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What is Blepharoplasty?

Blepharoplasty is a procedure to remove fat, usually along with excess skin and muscle from the upper and lower eyelids, correct drooping upper lids and puffy bags below your eyes. These features make you look older and more tired than you feel, and may even interfere with your vision.

Results of Blepharoplasty
Blepharoplasty results are dramatic and long-lasting. There will be lesser chances of having puffy fat pockets and excess skin around the eyes as you grow old. In order to maintain these results, you may need to have a secondary procedure done in the future.

Candidates for Blepharoplasty
Many of our patients find that the signs of aging are more severe around their eyes than anywhere else. If sagging, drooping eyes are making you look old and tired, blepharoplasty may be just the solution to revitalize your appearance.
Men and women who are good candidates for Blepharoplasty have any of the following:

Excess skin covering the natural fold of the upper eyelids.
Loose skin hanging down from the upper eyelids, especially along the sides.
A tired and puffy appearance of the upper eyelids.

  • Excess skin, fine lines and wrinkles of the lower eyelids.
  • Drooping lower eyelids revealing excessive “white” of the eyes.
  • Dark circles or bags under the eyes.

Blepharoplasty can usually solve these problems, but some patients may need to consider additional treatment to further correct other problem areas.

Your Consultation
During the initial consultation, RVB will ask for a complete medical history and will conduct a careful examination to evaluate your overall health. After that, he will ask you to describe your concerns with regards to your eyelids. A careful and thorough evaluation of your health will be done before the evaluation of your eyes to check for any other conditions that may bring complications to the upcoming procedure. Examples of these conditions are visual impairment or inadequate tear production, thyroid diseases, allergy and glaucoma. During the consultation, the doctor will also advise you of other appropriate procedures to be able to achieve the best results. There may be circumstances where you will be asked to have a complete evaluation by your personal physician or ophthalmologist prior to surgery. Referrals may be given if needed.

You will be provided with pre- and post-operative instructions and all necessary prescription medications before the date of your surgery.. Another thing you will be given is a list of anti-inflammatory and aspirin-containing medications, which should be avoided for at least 2 weeks before and after surgery.

The Blepharoplasty Procedure

Blepharoplasty is done on an outpatient basis in a surgical center. Blepharoplasty can be performed under intravenous sedation, known as twilight sleep, or under a light general anesthesia. Local anesthesia is administered around the eyes in all cases, and in certain cases, the entire procedure may be done under local anesthesia only. Prior to surgery, the doctor will carefully mark the location of the incisions to be made. You can be assured that every effort will be done to assure that the incisions are placed in the most inconspicuous locations to maximize cosmetic healing and preserve natural eyelid shape and mechanical function. The amounts of skin and fat to be removed from each eyelid will be measured precisely to assure symmetry. Pinpoint electrocautery will be used for the fat removal and dissection to insure an almost bloodless operation. In effect, this will minimize bleeding, as well as subsequent bruising and swelling, leading to a speedier recovery. All incisions are then carefully closed with nylon fine sutures.

For the lower eyelids, excess fat is removed either through the traditional skin-muscle flap technique or through the lining tissue of the lower eyelid, or more commonly known as the trans-conjunctival technique. In certain cases, the arcus marginalis release technique is used where the lower eyelid fat is preserved and used to fill the hollow, dark circle or prominent lower border of the bony orbit. The excess lower eyelid skin can then be directly trimmed or resurfaced and tightened using chemical or laser resurfacing techniques.
Blepharoplasty takes from 1 to 2 hours as an isolated procedure.

Below are the different types of Blepharoplasty procedures:

The Traditional Blepharoplasty

The incision is made in the crease of the upper lid towards the corners of the eyes. After healing, this incision would not be noticeable when the eyes are open. Then, on the lower lid, the incision is made just below the lash line towards the corner of the eye. This incision will be hidden by lashes when healed.

