Douglas J. Van Putten, M.D., F.A.C.S

Products And Services

• Brow Lift

  Also known as a forehead lift, a brow lift is a surgical procedure performed to reduce signs of aging in the forehead area. It aims to remove or minimize deep horizontal creases across the forehead and bridge of the nose, and the frown lines between the eyebrows. It also lifts the eyebrows, making the eyes look more open. Common Brow-Lift Techniques There are two techniques used for performing brow lifts. The classic lift requires a long incision that runs across the top of the head, at the hair line, and down to the ears. However, for a woman who has a high forehead, a coronal incision, which is made behind the hairline, may be used. The endoscopic lift requires three to five small incisions that are made across the forehead, at the hairline. These shorter incisions mean a shorter recovery time and less scarring than those from a traditional brow lift. Which technique is chosen depends on the thickness, texture and elasticity of the skin, the bone structure of the face, the overall appearance of eyebrows and eyelids, and the position of the eyebrows. The Brow-Lift Procedure Brow-lift surgery usually takes about one to two hours to perform, and takes place at a hospital, an office-based surgical suite, or an ambulatory center. Either general anesthesia or intravenous sedation is used. Depending on the surgical technique used, one long incision or a series of small incisions is made. Tissue and muscle underneath the skin are moved or repositioned as necessary. At the end of the procedure, the incision(s) is closed with sutures, screws, adhesives or surgical tape; a drain may be put in to collect excess blood and fluid. Postsurgery, the patient is moved to a recovery area for observation. Recovery From A Brow Lift A patient typically returns home on the day of the brow-lift surgery, although an overnight stay may be necessary for some. Swelling may be pronounced for the first day or two after surgery, although most swelling goes away within 2 weeks. To prevent post-operative bleeding, bending and heavy lifting should be avoided for a few days. It can take up to 6 months for swelling to fully subside and scars to fade. Results Of A Brow Lift Depending on the patient‘s presurgical appearance and goals, a brow lift‘s results, which can be seen immediately, can be either subtle or dramatic. Eyes will appear more “open,” and creases across the forehead, bridge of the nose, and between the eyes will be much less prominent. Risks Associated With A Brow Lift Prior to scheduling surgery, the patient and surgeon should fully discuss the risks associated with a brow lift. In addition to those associated with any type of surgery, a brow lift‘s risks include the following: Hair loss around the incision site(s) Facial asymmetry Higher hairline Injury to facial nerves Eye dryness/irritation The chance of complications is minimized by choosing a board-certified plastic surgeon who has experience in performing brow lifts.

  Link: Brow Lift

• Dermatochalasis

  Dermatochalasis is a medical condition that is characterized by an excess of slack, droopy skin on either the upper or lower eyelid, although it more often affects the upper. Although they often occur together, it is not the same as blepharitis, which is a drooping of the eyelid itself. Dermatochalasis is more prevalent in those older than 40, but can occur at any age. It is typically caused by the loss of elasticity and gradual weakening of connective tissues in the skin that come with aging. Although it tends to run in families, it can be a secondary effect of certain systemic diseases, trauma or prior surgery. Effects Of Dermatochalasis In some cases, dermatochalasis affects eye function. The excess skin can block a portion of the visual field, making it difficult to perform everyday tasks. To increase the field of vision, sufferers may continually raise their eyebrows, which can lead to chronic headaches. Dermatochalasis can also result in the eyes' becoming dry or irritated; an inward turning of the upper eyelid; an outward turning of the lower eyelid; and dermatitis. Even in cases in which it does not result in medical problems, sufferers are often unhappy with the puffiness and bags it causes. Treatment Of Dermatochalasis The standard treatment for dermatochalasis is blepharoplasty, which tightens eyelid muscles and tissue, and removes excess fat and skin. If dermatochalasis is not causing vision problems, surgery is usually unnecessary, unless it is requested for cosmetic reasons.

