed under: Dr. Steinsapir, Eyelid Surgery — Tags: , , , , — admin @ 11:42 am

“Double eyelid” is applied to describe Asian eyelids where there is a defined upper eyelid fold above the eyelashes with and exposed eyelid platform.  There is great variation in eyelids and not every eyelid has a double fold.  The fold is created by a crease at the top of the eyelid platform under the fold.  This crease represents a defined attachment between the eyelid skin and the tendon that raises the upper eyelid.  The Double fold creates definition in the upper eyelid and it is generally considered desirable in both men and women.  For women, the defined platform also creates a protected place to apply make up and further beautify the eyes.

Asian Double Eyelid Surgery Before and After

Asian Double Eyelid Surgery Before and After

Will Asian Double Eyelid Surgery “Westernize” My Eyes?

Double eyelid surgery is not about westernizing the eyes, which is a common mischaracterization.  Both the double eyelid and its absence are common in Asian people.  Some people who don’t have a double eyelid wish to obtain one, but they worry that this means they have to “westernize” their appearance.  This is not an accurate depiction although this was how the surgery was characterized in the past and is sometimes described in articles where the writer does not understand the purpose of the surgery.  Double fold surgery aims to create a natural appearance by creating a well defined upper eyelid fold.  This is accomplished by creating a low crease and removing a small amount of skin, while leaving the rest of the eye’s natural appearance intact.  Unfortunately, there are practioners who make the crease too high and take too much skin and this type of poorly designed surgery can harm the appearance.   The key is to go to an very experienced eyelid surgeon who has thoroughly mastered the procedure and understands what needs to be accomplished.  The goal is the conservation of normal eyelid structure while providing complementary eyelid definition in accordance with what you desire your eyes to look like.

Creating a Double Fold

There are two basic ways to create a double fold.  Suture methods are common in Asian countries and utilize temporary stitches to that make an upper crease.  The threads always eventually fail, which means that they are not the best option for those seeking permanent.
In double eyelid surgery, the doctor removes some tissue to form a defined crease in the eyelid at the top of the eyelid platform.  It is a critical goal of the surgery to maintain the essential Asian character of the upper eyelid while at the same time adding an eyelid crease to form a defined upper eyelid fold.

Many of these surgeries can be performed in the office under local anesthesia.  Recovery is about 10 days before all bruising and most noticeable swelling has resolved.  Most stitches are removed at 1 week for most individuals three tiny stitches are left at the crease for about 3 weeks to help make a permanent crease.  By about 10 days after surgery most people will not be aware that you just had surgery.

What If My Eyes Are Small?

An eye’s size is usually measured by how much of the white area, otherwise known as the sclera, can be seen.  Eyes that appear small may be the result of upper eyelid ptosis, or “droopy” lids, or they may mean you have deep set eyes.  Depending on your condition, the surgical approach will vary.  Often the double eyelid surgery makes the eyes appear larger by adding definition and naturally framing the eye with aesthetic contours.   As always, the best approach is a flexible one that relies on a careful physical examination and weighing the options to choose the best method.  There is no standard surgery or procedure for small eyes – surgery must always be adapted to the individual circumstances.

What about My Other Asian Eyelid Concerns?

If you are worried about other issues including asymmetry or a tired look, these are again best addressed on an individual basis.  All aesthetic reconstructive eyelid surgeries must be tailored and adapted for the unique characteristics of your eyelid.  For this reason, it’s best to find a doctor who specializes in eyelid treatment and who has helped people with widely varying eyelids obtain the best possible results.  There are certainly procedures besides the double eyelid surgery that may be right for you and a doctor who understands the anatomy and variations in Asian eyes will be able to help.

Taking the First Step

Now that you know a bit more about double eyelid surgery and Asian eyelid surgery, call for a consultation rather than try to make sense of all the information and misinformation on the internet.  Remember, a consultation does not obligate you to go through with any procedure, and it will give you an excellent opportunity to seek personalized advice from an experienced professional.  As a specialist, Dr. Steinsapir has extensive experience with oculoplastic surgery and has helped many people obtain their desired results.  Contact us today for an individualized approach that will help you realize your personal goals.

How Can Lower Eyelid Surgery Improve My Puffy Eyelids and Under-Eye Circles?

Filed under: Dr. Steinsapir, Eyelid Surgery — Tags: , , , — admin @ 11:14 am

In our last post, we discussed upper blepharoplasty or upper eyelid cosmetic surgery and its benefits in solving particular cosmetic concerns. Lower blepharoplasty or lower eyelid cosmetic surgery (also known as lower lidlift) has its own set of indications and can vastly improve many lower eyelid or under-eye problems. By removing excess fat, skin, or both on and around the lower eyelid, lower eyelid surgery can eliminate bags under the eyes by correcting problems caused by excess and unsightly skin, muscle, and tissue.

Lower Eyelid Surgery Before and After

Lower Eyelid Surgery Before and After

Transconjunctival blepharoplasty, or tranconjunctival lower eyelid surgery, is the preferred lower eyelid procedure, although what is best for you depends on your particular situation. Transconjunctival blepharoplasty improves the contour of the lower eyelid by correcting herniated orbital fat trapped beneath the eyelid, causing a ‘puffy’ look. This approach uses an incision made behind the eyelid to avoid scaring the eyelid skin or altering the eyelid margin. With an incision from behind the eyelid, unwanted results can be more easily avoided with the utmost precision. Removing this excess fatty tissue will give you a softer, more alert and interested appearance.