The Trans-Conjunctival Blepharoplasty

This is a newer technique for lower eyelid Blepharoplasty that involves an incision inside the lining of the lower lid. Fat can be removed through this incision. In order to attend to excess skin, a “pinch” of skin can be taken, or the lower eyelid skin can be tightened using chemical peeling or laser resurfacing, without the actual removal of skin. The upper eyelids are treated using traditional techniques only if required.

Risk

It is rare for complications to happen after a Blepharoplasty procedure. It may be highly unlikely, but some of these complications include:

  • Dryness or irritation of the eyes.
  • Bleeding and swelling.
  • Delayed wound healing or infection.
  • Drooping of the upper or lower eyelid, asymmetry, and double vision.
  • In the event of the following, it is usually advised to have additional surgery to correct these problems.

Recovery

An hour after surgery, you will be cared for in the recovery room where nurses will apply cold compresses to the surgical area to minimize swelling. You can be discharged soon after you wake up, fresh and alert from the procedure.
Please make sure someone is able to assist and drive you home and be available to care for you continuously for the first 24 hours. The area around the eyes may remain puffy and slightly discolored for a few days following the surgical procedure.
Here are some recommendations for a smooth recovery:

  • Keep your head elevated at all times for the first several days after surgery. Continue to use cold compresses to minimize swelling and bruising, which should begin to subside on the second or third day after the procedure. There should be minimal or no pain at all after the surgery, although pain medications will be given for use only if needed.
  • On some occasions, you may experience a dry and scratchy sensation on the eyes, with excessive tearing and sensitivity to bright light. This condition does not usually come about, and the use of eye drops during the day and eye ointment at night will help lessen its occurrence. Also, some blurring of vision or transient double vision is normal after this procedure, and you may notice the eyes to be easily tired while reading or watching television.
  • In 4 to 7 days, the stitches will be carefully removed. The swelling and bruising may persist for up to 10 days. Women can start wearing makeup to help conceal it after about 5 days, or after healing of the skin is complete, if you have had laser or chemical peel resurfacing of the eyelid skin. From a week to 10 days, you may anticipate to resume normal work and social activity. Wait for 10 days to wear your contact lenses. In 10 to 14 days, you may do some exercise or other strenuous activities. From within 6 months to a year, your incisions will start to fade.

Blepharoplasty FAQ’s

At what age is Blepharoplasty performed?

  • There is no set age when blepharoplasty is performed, however the usual ages that patients start making consultation appointments for blepharoplasty is from 35 upwards. It is however highly individual and excess skin and fat around the eye area may be desired to be removed younger than 35 years of age.

Is the Blepharoplasty going to be painful?

  • Usually, there is minimal discomfort for the patient after this surgical procedure. Some patients might feel a scratchy sensation in the eyes because of the dryness or possible irritation of the cornea during surgery. This is usually controlled by the use of eye drops during the day or ointment during the night. If there is any other pain observed, do not hesitate to ask for a consultation.

Will I have scarring?

  • Most scarring following a blepharoplasty is sufficiently minimal that is shouldn’t be visible at all. If you’ve had an upper lid procedure, the incision is made along the lash-line, and for a lower lid procedure, the incision is made in the crease of the lid.

Is it normal for my eyes to be unable to close completely after this procedure?

  • Your eyelids may not close properly or completely during the first few days after the Blepharoplasty due to swelling and tightness.A few instructions to share:
    1. Wear dark sunglasses when going outside to protect the eyes against excessive brightness and wind exposure.
    2. Wear dark sunglasses when going outside to protect the eyes against excessive brightness and wind exposure.
    3. Sleep with your head elevated on two pillows.
    4. Massage your eyelids as instructed, and use iced compresses to speed up the resolution of your eye’s swelling.

When can I wear makeup after the procedure?

  • Women can start wearing makeup after the stitches are removed. Although, if you have had laser or chemical peel resurfacing of the eyelid skin, please make sure the skin is completely healed before using makeup.

When can I wear contact lenses?

  • Patients sometimes develop a condition called “Chemosis” after the procedure which is a transient, gelatinous-appearing swelling of the lining layer over the white portion of the eyes. The swelling usually resolves within the first 10 days after surgery. After 10 days, patients may resume the use of contact lenses.