  Link: Dermatochalasis

• Ectropion

  Ectropion is an eye condition in which the eyelid turns outward. It typically affects the lower eyelid, exposing the inner lid in either one section of eye or across the entire lid. Ectropion prevents tears from draining from the eye correctly, resulting in irritation. It usually occurs in older adults as a result of the aging process, during which muscles, tendons and connective tissue around the eyes progressively weaken. Those who have had trauma to the face or eyes are at greater risk of developing ectropion. Causes Of Ectropion In addition to aging, there are a number of causes of ectropion: Facial paralysis due to Bell‘s palsy or tumor Facial scarring from burns or other trauma Eyelid growths (malignant or benign) Previous eyelid surgery (blepharoplasty) Radiation of the eyelid to treat a cancerous growth Excessive sun exposure Rapid weight loss Cosmetic laser-skin resurfacing Certain eye drop medications, such as those used to treat glaucoma In rare cases, ectropion is a congenital condition. It is usually found in infants with another genetic disorder, such as Down syndrome. Symptoms Of Ectropion In patients with ectropion, tears do not drain properly into the small openings on the inner part of the lid (puncta). This poor drainage causes several symptoms that include the following: Eye irritation and redness Excessive tearing Pain Sensitivity to light Inflammation Eyes that feel dry or gritty Patients with ectropion should be aware of its possible complications, and report any worsening of symptoms immediately. Complications Of Ectropion Several serious complications, including the following, can result from ectropion: Corneal abrasions Corneal ulcers Eye infections Evidence of complications includes eye pain, sensitivity to light or rapidly increasing redness, or a decrease in vision. Any worsening of ectropion symptoms is a sign that vision is in jeopardy and emergency treatment should be sought. Treatment Of Ectropion While there are temporary-relief treatments, such as artificial tears or soothing ointment, correction of ectropion is accomplished with a brief surgical procedure in which the eyelids are repositioned. For ectropion due to muscle weakness or scars from a previous surgery, the repair procedure may include the following: Stretching of scar tissue Removal of a small section of eyelid Skin graft to reposition the eyelid A patient usually needs to wear an eye patch for 24 hours after surgery. During recovery, an antibiotic and steroid ointment must be administered. Though there may be some short-term bruising or swelling after the operation, the symptoms of ectropion usually resolve immediately.

  Link: Ectropion

• Entropion

  Entropion is an eye condition where the eyelid turns inward. Typically entropion occurs on the lower eyelid where the skin and lashes rub painfully against the cornea. This condition may cause the lid to either turn in constantly or only at times when the eyes are closed tightly. Causes Of Entropion Entropion usually occurs in older adults as a result of the aging process. In adults the muscles around the eyes may progressively weaken. A spasm or relaxation of the muscles near the eye can cause the lid to turn inward. Other causes of entropion include: Injury Muscle weakness Congenital defect Skin disease Inflammation Surgery Symptoms Of Entropion The initial symptoms of entropion are often the following: Pain in the eye Excessive tearing Redness Irritation Pain Dry eyes Sensitivity to light Reduced vision Discharge from the eye A feeling that there is something in the eye Complications Of Entropion Over time, if the condition is not treated, the cornea may become damaged due to: Abrasions Corneal ulcers Infection Patients experiencing light sensitivity should contact their physician immediately. Without treatment a decrease in vision can occur. The doctor will be able to confirm the diagnosis of entropion upon an examination of the eyes. Treatment Of Entropion While there are treatments for entropion, correction of the condition is completed with a brief surgical procedure in which the eyelids are repositioned. Temporary relief of the entropion condition can also be found with the following treatment methods: BOTOX Cosmetic Skin tape to hold the eyelid in place Strategically placed stitches Lubricating eye drops Surgical Correction Of Entropion The eyelid area is numbed with a local anesthetic and a light sedation may also be provided. For entropion due to muscle weakness, the surgery may involve the removal of a small section of eyelid to tighten the muscles in the area. When the entropion is caused by scars or prior surgery, the procedure typically relies on a skin graft to allow a repositioning of the eyelid. Patients usually need to wear an eye patch for 24 hours after the surgery. Post-operatively an antibiotic and steroid ointment will need to be applied. Symptoms of entropion usually resolve immediately. There may be some short-term bruising or swelling as a result of the procedure.