Often the puffy lower eyes are confounded by two problems: as previously addressed, excessive herniated orbital fat under the lower eyelid gives this area an inflated look, while the sagging of the cheeks caused from age, stress, or genetics creates a hollow that exaggerates the appearance of swelling or circles under the eyes. Having both these concerns simultaneously means that each problem exacerbates the other; hollow under-eyes make the lower eyelids look even more overly full, while full eyelids makes the under-eye hollows stand out. This compounded problem can be resolved with a procedure called arcus marginalis release, which takes the transconjunctival blepharoplasty one step further. The lower eyelid fat is used to make a living fat graft with its own blood supply. This pedicle of tissue is rotated into the top of the cheek where there is hollowness. This is done through a small incision at a condensation of tissue known as the arcus marginalis. The acrus marginalis release corrects problems of both excessive eyelid fat and the hollow or circle that develops in many of us at the top of the cheek in a single procedure with no skin incision. Like other forms of fat transfers, this procedure is very safe because the body cannot reject its own natural cells. However, unlike other fat transfer procedures that need to develop their own blood supply, the fat from the lower eyelid already has its own blood supply making this transfer of volume highly dependable.

During a lower eyelid procedure, your surgeon’s goal is to correct these problems and aim for a natural, symmetrical look. Your surgeon will take care to remove and/or transfer just the right amount of fat, taking special care to not remove too much, because it is easier to remove more fat later than add it back.

The lateral canthal angle, which is the outer eye corner, may be used as a point of access to perform different procedures. If you are dissatisfied with your lateral canthal angle, this may be a good time for the surgeon to improve it. Dissatisfaction of this anatomic feature is usually caused by prior eyelid surgery. With canthoplasty the surgeon can tighten the lower eyelid and also reconstruct the lateral canthal angle adjusting unsatisfactory issues like a position that is too high or too low. By controlling the shape and position of this corner with precision, an experienced oculoplastic surgeon can attain the desired results.

Improved Methods

Years ago, it was popular to perform related procedures through an incision made just below the lower eyelid lashes. Unfortunately this method sometimes damaged the lower eyelid muscles and created scar tissue. The good news is that the introduction of transconjunctival lower blepharoplasty many changes associated with old style lower blepharoplasty can now be avoided. What does this mean for you? If you are worried about problems you’ve heard are associated with lower eyelid surgery, these are likely the results of older methods that are completely avoidable through more appropriate methods available today. Professionals like Dr. Steinsapir have extensive experience performing transconjunctival lower blepharoplasty, enabling them to obtain the desired eyelid improvement with a significantly reduced risk of complications.

Combined Procedures

Many eyelid procedures can be combine with other facial surgery such as a facelift or forehead lift. Most oculoplastic surgeries can be performed under local anesthesia or local anesthesia augmented with intravenous sedation. Dr. Steinsapir performs many of his surgeries at the UCLA Medical Center Outpatient Surgery Center. Many eyelid procedures can be performed under local anesthesia in the office setting. The doctor will discuss with you the appropriate setting for your surgery. Receiving a chemical peel at the time of lower eyelid surgery is often a fantastic option that will improve your results. Often lower eyelid wrinkles are the result of a combination of fullness and skin laxity. A chemical peel firms the skin and together with fat removal from surgery, the results is improved lower eyelid rejuvenation. A skin pinch is sometimes used as an alternative to the chemical peel in the right circumstance.

Personalizing Your Results

Because no one has eyes quite like your own, a one-size-fits-all approach simply will not do. This is why consulting a doctor who has worked on a diverse range of eyelids will be most informative and yield the best results. Dr. Steinsapir is such a doctor who has improved many combinations of eye concerns. He specializes in minimally invasive techniques and is exceptionally adept at performing corrective procedures. He has developed an number of surgical techniques and treatment methods. His specialization in treating the eyelids is supported by multiple fellowships, residencies, professorial positions, published papers, and of course extensive experience. Dr. Steinsapir never turns over his work to nurses or “physician extenders,” ensuring that you receive the best treatment possible. Contact us today for a consultation to discuss your specific concerns and learn how Dr. Steinsapir can help.

November 30, 2009

Upper Eyelid Surgery Can Correct Many Problems

Filed under: Dr. Steinsapir, Eyelid Surgery — Tags: , , , — admin @ 5:25 pm

There are a number of good reasons to seek upper eyelid surgery and clients have come to Dr. Steinsapir with a wide variety of concerns.  Some have visual problems caused by ptosis, normally referred to as droopy eyelids, which gives not only the appearance of advanced age and sleepiness but can also impair vision.  Others have concerns about asymmetry, side effects of problems like lazy eye, and other conditions.  Some wish to look younger and more alert seeking to correct their tired, puffy, small, or droopy eyes while still others may be dissatisfied with previous surgeries.  Some wish for the eyes to appear larger or for an improved double fold crease above the eyelid.  Whatever your concern, it is important to learn about how different procedures can help your particular situation.  By reading this article you will have begun this education.  Congratulations on taking this important step!

Which Procedure Do I Need?

