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March 8, 2010

Is Mesotherapy Good For Lower Eyelid Bags?

Filed under: Eyelid Surgery, blepharoplasty, eyelid fat, lower blepharoplasty, mesotherapy, under eye fat — Tags: , , , , , — admin @ 10:14 pm

Two common problems in the undereye area are the absence of fat and the presence of excessive fat.  Too little fat gives the eyes a hollow, sunken appearance, while too much fat makes them look puffy and swollen.  Because the appearance of the eyes makes a big difference in how we read facial expressions, correcting excess fat under your eyes can greatly improve your appearance.  While searching for solutions through cosmetic eye procedures, you may hear about a procedure called mesotherapy, which is being actively marketed by a few less ethical practitioners today.

What Is Mesotherapy?

Mesotherapy is a procedure in which a solution is injected into the body with the hope of reducing fat.  The solution includes chemicals like aminophylline, dimethylethanolamine, glutathione, hyaluronidase, isoproterenol, L-arginine, lidocaine pentoxifylline, yohimbine, and the bile salt deoxycholate and phosphatidylcholine.

Mesotheraphy is marketed under many catchy names like Lipodissolve, LipoShape, and Lipostabil.  Unfortunately, this procedure sounds appealing but is actually untested and unproven, making it a very real danger to those seeking treatment.

Is Mesotherapy FDA-Approved?

Mesotherapy has not been tested enough to demonstrate if it is safe, and we have documented some unpleasant side effects.  Mesotherapy remains an unproven treatment that not only doesn’t live up to its hype, but also presents a serious threat to anyone trying to sort through eyelid surgery options.  Mesotherapy dangers include scarring, damage to blood vessels, and pain.

For these reasons, the FDA has not approved mesotherapy.  The FDA will not endorse mesotherapy for human use unless further research can resolve its side effects and prove it safe and effective.  It is unlikely that mesotherapy will ever receive FDA approval. It can destroy fat cells, but it also causes significant inflammation.

You may be wondering what this means for removal of fat under eyes, since this represents a small yet significant fat deposit.  If mesotherapy someday be approved for under the eyes, then why not use it now?  In answer, you especially shouldn’t use mesotherapy under the eyes now or anytime soon.  The area under the eyes is especially sensitive to aging and treatment.  Because the skin here is so thin and delicate, it’s very hard to disguise problems in this area.  There are a narrower range of treatments that are proven to work here, primarily because the fragile skin here cannot compensate for even small mistakes or irregularities.  You don’t want to damage an already-sensitive area by experimenting with an unapproved and unsafe treatment.  And that’s exactly what someone performing mesotherapy is doing; they are conducting an uncontrolled experiment on you with chemicals not approved by the FDA.  Most doctors will not administer mesotherapy for ethical reasons, but there are a few people hoping to make a quick profit who will try to tell you that mesotherapy is safe.  Here’s the bottom line: if the FDA hasn’t approved it, they don’t have science on their side.

Here’s another word of caution: those who administer mesotherapy do not respect the recommendations of the FDA, so you are at increased risk for infection because these same practitioners may also disregard safe preparation procedures.  The chemicals are concocted in an unlicenced lab, which gives you no assurance that they were mixed under ideal conditions.

Alternative Treatments for Undereye Bags

Overall, mesotherapy is not a suitable alternative to liposuction and it is certainly no alternative to lower eyelid blepharoplasty.  If you are seeking treatment for your undereye bags in particular, a personal consultation may reveal that blepharoplasty or lower eyelid surgery is a much better option for removing fat under eyes.  These are flexible procedures that enable a qualified, experienced oculoplastic surgeon to present different treatment options to you and customize a procedure to help this sensitive area.  The eyelids and surrounding areas are incredibly complex, and our brains are programmed to pick up on very subtle irregularies, assymmetries, and problems in these areas, cuing us in on how a person is feeling and determining how attractive we view them as.  This is why only a proven, time-tested treatment should be administered by a highly experienced doctor who can treat you with the precision necessary to avoid mistakes while improving this area.

Find a Doctor Who Cares

Dr. Steinsapir specializes in cosmetic eye procedures in Beverly Hills and Los Angeles.  His approach is to work with a patient to determine their goals and then customize a minimally-invasive treatment plan that makes sense and, most importantly, works.  Dr. Steinsapir has completed numerous fellowships and teaches at the prestigious Jules Stein Institute at UCLA.  Please contact us today to find out how Dr. Steinsapir can customize your safe treatment program today.

January 17, 2010

Anchor Blepharoplasty: Is It for Me?