  Link: Entropion

• Eyelid Papilloma

  An eyelid papilloma is a rounded growth that protrudes from the upper or lower eyelid. These are very common lesions that most frequently develop in middle-aged and older patients. Papillomas are most often benign, but in rare cases may be precancerous or malignant. Many patients opt to have these lesions removed even if they pose no medical risk for cosmetic purposes or because they are a source of discomfort. The standard of treatment for most eyelid papillomas is surgical excision. Due to the proximity to the eye, especially if the lesion is near the margin, cutting it away is safer than most alternative procedures. After a local anesthetic is applied, your doctor will use surgical tools to remove the papilloma in its entirety. The procedure typically takes less than 30 minutes. Some patients experience mild bleeding or bruising at the treatment site afterward, but these usually resolve within a few days. Even after a complete excision, there is a possibility that the papilloma will eventually return.

  Link: Eyelid Papilloma

• Eyelid Retraction

  An eyelid retraction is another form of eyelid malpositioning, which can affect either the upper or lower eyelid or both eyelids. Eyelid retraction occurs when the eyelid pulls away from the eye. Causes Of Eyelid Retraction Common causes of eyelid retraction include: Trauma Complications from eyelid surgery Graves‘ Disease Parkinson‘s disease Tumor Facial nerve palsy Ophthalmic disease Herpes zoster Contact lenses Radiation therapy Symptoms Of Eyelid Retraction Since a larger portion of the eye is exposed, symptoms of eyelid retraction may include the following: Irritation and dryness of the eyes Pain A wide-eyed appearance Treatment Of Eyelid Retraction Conservative treatments for eyelid retraction will usually be the first course of action and may include the use of lubricants such as artificial tears or an ointment. If that does not provide relief of the symptoms or if the patient is very uncomfortable with the appearance of the eyes, surgery will be considered. Depending on the location and severity of the retraction, the surgeon will determine the best type of procedure for your needs. Grafting techniques may be used to strengthen and reposition the lid, these include: Hard palate grafts Free tarsal grafts Spacer grafts In other cases, skin tissue and fat are relocated or removed to improve positioning.

  Link: Eyelid Retraction

• Blepharoplasty

  Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. Reasons For Blepharoplasty Blepharoplasty tightens the eyelid‘s muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons. Functional Blepharoplasty If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Cosmetic Blepharoplasty Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person‘s looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face. Candidates For Blepharoplasty The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty. The Blepharoplasty Procedure Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. Recovery After Blepharoplasty After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. Risks Of Blepharoplasty Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

  Link: Blepharoplasty

• Facelift

  Over time, gravity and sun exposure take their toll on the face and neck. Deep creases that run from each side of the nose to the corners of the mouth appear; the jawline slackens; and the neck develops loose folds and fat deposits. A facelift (rhytidectomy) counteracts these signs of aging by tightening muscle, removing fat and trimming excess skin, giving the face a fresher, more youthful look. What Can A Facelift Do For Me? A facelift improves the look of the lower and middle areas of the face, and the neck. It is most effective for correcting the following: Mid-face sagging Deep creases under the eyes Nasolabial folds Jowls Sagging fat Loose skin and fat under the chin and jaw Although a facelift removes or reduces signs of aging, over time, they will gradually reappear. A facelift does not improve the look of the brow, eyelids and nose, and some parts of the mid-face. A patient who wants to improve those areas might combine facelift with a brow lift or eyelid surgery, and/or with injectable soft-tissue fillers, facial implants and skin resurfacing. Who Are Good Candidates For A Facelift? The best candidates for a facelift want to correct one or more of the signs of aging indicated above; have some facial sagging, but still have elasticity in their skin; are generally healthy; do not smoke; and have realistic expectations about what rhytidectomy can do. How Is A Facelift Performed? A facelift is typically performed as an outpatient procedure in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about 2 hours. The way a facelift is performed depends on the surgeon, the patient‘s facial structure, and the extent of correction desired. The types are traditional facelift and limited-incision facelift. In both methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face. What Is The Recovery From A Facelift Like? After facelift, the surgeon wraps the incisions in bandages, and may place drainage tubes. The tubes are taken out the next day, when the hair is carefully washed. If surgical clips are holding some incisions closed, they are removed, along with any stitches, one week after the procedure. Swelling, numbness, bruising and a feeling of tightness or tension in the face and neck may be felt. The face may look uneven or distorted, and facial muscles may feel stiff. Most of these side effects resolve within 3 to 6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy and itchy over time. How Long Do The Effects Of A Facelift Last? Results of a facelift are not permanent, and some patients choose to undergo another in 5 or 10 years. In some sense, however, effects are permanent; years later, the face continues to look better than if rhytidectomy had not been performed. What Are The Risks Of A Facelift? Possible complications of a facelift include bleeding, infection, bruising, swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only in smokers), nerve injury, and temporary or permanent loss of sensation in the face.