Due to the individual nature of each human eye we cannot over-emphasize the importance of an individual consultation.  Learning about different procedures is a good place to start but it is common for people to misjudge which procedures will be most beneficial.  We’ll go over some procedures in this article to help you understand how to approach and understand your doctor, but remember that no online reference can provide the insights you might receive during a personal consultation with a specialist like Dr. Steinsapir, a Fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Blepharoplasty, also known as the eyelift or eyelid surgery, can vastly improve the aesthetics of your entire face by focusing on improving the appearance of the eyes.  In this procedure, your surgeon will remove excess skin and fatty tissue that make your eyes look droopy, inflated, or otherwise less than optimal.  After surgery, patients presenting this concern appear younger, refreshed, and more lively.  The benefits are often more than simply aesthetic; removing this excess tissue frequently improves peripheral vision that was previously blocked, hampering the individual’s full visual capacity.  Some insurance plans cover blepharoplasties that improve your vision but generally only when the axis of vision is blocked by eyelid tissue.  Most of us can’t afford to wait that long for surgery if we want to be taken seriously in a social setting.

Other forms of eyelid surgery or filling methods may be appropriate depending on your needs. Some people who are dissatisfied with the appearance of their eyes may actually benefit most from a midface or forehead procedure.  This can be surprising to someone whose primary concern is their eyes, but when they learn about how the entire facial anatomy interacts with the eyes, they see how other procedures can open up or otherwise improve the eyes.  In this article, we focus on those for whom upper eyelid surgery is the best option – however, you should be open to the possibility that a different procedure may be more suitable to your unique needs and can immensely improve the appearance of your eyes.

A Delicate Procedure

The eyes are perhaps the most important feature on the face because they enable us to see the world.  We also use the eyes, the eyelids, and the eyebrows to communicate how we are feeling. The eyes are extremely important in what makes a face interesting and attractive. This attractiveness is generally not as subjective as many would like to believe, but rather stems from a deeply in grained need to scan the face and eyes for evidence of interest, health, and other aesthetic concerns. An eyelift helps improve our eyelid structure to help restore an appearance of youth and friendly interest.  Getting a natural result that achieves these goals requires a surgeon with experience in performing eye surgeries successfully and with finesse.  Upper eyelid surgery is a safe procedure that yields great results, which are maximized when performed by a highly experienced and respected oculoplastic surgeon.

Because the fine details of the eye are so important in this particular procedure, surgeons who specialize in treating the eyelids will be able to give you the best results. Your doctor must balance numerous factors at once, accounting for the dynamic nature of the face and the surrounding muscles and tissues that surround and protect the eyes.  During an eyelid lift procedure, it is especially important to preserve and in some cases improve the upper eyelid fold since the placement and shape of this crease can give feminine or masculine qualities to the face.  For example, in women the crease is naturally about eight millimeters above the eyelash.  A surgery intending to create or improve this crease requires an incision about six or seven millimeters above the eye, which will heal to a height of the ideal eight millimeters.  Such precision is very important in obtaining the best possible results.

The eyelid platform skin needs correct tension to maintain the upward tilt of the eyelashes.  A talented oculoplastic surgeon can do this and more with precision, while performing the blepharoplasty so that the brain communicates with the face correctly.  This will restore your facial features to their optimally functional and most attractive state.  An experienced oculoplastic surgeon also understands how the forehead interacts with the eyes to give you the best results.

Do not let the complexities of eyelid surgery deter you from pursuing treatment.  Consider yourself informed and better equipped to find your ideal surgeon.  Qualified surgeons can balance all these dynamics with precision, expertise and insight to give you the results you desire.  When seeking a doctor look at the doctor’s before-and-after eyelift photos for an indication of his or her abilities.

What to Expect

Before surgery your doctor should examine you and ask about your medical history, giving special attention to your eyes.  With the information gleaned from a consultation and examination, your doctor will meticulously plan the most appropriate procedures, detailing how to execute them with exactness catered toward your particular case.  The doctor should spend time talking with you about your needs and treatment goals.  This way, you will both know exactly what to expect from whichever procedure you agree is ideal.

Your doctor will help you understand what to do and expect before, during, and after surgery.  Before surgery, he or she will instruct you to avoid certain medications and herbs.  Upper blepharoplasty complications should be unusual, and eliminating a few substances that can affect blood clotting will make the surgery even safer.  If there are certain medications you must take for health reasons, your doctor will be able to answer your questions about whether this will affect your surgery and healing and together you can discuss the best course of action.

Upper eyelid surgery is a remarkably comfortable procedure that is best done under local anesthesia.  General anesthesia is not advised because the best and most precise results require the patient to cooperate with the surgeon during surgery by opening and closing his or her eyes when prompted.  This helps the doctor to see how the surgery is working and the precise actions needed.  The surgery will not hurt and you will likely feel relaxed and comfortable.  It may take 1 to 2 hours, which is a good indication that your doctor is working with care and precision. It can take up to twenty or thirty minutes to perfectly mark the upper and lower lines of the procedure before proceeding.  A doctor who works slowly is applying the thought and attention that yield the best results instead of taking a one-size fits all approach.

Your doctor may advise you to refrain from certain strenuous activities while you recover.  Generally patients feel ready to return to work and social activities after seven to ten days, when their swelling is minimal and they’re feeling great.  Many lidlift patients report that they need no or minimal painkillers after surgery because they feel so comfortable.

Combining Surgeries

Because eye surgery is such a detailed procedure that requires localized anesthesia, it is usually not advised to combine it with procedures that may temporarily alter the appearance of your eyes, compromise your ability to cooperate during surgery, or require that the doctor work on a tight schedule.  Because the first hour of anesthesia tends to be the most expensive one, it can be tempting to opt for the “blue plate special” but we advise you to reconsider.  Having only the necessary eye procedures performed at once will help you and your doctor see precise results.  Your doctor will talk with your regarding what surgeries are appropriate to combine.