How soon after the procedure can I shower or bathe?

  • Soap and water will not harm your sutures so you may shower, bathe, or gently wash your face and eyelid area immediately after your Blepharoplasty. Afterwards, apply a thin layer of ophthalmic ointment to your external suture lines to soften dried blood on the suture lines, if there are any. In the occasion that the eyelids and eyelashes become sort of stuck together, just gently wash with soap and water or use a warm compress around the area.

When can I start doing my normal activities after Blepharoplasty?

  • You may gradually resume your usual physical activities approximately 1 week after Blepharoplasty if you have normal blood pressure. If medications control your blood pressure, make certain that your baseline blood pressure is within the normal range before doing exercises. Patients are reminded that they should avoid strenuous activities or any actions that may require bending where the head will be below the heart level. This tends to increase pressure in the small veins around the eyes that may lead to delayed bleeding complications.

Can Upper or Lower Blepharoplasty change the shape of my eyes?

  • In certain cases, Blepharoplasty can change the shape of the eyes, making it rounder or more open. Also, it is not unusual for the two eyes to appear kind of different from one another right after the procedure. As the healing progresses and the swelling goes down, you will be able to adjust to your improved appearance.

Will Blepharoplasty resolve my “Crow’s Feet”?

  • No, it will not.

Hair Transplant

Hair transplant (or hair restoration, hair implants) is a hair replacement treatment for men and women. The procedure permanently restores hair by transplanting new follicles into balding or thinning areas. Hair transplants correct male-pattern baldness and other forms of hair loss.

Hair restoration surgery usually takes a full day and is performed under local anesthesia and sedation, although some cases may require general anesthesia. In this surgery, healthy hair follicles are removed from the back and/or sides of the head, and transplanted to areas where hair loss is occurring.

Surgery usually involves transplanting follicular units (the natural bundling of hairs as they grow in the scalp), with each unit containing one to four hairs. The most common technique is “strip harvesting” (sometimes referred to as follicular unit transfer, or FUT), which involves removing a single strip of the scalp where follicles are plentiful (the “donor site”) and then cutting out the follicular units to create grafts for transplanting.

Another increasingly common technique is follicular unit extraction (FUE), in which each follicular unit is removed one at a time–a more time consuming process, but one that avoids the linear scar from the donor site. It can result in tiny dots on the back of the head that can sometimes be visible if the head is shaved. FUE is usually chosen by men, particularly those under 30 who may wish to shave their head, and by African Americans.

The average number of individual grafts needed depends on the patient; anywhere from 1,000 to 3,000 grafts is possible in an average day of surgery.

Your recovery time will depend on the extent of the surgery. Most patients report mild pain, numbness and soreness; this can be controlled with pain medication prescribed by your surgeon. It is common for hairs from the transplanted follicles to fall out in the first month and then regrow. Within 4 to 5 months, they should be growing normally in their new location.

Complications with hair transplant surgery are relatively uncommon. Potential hair restoration side effects may include scarring or uneven hair growth. If the results of the surgery are patchy or if the follicle grafts don’t establish well at the new site, your surgeon may wish to perform a follow-up surgery to correct scarring or to transplant more follicles to fill in thinner areas.

What is Stem Cell Therapy?

Stem cell therapy is a set of techniques that aim to replace cells damaged or destroyed by disease with healthy functioning ones. The techniques themselves are still relatively new but their applications and benefits are broad. Some of the diseases they can help include:

  • Cancer
  • Parkinson’s disease
  • Diabetes
  • Various injuries (e.g. spinal cord)
  • Eye diseases

Types of Stem Cell Therapy
There are a number of stem cell therapies that are currently being investigated or used to treat a range of diseases. These are:

  • Adult stem cell transplants using bone marrow stem cells
  • Adult stem cell transplants using peripheral stem cells
  • Stem cell transplants using umbilical cord blood
  • Therapeutic cloning