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• Lower Eyelid Blepharoplasty

  Blepharoplasty, also known as eyelid surgery, is a surgical procedure that improves the appearance of the eyelids by tightening muscles and tissue or removing excess fat and skin. A lower eyelid blepharoplasty is used to treat the following: Under-eye bags Drooping lower eyelids Excess skin Fine wrinkles Circles under the eye A lower eyelid blepharoplasty can be performed on adult men and women alike and offers a younger, more refreshed look that reflects across the whole face. Blepharoplasty is one of the most commonly performed facial plastic surgery procedures. The popularity of this procedure reflects the importance of the eyes in perfecting overall appearance. If the appearance of the eyes causes a patient to be unhappy, they may want to consider lower eyelid blepharoplasty to improve their look and boost their confidence through a safe procedure with minimal downtime. Candidates For A Lower Eyelid Blepharoplasty The best candidates for lower eyelid blepharoplasty are those individuals who meet the following conditions: Are in good overall health Do not smoke Do not have any serious eye conditions Have healthy facial tissue and muscle If a patient has loose, sagging skin or puffy bags beneath their eyes, this procedure can help reduce these unwanted effects and leave the eyes looking young and fresh. It is important for patients to have realistic expectations before undergoing a lower eyelid blepharoplasty procedure in order to be satisfied with their results. While the procedure can enhance their appearance and may improve self-confidence as a result, it cannot alter a patient‘s entire appearance or change the structure of their face. The Lower Eyelid Blepharoplasty Procedure The lower eyelid blepharoplasty procedure is performed with either local or general anesthesia. The method or procedure to be used will be determined by the amount of fat that needs to be removed, the location of the fat and how tight to make the eyelid. The procedure typically takes from 45 minutes to an hour. There are several different surgical approaches that can be used in a lower eyelid blepharoplasty. They are as follows: Transconjunctival Lower Lid Blepharoplasty Often chosen when no skin needs to be removed, a transconjunctival lower lid blepharoplasty creates an incision on the inside of the lower eyelid, leaving no visible scar or other evidence of the surgery. Transcutaneous Lower Lid Blepharoplasty A transcutaneous lower lid blepharoplasty is performed with a subciliary incision, also known as a pinch technique, to remove protruding fat and excess skin. Transconjunctival Arcus Marginalis Release A transconjunctival arcus marginalis release moves the fat within the lid to maintain some volume in the soft tissue. It prevents the ridge of orbital bone from becoming too prominent, which causes the eyes to look hollow and the face to appear older. After the lower eyelid blepharoplasty procedure is performed, the incisions are closed with sutures and usually wrapped in gauze to allow the area to heal. Recovery After A Lower Eyelid Blepharoplasty After the lower eyelid blepharoplasty procedure, the surgeon may recommend applying lubricating drops or ointment and cold compresses to aid in the healing process and minimize side effects such as: Swelling Bruising Irritation Dry eyes The eyes may be wrapped in gauze after the procedure as well. Patients can usually return to work within a few days, but should avoid exercise and strenuous activities for at least two weeks. Stitches are usually removed three or four days after the procedure. Swelling and other side effects usually subside within two weeks after surgery. Contact lenses and eyelid make-up may not be worn for two weeks after surgery. The surgeon will give specific instructions on how to care for the eyes post-procedure. Results Of A Lower Eyelid Blepharoplasty Procedure The results of a lower eyelid blepharoplasty procedure are visible as swelling and bruising subside and will continue to improve for up to a year after surgery. The lower eyelid blepharoplasty procedure is designed to produce long-lasting results. While surgery cannot prevent the eyes from aging, most patients are satisfied with their results and do not seek a repeat procedure. Risks And Complications Of A Lower Eyelid Blepharoplasty As with any surgical procedure, there are certain risks associated with a lower eyelid blepharoplasty procedure. While rare, these risks include the following: Bruising Swelling Blurry vision Malposition of the eye Bleeding Infection Dry eyes Skin discoloration An inability to fully close the eyes