Seeking a Consultation

Some people are nervous and put off seeking a valuable eye surgery because of the fear of the unknown.  This concern is understandable and may be lessened or even eliminated by simply consulting with a surgeon.  Once you talk to the doctor and learn more about how he or she can help and what to expect, you may find that your worries diminish.  The unknown can be frightening – once you connect to a real, live doctor in whom you feel confident, you’ll likely feel much better.

Dr. Steinsapir is renowned for his experience, talent, and insight in performing eyelid surgeries.  He specializes in minimally invasive oculofacial surgery and is respected as one of the top eye plastic and ophthalmic microsurgery experts in Los Angeles.  Dr. Steinsapir has completed multiple fellowships that make him particularly qualified to perform the most delicate upper eyelid procedures.   He is an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, David Geffen School of Medicine at UCLA. Dr. Steinsapir offers the personal time, talent and precision necessary to give you the best results.

Remember that a consultation does not mean you have to commit to surgery if you still feel uneasy.  There is no harm in seeking more information, so contact us today for your personalized consultation.

November 24, 2009

How Can Fat Transfers Correct My Undereye Circles, Hollow Cheeks, and Sunken Features?

Filed under: Cosmetic Surgery, Dr. Steinsapir — Tags: , , , , — admin @ 10:09 pm

Some people are born with naturally full faces, while others may have a sunken face, particularly around the eyes and cheekbones. For many people, what was once a youthful, full face develops volume deficiencies due to aging and gravity. The cheeks may begin to droop, creating circles under the eyes and hollowness in the midface. Fat transfers are an excellent solution for correcting volume and contour issues, as they are completely natural and come from your own body, making them biologically safe. Fat transfers are often complimented by other procedures, such as eyelid surgery and lower face and neck lifting.

fat transfer before and after picture

How Do Fat Transfers Work?

Fat transfers, also called fat grafting and fat injections, soften facial features by correcting facial deficiencies. Fat is harvested from another part of the body, such as the abdomen, buttocks, or thighs – the harvest site depends on the recipient’s individual needs. Harvesting can be done through local anesthesia and may improve the shape of the harvest area. This is done with remarkable comfort. The harvested fat, which may be called fat pearls, are living grafts from your own body. These are transferred into regions of the face through very small cannulas and a tiny poke in the skin. These sites heal without a scar. Approximately 70% of the transferred fat survives creating long-term benefits. The fat is delivered very precisely using as series of specially shaped microcannulas designed specifically for this purpose. The amount of fat injected depends on the shape of your face and the volume of the deficiencies. The fat is usually placed under the subcutaneous fat already present just under the surface of your skin or adjacent to the facial musculature according to the FAMI technique based on the surgeon’s artistic judgment, so the ultimate results appear completely natural.

Fat injections are safe because your body cannot reject the transfers or have an allergic reaction to them. Since this procedure uses your own fat cells, the body accepts these transfers as a biological match.

When Do I Need Fat Transfers?

There is no universal answer to this question. You will need an individual consultation to find out which filling method(s) are most appropriate. Juvederm and Restylane injections may be appropriate, but if they don’t get the job done or are inappropriate to your needs, then fat injections may be an alternative. Fat grafting is an excellent choice when the face needs more volume than can be practically done with the other facial fillers. Fat grafting can be particularly helpful in areas like the midface, cheek, jawline and brows. If you have areas of hollowness in the cheek and bags, circles, or sunken areas around the eyes, you may be an excellent candidate for fat transfers. If your face looks hard and aged rather than soft and full, fat transfers may benefit you. The required procedure depends on many factors, such as the natural shape of your face, the thickness of each region of your skin, how much soft tissue is present, what kind of deficit you have, and of course the unique needs of your face. In some cases more than one filling method may be appropriate. Only an experienced surgeon who specializes in improving facial aesthetics will be able to tell you for sure. Ultimately, there is no substitute for a personal consultation.

The Healing Process

People receiving facial fat transfers see results right away but it is important to remember that swelling and bruising after treatment is normal. Typically the bruising lasts about 10 days and most feel ready to return to work at that point. Swelling of some degree may persist for several weeks. A key to peace of mind after your procedure is to allow yourself time to heal. Fat pearls and fat transfers naturally heal with a somewhat lumpy firmness. You will notice this when you feel the treated locations with your hands but it is unusual to see the processes at the skin surface. This is most noticeable at weeks 4 to 6 and then gradually resolves. Typically by four months this firmness as completely resolved.

Your doctor will go over the healing process with you and help you understand what to expect. Although you are bruised after surgery, you will find that you are remarkably comfortable. Downtime is usually about 10 days, although certain activities, such as intense contact sports should be avoided to 2 weeks.

Since fat pearls and fat transfers are 100% natural and come directly from your own body, the transfer region will accept the new cells with results that typically last longer than other filling methods.

There Is No Substitute for Experience

Fat transfer can be a fantastic procedure and with the right surgeon there is no reason it shouldn’t be. Facial fat transfers require precision, insight, and attention to detail. Benefit form Dr. Steinsapir’s exceptional experience and skills. Call for a consultation today and find out how you can rejuvenate your appearance.

November 22, 2009

BOTOX® Is the Answer to Smoothing Facial Lines Without Surgery

Filed under: Botox Los Angeles, Cosmetic Surgery, Dr. Steinsapir — Tags: , , , , — admin @ 10:05 am

For those seeking a rejuvenated, youthful appearance of the eyes and forehead without undergoing surgery, Dr. Steinsapir’s minimally-invasive Microdroplet™ BOTOX® technique is perhaps the best solution to date.