Benefits of Current Stem Cell Therapy

Although a great deal of stem cell therapy is still experimental, researchers have found the treatments promising for many diseases. Bone marrow stem cells, for example, are used to replace blood cells in people suffering from leukemia and other cancers. Burn victims are also benefiting from stem cell therapy, which allows for new skin cells to be grafted as a replacement for damaged ones. New healthy cells can also be grown to treat eye diseases as well as replace dysfunctional tissues. The ultimate goal of stem cell therapy is to replace unhealthy cells with healthy ones and to do so efficiently, allowing proper cell functioning in the human body. In addition, the potential uses for stem cell therapy continue to grow as we learn more about the process whereby a healthy cell becomes a diseased one.

Challenges of Stem Cell Therapy

A major difficulty with stem cell therapy is to identify stem cells within an actual tissue culture. Cultures contain many different cells and it is a challenge to identify specific cell types. When the stem cells are identified and then isolated from tissues, the appropriate solutions must be created to trigger these cells to develop into the desired cell types.

Finally, there are additional issues even when cells are identified, isolated and grown. The new cells require implantation in a person and they must then essentially learn how to effectively function alongside a person’s own tissues. For instance, if you imagine a cardiac cell being implanted, think about the fact that it may not beat with the same rhythm of a person’s heart cells and is thus ineffective. A person’s immune system may also recognize the transplanted cells as foreign bodies and this can trigger an immune reaction that results in rejection of the new cells.

The potential of stem cell therapy to ease human suffering and dramatically affect disease has motivated scientists to research ways of enhancing current stem cell therapies and develop new ones. Stem cell therapy remains a new science but the results have thus far been impressive enough that scientists are eagerly studying ways to treat the many diseases that you or a loved one may suffer from one day.

What are the types of Ance?

There are several types of acne. Some are simply clogged pores while others contain inflammatory bacteria. Understanding the difference between the various types can aid in choosing the proper treatment method.

Comedones – Whiteheads and Blackheads

The most well-known forms of acne are comedones. Whiteheads are closed comedones and blackheads are open comedones. Both are clogged pores, follicles that are filled with sebum and sloughed off cells. Whiteheads are closed off and have not been exposed to air. Contrary to popular belief, blackheads are not dark because they are just dirt ground into open pores that can simply be scrubbed away. Blackheads are whiteheads turned black because they are exposed to air and oxidize.

Papules

Papules are red or pink bumps that never seem to “come to a head.” Papules are clogged pores or sebaceous glands that are infected with bacteria. They are often tender, and appear to be a whitehead in formation, but it is important not to squeeze or try to force a papule to the surface, as that can cause scarring or further infection.

Pustules

Pustules may at first glance appear to be whiteheads, but they are different. They are yellow or white at the center, but have a pink or red base. These are inflammatory and infected with bacteria. They can leave scars.

Nodules and cysts

Larger than other acne formations, nodules and cysts are more like boils. Both can be very painful, infected with bacteria, can last for months, and are subject to collapse and can cause severe scarring. They both form hard lumps and should be treated by a dermatologist. The primary difference between them is that cysts fill are filled with pus. In order to properly address any legions or formations it is necessary to understand what you are dealing with. Whiteheads and blackheads are easily dealt with at home. Inflammatory legions, such as papules and pustule, are filled with bacteria and pose a risk of scarring. Nodules and cysts are serious, can cause significant scarring and are often a symptom of a more serious health problem which should be brought to the attention of you health care practitioner.

Even those who practice a regular washing and moisturizing routine can suffer from various forms of acne. Responding to acne with a more vigorous cleansing routine can aggravate the problem. While daily washing and moisturizing can help minimize acne, other underlying causes are usually involved.

Solutions and Treatments

Acne is a very common problem, and the treatments vary from simply improving your skin care regimen, to costly medical procedures. Some acne is serious enough to warrant treatment from a dermatologist or other skin care specialist, and some can be handled at home. In either case, proper diet, drinking plenty of water, and cleaning your skin properly, not necessarily more often, will contribute to the solution.