Filed under: Eyelid Surgery — Tags: , , , , — 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

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.

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.

January 3, 2010

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

Filed under: Cosmetic Surgery, Eyelid Surgery — Tags: , , , — 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.

December 15, 2009

Should I Get Perlane® or Restylane®?

Filed under: Cosmetic Surgery, Eyelid Surgery, Restylane Injections, Under Eye Restylane — Tags: , , , — admin @ 3:37 pm

Restylane® and Perlane® from Medicis, Inc. are both hyaluronic acid fillers made of sugar gels. It is common to ask which product is better.   The reality is that these are similar products with important differences.  Restylane® is a softer product that provides excellent volume, tends to stay where it is injected, but can be shaped well once placed in the tissue.  Perlane® is also a soft product that provided slight better volumizing, tends to stay where it is injected, and resists shaping more than Restylane®.

Each product has a somewhat different role in facial volumizing.  The right choice for you very much depends on your issues.  This is best determined by an individual consultation with a highly qualified cosmetic surgeon.  Here are some general guidelines and common usages that can give you an idea of when each filler tends to be appropriate, but individualized treatment never takes a one-size-fits-all approach and diagnosis and treatment planning must be done in person.

Before and After: Restylane, Botox and Perlane by Dr. Steinsapir

Before and After: Restylane, Botox and Perlane by Dr. Steinsapir

What’s the Difference between Perlane® and Restylane®?

Both Perlane® and Restylane® are fillers that work especially well when volumizing the face to give it a softer, more youthful look and restore hollow and deflated areas.  Perlane® is a thicker material than Restylane® and it usually lasts a few months longer.  This is an amazing length of time as Restylane can be effective for a year or more.  Restylane® usually works better for the sensitive area under the eye where the skin is thin and there is little fat.  The ability of the Restylane to be readily shaped once it is placed in the tissue means that many potential irregularities can be resolved as the material is placed.  For the same reason, Restylane is also excellent at the lip edge.  Elsewhere in the face, there is much better tissue coverage for the placement of the slightly thicker Perlane®.

Perlane® has a larger molecular structure that Restylane and as a results it is a somewhat better volumizer than Restylane®.  It is preferred in areas like the cheeks, eyebrow, chin, and the tissues around the mouth called the perioral area. Why does it work best in these areas?  Because these areas have more fat to work with than the lower eyelid dark circle.  Perlane®’s thickness necessitates that it be placed deeper than Restylane®, while Restylane® works very well near the surface of the skin and in areas where little fat is present.  Perlane® is wonderful for adding volume to places with more fat under which a doctor can place this filler.  It is less ideal for the lip edge and under eye area where the Restylane serves as a better choice.

Because of both their similarities and differences, Restylane® and Perlane® can be used together to improve the facial aesthetics by eliminating unsightly angles, sunken features, and haggard looks.  For example, Perlane® can be placed in the top of the cheek at the time that Restylane® is used to treat the dark circles in the lower eyelid hollows.  Both of these actions are beneficial in themselves, and when used together they amplify the improvements even more.

What If I’m Unhappy with My Results?

These services are the fastest growing cosmetic services because of how happy people are with the results.  Yet service is not a magic wand and it is sometimes necessary for a treatment to be adjusted.  First make certain that your doctor is aware of your concerns.  If you are having an issue, don’t simply wait until your next visit.  It is a good idea to contact your doctor and let them know what is going on.  There is often a great deal of value in being seen early if there is some issue.  By consulting with your doctor after a procedure, these issues can be readily addressed.

Unlike other fillers, hyaluronic acid fillers like Restylane® and Perlane® can be adjusted after treatment to resolve any surface irregularities that might be present after treatment.   In fact, it is possible to modify these treatments even if it has been quite some time since you were treated.  Over time, these products are absorbed by the body and eventually disappear over a year or two.

Seeking the Right Doctor

Dr. Steinsapir specializes in improving the face in both aesthetic and medically necessary situations.  As a specialist he has some of the highest levels of experience in addressing concerns about the face, including how to best apply fillers like Perlane®.  In fact, Dr. Steinsapir has served as a physician consultant to Medicis, Inc., who distributes both Perlane® and Restylane®, and he is considered among the top 3% users of these products.  He is thought to have the largest under eye filler practice in the World.  Call for a consultation to find out if you are a good candidate for Perlane®, including whether it will improve upon another procedure or could be combined with Restylane® treatment.  Dr. Steinsapir approaches everyone as an individual, customizing treatment to each person’s needs.  Contact us today to find out how he can customize treatment for you.

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.

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