How BOTOX Helps

We use our faces every day to communicate with others. If you laugh, frown, or make an angry face in front of a mirror, you will probably see lines appear on your face. Dynamic lines – those that appear when we smile, laugh, become angry, and so on – are very important to nonverbal communication and these natural lines are vital to self-expression. However, you may still see some lines present when you relax your face. This is because years of making facial expressions and environmental stressors can cause lingering imbalances in our skin. We may end up with unwanted worry lines, forehead wrinkles, or frowns etched into our faces, known as static lines, which cannot be remedied through use of over-the-counter “miracle” products and creams. Fortunately for those who don’t want surgery, BOTOX® is a natural protein treatment that relaxes the muscles responsible for the static lines on the face and improves aesthetics by helping the face return to its softer, relaxed, youthful look.

BOTOX® can also be used as a preventative measure for younger individuals who wish to retain a youthful appearance, reduce facial lines and prevent forehead wrinkles and frown lines from occurring before their first signs. No matter how well we take care of ourselves, even the healthiest, most care-free individuals can end up with these lines. It may be beneficial to think about how BOTOX® can prevent the signs of aging so that you don’t have to worry about them later in life.

Is BOTOX a Safe Treatment?

Many potential candidates wonder about the side effects of BOTOX®, but it is a safe procedure that involves injecting drops of highly purified protein into areas of the face. A skilled physician can use BOTOX® to relax the muscles that create unwanted static lines and often improve or eliminate them while still allowing you to retain your ability to make a range of expressions, including the Duchenne smile, which occurs naturally when we are genuinely happy. The stereotype that BOTOX® commonly causes the face to “freeze” is inaccurate and originates from misuse of the procedure. BOTOX® is in fact completely customizable to the needs of your particular appearance. Because BOTOX® works on individual muscles, an experienced physician administers the correct amounts of BOTOX® to the appropriate muscles and the results are entirely predictable.

Most people notice that their face appears more youthful, relaxed, and natural after BOTOX® treatments. They see a younger version of themselves looking back in the mirror. In smoothing facial lines caused by stress, BOTOX® patients no longer look perpetually worried and are still able to nonverbally communicate what they truly feel.

An Innovative, Tested Approach

Dr. Steinsapir has invented Microdroplet™ BOTOX® to address the need to retain authentic facial expression and natural eyebrow placement. Where standard BOTOX® procedures work great, Microdroplet™ BOTOX® works even better. If you have had BOTOX® treatments in the past but were not satisfied, Microdroplet™ BOTOX® can give you the results you need by working with greater precision with your facial muscles. The care and interest Dr. Steinsapir has shown in inventing this treatment demonstrates his dedication to achieving a beautiful, youthful appearance without impeding the ability to express emotion.

Don’t Wait to Improve Your Facial Lines

Simply stated, BOTOX® improves facial lines. To find out how BOTOX® can improve yours, contact Dr. Steinsapir today to personally ask questions and discuss your particular needs and concerns. At an individualized consultation, you can find out how Dr. Steinsapir caters his expertise and experience to the needs of each individual and he can tell you more about how lines affect your unique face.

November 8, 2009

Why Do We Seek Cosmetic Surgery?

Filed under: Cosmetic Surgery, Dr. Steinsapir, Psychology of Cosmetic Surgery — Tags: , , , , , , , , , — admin @ 11:24 pm

As a cosmetic surgeon devoted to aesthetic and aesthetic reconstructive surgery, I often find myself analyzing what motivates my patients to desire and ultimately have cosmetic surgery. In this “Makeover” world we now inhabit, it is easy to suggest that the reason men and women get cosmetic surgery is to increase self-esteem. This fits the American story line of hard work and self-improvement. However, accepting this explanation pushes aside important questions that commonly get overlooked – Why is it that the overwhelming majority of people having cosmetic surgery are women? Do surgeons really understand why people seek cosmetic surgery? How do surgical paradigms affect the outcome of a surgery? How do neuroeconomics play a role in influencing decisions to have cosmetic surgery? In the following article, I present some important psychological and cultural aspects related to why we seek cosmetic surgery.

FLESH WOUNDS

According to the American Society of Plastic Surgeons (ASPS), over 12 million cosmetic procedures were performed in the United States last year. This represents an increase of 40% over the number of procedures done in 2000, despite the economic recession. One of the reasons why cosmetic surgery has become so popular is in part because it provides an accessible if not always affordable mean to reinvent one’s self. To use the term coined by author Virginia Blum (Flesh Wounds: The Culture of Cosmetic Surgery), we are all “surgical”-potential consumers of cosmetic surgery. Blum suggests that all features become categorized into those that need and don’t need surgical work.

One important fact to note from the ASPS statistics is that 91% of the total cosmetic surgeries in 2008 were performed on women. It is interesting to know that there exists a reverse gender imbalance in the world of cosmetic surgery, where men make up for 91% of the cosmetic surgeons and women make up 91% of patients undergoing cosmetic surgery.

GIRL POWER

The feminist drive for equality and empowerment has somehow gotten translated into “girl power” where equality is transformed into sexual aggressiveness in the media. It is difficult to argue that shaving one’s genitals, having breast implants, and pole dancing represents equality and empowerment. Yet for girls and young women this is the message from mainstream media. Female agency is co-opted by commercial representations where sex is used to power consumer demand. Consider the 145 million Bratz dolls that have been sold to preteen girls. These skanky dolls are marketed to six year olds and the junior version, Bratz babyz, to 3 year olds. They make Barbie with her anorectic proportions look down right wholesome. This isn’t just a method of imposing heternormativity on our children. No, this “sexualized too soon” message, what Sociologist Brian McNair describes as the “pornographication” of everyday life sells.