Things you can do for yourself include:

  • Reduce stress
  • Drink plenty of water
  • Shower immediately after working out
  • Wash and moisturize your face daily, but no more than three times a day
  • Exfoliate
  • Eat healthy foods

Topical treatments

Includes:

  • Retinoids – derivatives of Vitamin A that help to unblock pores. They are available in over-the-counter and prescription forms, usually as a cream containing retinol or retinaldehyde. Retinoids can increase the chance of sunburn.
  • Benzoyl peroxide – available over-the-counter or in a stronger prescription form. It works by helping to unblock pores and killing bacteria.
  • Antibiotics/Anti-inflammatories – kill bacteria and sooth as well as reduce swelling and redness.
  • Azeliac acid – kills bacteria and decreases the production of keratin.

Oral Medications

Antibiotics work by reducing bacteria from the inside. This is an effective way to reduce acne, but can have side effects such as increased chance of sunburn and yeast infections. Birth control pills can reduce or stop acne by regulating the hormones which increase the production of sebum causing breakouts.

Triamcinolone Acetonide Injections

Triamcinolone acetonide is a corticosteroid which is injected directly into acne legions. This anti-inflammatory works well on cystic acne that has not responded to other treatment.

Laser Treatments

Laser treatments kill the bacteria and alter the sebum gland, resolving existing acne and reducing the production of sebum to prevent its return. Most patients will need several treatments about two weeks apart for full results.

Photo Therapy

Red and Blue light kill the bacteria associated with acne, and promote healing of the skin. The treatment is gentle and painless. In-office treatments resolve acne in about four weeks with treatment at intervals of twice a week. Photo therapy at home normally requires daily sessions for about 12 weeks. Photo therapy is not appropriate for cystic acne, but is very effective for persistent mild to moderate acne.

Acne Treatment FAQ’s

Is acne caused by a lack of cleansing?

Acne is a disorder of the pilosebaceous unit, which consists of the hair follicle, sebaceous gland and duct. When oil and dead skin cells become trapped within the follicle, it creates a comedo. If bacteria invade and the follicle wall ruptures, an inflamed lesion develops.

Acne is triggered by androgens. Androgens are hormones released from the adrenals, ovaries, and testes. Androgens stimulate the sebaceous glands, creating an oilier skin that is more prone to comedones.

Acne is not caused by lack of cleansing. In fact, scrubbing your face too often or using harsh soaps can exacerbate the condition.

Can you prevent acne?

If you know your skin is prone to acne, there are a few steps you can take to reduce the chance of a breakout.
Cleanse daily with a mild cleanser.
Exfoliate regularly to help reduce the amount of dead skin cells.
Drink plenty of water.
Avoid oily skin and hair care products.
Don’t pick or “pop” existing blemishes.

What can I do about my acne?

Although there is no cure for acne, there are many options available to help improve and control acne breakouts. If your acne is mild, try an over-the-counter acne product that contains benzoyl peroxide. Benzoyl peroxide helps control Propionibacterium acnes, the bacterium responsible for acne breakouts. Other helpful ingredients include salicylic acid, sulfur, and resorcinol.

If you have moderate to severe acne, you should talk to your dermatologist or skin care professional. They can discuss treatment options with you, which may include topical treatments and/or oral medications.

How long will it take my acne to clear up?

The severity of your acne and how consistent you are with your treatments are just some of the many factors that determine how long it will take to see improvement. There is no reliable acne therapy that works for 100% of sufferers. It isn’t uncommon to try several acne treatment options before finding one that works best for you.

Most dermatologist agree you should see improvement of the skin within one to six months. Results are seen more quickly if you adhere to a strict skin care regimen.

What role does diet play in acne?

Acne is not caused by food. Following a strict diet will not, clear your skin. While some people feel that their acne is aggravated by certain foods, particularly chocolate, colas, peanuts, shellfish and some fatty foods, there is no scientific evidence that suggests food causes or influences acne. Avoid any foods which seem to worsen your acne and, for your overall health, eat a balanced diet–but diet shouldn’t really matter if the acne is being appropriately treated.