Kids in the United States are exposed to 8 hours of media each day. It is no wonder that girls as young as 6 ask their parents if they are too fat and complain that they are not sexy enough. This demonstrates how this phenomena compresses into childhood. Teachers report an increasing intensity of gender separation between young boys and girls with girls focused on princess culture and femininity and boy on fighting and violence.

Rosalind Gill, a lecturer in gender and media studies at the London School of Economics, has analyzed the way a woman’s sexuality is manipulated in contemporary advertising. Advertisements today represent the empowerment of women by showcasing assertive women who make a statement with their sexual power. Gill argues that we are witnessing a shift from sexual objectification to sexual subjectification, where women today are being presented as knowing and active sexual subjects. To deal with the fierce feminist attitude observed in young women who oppose being portrayed as sexual objects, the advertising world has stealthily constructed a new femininity, which is built around sexual confidence and autonomy. This new construct “girl power” lures those same young women to accept themselves as sexual subjects. The contemporary sexualized representations of women in media and popular culture, unlike in the past, does not depict women as passive objects but as desiring and glorified sexual subjects, so that that activities such as cleaning a toilet with a disposable brush, buying yogurt, and wearing stiletto heels are portrayed by media as self-actualizing personal choices. So instead of the lean, well dressed, apron clad homemaker greeting her suburban husband at the door with a home cooked dinner on the table, advertisements are now assembling the young, narcissistic, sexually assertive, “always up for it”, lean, tattooed, pierced woman who plays with her sexual power. Gill suggests that these images represent a shift from the objectification of women by the male gaze to the subjectification of women.

UNTOUCHABLE

Sandra Bartky, Professor of Philosophy and Gender Studies at the University of Illinois at Chicago has said “Feminine bodily discipline has this dual character: on the one hand, no one is marched off for electrolysis at the end of a rifle, nor can we fail to appreciate the initiative and ingenuity displayed by countless women in an attempt to master the rituals of beauty.” However, the standards for feminine appearance are becoming increasingly unattainable. For example the singers Christina Aguilera and Britney Spears during their pregnancies were featured on the covers of Marie Claire and Harper’s Bazaar respectively -literally and figuratively as new Madonnas. No woman could hope to emulate the perfection Photoshopped into these magazine covers.

Please watch the movie at: http://www.youtube.com/watch?v=hibyAJOSW8U

In return for access to celebrities, fashion magazines now routinely turn over complete control of the photography to the celebrity who employs design staff for the purpose of adjusting the images to their liking in the photographic manipulation program Photoshop as illustrated in this Dove Self-Esteem Campaign movie. Not only are the celebrities and models attractive in their own right, their photographs are retouched and their features enhanced. Yet their published images define sociocultural standards for appearance that many women feel they need to attain. This is also occurring with male models and celebrities but the social pressure is less intense for men.

This is what Naomi Wolf described as the “beauty system.” Second wave feminists have referred to women who attempt to discipline themselves to comply with the social norms of femininity portrayed in the media as “cultural dopes.” While it seems innocuous when a mother takes her daughter to have an ethnic nose refined by rhinoplasty at age 16, it is much more troubling when a mother takes her daughter of the same age to the plastic surgeon for breast augmentation or female genital cosmetic surgery. The American Society for Plastic Surgery reported that 18 and 19 year olds made up 3 % of all breast augmentation surgeries last year. Cosmetic surgery on children under 18 years of age constituted 5% of all cosmetic procedures in 2008.

EXTREME MAKEOVER

Wheeler Dixion writing last year in the Quarterly Review of Film and Video argues that the perfect body and face “is becoming the ultimate status acquisition of the 21st century.” One might ask if shows like I Want a Famous Face, The Swan, and Extreme Makerover have increased consumer demand for cosmetic surgery. Anecdotally, surgeons feel that they have. However, objective studies are harder to come by. Robin Nabi reported her study this year in the journal, Human Communication Research, that these shows, with the exception of I Want a Famous Face, are associated with a small increased interest in cosmetic surgery. I Want a Famous Face highlighted the risks associated with cosmetic surgery and viewing this show was associated in this study with an increased perceived risk of having surgery. Meredith Jones observes that these shows pull back the curtain on the “during” that is normally removed from before and after pictures.

Feminists have increasingly accepted that cosmetic surgery is not going away. Quoting Kathy Davis, a medical sociologist, who studies cosmetic surgery: “It opens the possibilities for biographical reconstruction and opportunities for women to redefine their sense of self.” Susan Paulson and Carla Willig writing last year in the Journal of Health Psychology found that the concerns of women ages 58 to 80 regarding their appearance are related to loss of social relevance and fears of disappearing. In contrast men of a similar age are more concerned with how they function. These women operate with a frame of mind that the aging body represents a mask over the inner younger identity. Some older women reject cosmetic surgery as too radical or dangerous. Screenwriter Nora Ephron in her collection of essays “I feel bad about my neck,” summarizes her concern about being overdone by plastic surgery writing: “ I learned the hard way that just because a doctor was a famous surgeon didn’t mean he had any gift for sewing people up.”

THE NEW NEW FACE

As boomers age, marketers have found glamorous aging celebrities to take up the cause of maintaining appearance. Actresses such as Diane Keton and Susan Sarandon were chosen for the L’Oreal Age Perfect campaign because it could be plausibly implied that they have maintained their appearance without cosmetic surgery. Whether they have or have not had surgery is irrelevant. Who needs surgery when a little Photoshop magic can make you look thirty year younger as can be seen when comparing magazine cover images of Sarandon with images taken at the same time without the benefit of Photoshop.

Meredith Jones in her article “Mutton cut up as lamb” notes that the emphasis on youth culture means a decline in the value of the elderly. In this formula, youth equates to beauty and aging to ugliness. She describes cosmetic surgery as an increasingly essential “toolkit” to maintain a stretched middle age or “agelessness.” This is what I call designer aging, a process eloquently described by Jonathan Van Meter in his August 2008 New York Magazine article where he define the “New New Face.”

Jones contends that women have only two choices: actual youthful beauty or youthful verisimilitude. Trying to appear youthful is almost as important as being youthful perhaps justifying surgical and non-surgical treatment effects that generously are idiosyncratic in their results or less generously hideously unnatural. Jocelyn Wildenstein, the socialite, or Orlan, the body artist, come to mind. Jocelyn is reported to have spent 4 million dollars on cosmetic surgery. Her late husband Alex was quoted as saying: “She seems to think that you fix a face the same way you fix a house.”

Please watch the movie at: http://www.youtube.com/watch?v=ri61lBfMBu0&feature=related

Some of our most notable celebrities appear engaged in this exercise. This perhaps helps us understand why individuals with surgically disfigured looks defend and appear to love their faces. I would suggest that for some individuals, the extreme alteration in appearance actually meets a narcissistic need for attention. We look at these individual with disgust, but instead of experiencing shame and humiliation, they experience attention and interest, which serves to confirm that they are objects of adoration. In the case of Michael Jackson, it now appears that his addiction to cosmetic surgery was also reinforced by the exposure to drugs administered for his anesthesia, contributing to his premature death.

COSMETIC SURGERY JUNKIES

This raises one final issue I would like to discuss with you. In considering my more demanding poly-surgery patients, I would like to suggest that there is a difference between body dysmorphic disorder and what Pitts-Taylor has described as “the surgery junkie.” The line between normal enthusiasm for the benefits of cosmetic surgery and cosmetic surgery addiction is not well defined. Body dysmorphic disorder is defined in the revised DSM IV as excessive preoccupation with a specific body part that causes significant impairment in functioning.

The cosmetic surgery addicts do not restrict themselves to a particular body part. Instead, they have a global appetite for cosmetic surgery. Like the painters of the Golden Gate Bridge who begin repainting the bridge immediately upon completing the last job, cosmetic surgery addicts are never satisfied and are only constrained financially in their quest for ever more enhancement. These individuals have surgery with many doctors and may not be forthright in disclosing recent procedures. I believe that this type of individual is more a victim of the neuroeconomics of appearance rather than some deep-seated psychological problem. Unattainable standards of beauty, the fear of loss of status, and the ready availability of cosmetic surgery all contribute to the problem. As such, cosmetic surgery addiction has more in common with drug addiction and pathological gambling than with body dysmorphic disorder. Unfortunately we are all familiar with the horrible disfigurement that seems to be the final common pathway for these individuals.

When does cosmetic surgery become too much? This is a question that we currently wrestle with as individual surgeons. However, I suggest that this is a public health issue. I ask you to consider that we may already be experiencing an epidemic of adverse cosmetic surgery outcomes. If surgeons can’t address this growing problem, we can look forward to solutions by angry legislators prompted by what will be the inevitable consumer backlash.

CONCLUSION

Socio-cultural pressures have elevated the standards of appearance predominantly for women. The difference between these standards and what people see daily in the mirror creates various levels of chronic shame. More than narcissism it is low self-esteem that drives the demand for cosmetic surgery. Cosmetic surgery is used as a survival kit to mitigate these negative emotions and personal insecurities. In the future, I hope to share my insights on shame mechanisms, attachment and terror management theory, mortality salience and the role of neuroeconomics in the cosmetic surgery, which ascertain the cultural concerns discussed in this article.

This article was given as a lecture before the 40th Anniversary Fall Scientific Symposium for the American Society for Ophthalmic Plastic and Reconstructive Surgery in San Francisco, California on October 21, 2009.

October 1, 2009

The Straight Talk About Liposuction

Filed under: Dr. Steinsapir, Liposuction Beverly Hills — Tags: , , , , , , — admin @ 6:27 pm

At times the “The Battle of the Bulge” becomes extremely challenging to conquer, despite regular exercise and a healthy diet. Liposuction is an effective cosmetic procedure that addresses the excessive fat that gets accumulated in certain areas of your body, which is difficult to remove by natural means.

The areas that commonly concern women include the inner and outer thighs, inner knees, stomach, and flanks. In men the common areas of concern are the love handles, stomach, and flanks. Less common areas include the tail of the breast in women and the breast area in men. Liposuction is one of the most popular cosmetic procedures. However, it is essential to understand what liposuction can and can’t accomplish. How liposuction is performed, and what factors contribute to make liposuction unsafe.

Even though liposuction is one of the most widely performed cosmetic methods, there remains a lot of confusion about the best way to perform liposuction and when it should be performed. Dr. Steinsapir, a renowned Eye Plastic and Cosmetic Surgeon in Los Angeles and Beverley Hills, provides his input on liposuction by presenting the following valuable facts…

Liposuction: Not a Quick Fix for Your Weight Problem
Liposuction is a body sculpting technique and not a weight reduction procedure. Liposuction improves your silhouette by getting rid of the fat that is localized to only certain areas of the body. As such, the surgery is best for individuals with stable weight. If you regularly yo-yo in weight more than 15 pounds, then liposuction is probably not right for you.
It is a misconception to think that you will lose weight from liposuction. You will not. While fat is removed from the body surgically, the swelling that follows usually more than compensates for the fat removed. The reality is that only two things determine our weight: How much we eat and how much we metabolize.

It is completely normal to regain the fat that has been removed, but due to the sculpting of the body with liposuction the fat that returns is more evenly distributed over the entire body, rather than getting disproportionately re-deposited in the problem areas. Your body weight primarily depends on two factors, the quantity and quality of the food that you consume and your metabolic rate. The only way to lose weight is to increase your metabolism by regular exercise and follow a healthy diet. No form of liposuction will cause you to weigh less.

Tumescent Liposuction: The Safest Liposuction Technique
Pure Tumescent Liposuction under local anesthesia is the safest technique to eliminate those stubborn fat cells. Widely acclaimed for his minimally invasive treatments, Dr. Steinsapir practices tumescent liposuction in Los Angeles because it causes minimal tissue trauma, nearly no blood loss, and a fast recovery. To execute this procedure, Dr. Steinsapir uses a dilute local anesthetic, which is infiltrated gradually into the fatty areas, and the fat is removed by micro-cannulas or very small cannulas. A microcannula takes out smaller amounts of fat with each pass offering a highly refined method to control how fat is sculpted.

Liposuction: Under General Anesthesia or Local Anesthesia?
The major difference between liposuction under general anesthesia and local anesthesia is safety. Liposuction under general anesthesia is much more profitable for the surgeon than doing liposuction under tumescent local anesthesia. The same liposuction that can be done in 45 minutes under general anesthesia may take about 3 hours to perform under local anesthesia. This means that surgeons who do liposuction under general anesthesia can do 3 times the number of cases in the same time frame. This is why liposuction is still performed this way.

However, you pay a huge price for your doctor’s convenience. The death rate due to liposuction under a general anesthesia has been estimated as 1 in 5000 cases, which is alarmingly high. Compare with the death rate associated liposuction under a local anesthesia, which is estimated as 1 in 500,000. This proves that liposuction performed under local anesthesia is much safer than performed under general anesthesia.

There are additional benefits for doing liposuction under local anesthesia. For one, with much few drugs in your system, you recover much faster. Instead of being hung over for days with a general anesthesia, you feel very much yourself the next day. There is far less trauma with liposuction under local anesthesia. The reasons for this are straightforward. When you are under general anesthesia, surgeons tend to do very aggressive liposuction with larger cannulas. This means that you are severely beaten up during surgery. It can take 6 to 8 weeks before the body recovers from this type of trauma. Blood loss can be so severe that a blood transfusion and hospitalization are needed. Not so with tumescent liposuction under local anesthesia. Liposuction is done with very small micro-cannulas and a pace that is comfortable for you. This means much less trauma, much more rapid recovery, and minimal blood loss. Hospitalization and blood transfusions are not reported in large studies of this technique. Most people return to their work out in two days with some soreness.

Laser Liposuction vs. No Laser
Laser based liposuction systems are being touted in marketing as the greatest thing since sliced toast. The marketing proposition is very compelling: lasers are sexy. It is practically a sure fired sales pitch. It works equally well on doctors and the public. However, think about another laser service: CO2 laser resurfacing. This has been and continues to be a huge disaster for the public. There are literally thousands of women out there with scarred or depigmented faces out there. Even after these complications were recognized and there was a public backlash, docs were out their performing these awful procedures. The reason was simple. Once you sign a 6 year lease or buy these very expensive machines, every one coming into your office has to be pushed into the service whether it is right for them or not. I know one doc who tells his patients that their faces will be depigmented by the service and there will be a line between where the face was treated and the neck skin where treatment stopped. At least he is honest about what this treatment does.

We are seeing a similar type of hype with the laser based liposuction machines with unrealistic before and after pictures. Typically these show a flabby stomach in the before and a rock hard etched 6-pack stomach in the after picture. Sure, this could be the same person but it is impossible that the only difference was laser liposuction. Try laser liposuction plus a carbohydrate free diet, hundreds of hours in the gym, and a little photoshop. Again, these machines cost over a hundred thousand dollars. Once a doc buys the machine, everyone is going to be pushed into this procedure. There is no evidence that the device is better than tumescent liposuction or any other form of liposuction. The incisions needed to insert these devices under the skin are larger than those needed for the microcannulas. The bottom line here is that you will be bearing the expensive of this pricy machine with no evidence that it is any better that pure tumescent liposuction under the safety of local anesthesia.

Liposuction: The After-Effects
It is common to experience a lumpy firmness after liposuction due to the inflammation caused by the surgery in the fatty areas. This inflammation gradually subsides in 4-6 weeks, as the body begins to heal from the surgery. Due to long term remodeling of the fat, the body continues to improve over a period of 4 to 6 months. It is common to experience soreness and bruising after the procedure. Generally most people take two or three days off from work and return to their work out in two days. Compression garments are provide with the procedures and are used for 5 to 6 days. Compare this with other liposuction techniqueswere compression garments need to be worn for 6 to 8 weeks.

Contact Dr. Steinsapir today for a Liposuction consultation and discussion that is perfectly tailored to your needs, concerns and desires.

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