  Link: Lower Eyelid Blepharoplasty

• Neck Lift

  A neck lift is a surgical procedure that smooths and tightens the neck‘s skin, which can sag from aging or weight loss. There are usually two components to a neck lift: cervicoplasty, which removes excess skin, and platysmaplasty, which removes or tightens muscles in the neck. A neck lift can be performed alone or as part of a facelift. A neck lift candidate is in good physical and emotional health, and has realistic expectations about the outcome of surgery. The results of a neck lift can last up to 10 years. Neck Lift Procedure A neck lift begins with a small, inconspicuous incision directly below the chin (platysmaplasty) and/or in front of the ear lobes, looping behind the ears and ending in the scalp near the back of the neck (cervicoplasty). Sagging skin is trimmed away and lifted during cervicoplasty; loose muscles that cause the “bands” around the neck to be prominent are tightened during platysmaplasty. In some cases, it is necessary to perform only one of the two procedures. Liposuction is sometimes used to remove excess fat; if so, it is performed before the neck lift. Incisions are glued and/or sutured closed. A neck lift usually takes 2 to 4 hours to perform, and the patient is given either general anesthesia or local anesthesia with sedation. Most neck lifts are performed on an outpatient basis. Bandages covering incisions are removed after a few days; sutures are typically removed after 7 to 10 days. Recovery From A Neck Lift Swelling and bruising from a neck lift can last up to 10 days. Applying cold compresses and keeping the head elevated for the first 48 hours following surgery minimizes swelling. Keeping the head still, and avoiding turning or twisting it for the first few days post-surgery, is recommended. Medication is prescribed to help alleviate discomfort. Most people return to work and other normal daily activities within 2 weeks, after which bruising and swelling have subsided. More strenuous activities should be avoided for 4 to 6 weeks. Risks And Complications Of A Neck Lift Although rare, possible risks and complications of a neck lift include the following: Scarring Excessive bleeding Hematoma Tissue death Blood clots Numbness Intense itching Skin discoloration Persistent swelling A more serious complication, also rare, is facial nerve damage that can lead to muscle paralysis.

  Link: Neck Lift

• Ptosis

  Ptosis is the drooping of the upper eyelid. While ptosis is usually the result of aging, some people develop ptosis after eye surgery or an injury, and sometimes the condition is congenital. Because ptosis may be present due to serious causes, patients with this disorder should be checked by a medical professional to determine whether treatment is necessary, and if so, what kind. Causes Of Ptosis Typically, ptosis results from a weakening in the muscle responsible for raising the eyelid or from damage to the nerves that control the muscle. In some cases, ptosis may simply be caused by loose skin on the upper eyelid. Sometimes, however, the reason for ptosis is more troubling. In addition to the possibility of the disorder occurring as a congenital condition, or as a consequence of an injury or surgery, ptosis may be caused by: Migraine headache Growth in the eyelid, such as a stye Bell‘s palsy Diabetes Stroke Myasthenia gravis Horner syndrome Benign or malignant tumor In rare instances, ptosis can occur due to a brain tumor or other malignancy that affects the reactions of muscles or nerves. Symptoms Of Ptosis Ptosis presents as the drooping of one or both eyelids and perhaps one or more of the following symptoms: Increased tear production Difficulty blinking or closing the eye Reduced vision (with severe drooping) Since ptosis caused by aging is usually gradual, a sudden onset of symptoms is greater cause for concern. Diagnosis Of Ptosis Ptosis is typically diagnosed by an ophthalmologist, who can also frequently determine the cause of the problem. In order to perform a comprehensive eye examination, the doctor may test visual acuity, perform visual field testing, a slit-lamp examination, and, possibly, a tension test for myasthenia gravis. If there is a suspicion of an underlying systemic disease, the patient will be referred to an internist or other physician for further investigation. Treatment Of Ptosis Patients may seek treatment for droopy eyelids for cosmetic or medical purposes. Severe drooping may obstruct vision as the eyelid gradually droops lower and lower, eventually covering the eye. If ptosis interferes with a patient‘s vision, a blepharoplasty will be performed to eliminate the drooping. Many young patients with mild to moderate ptosis should be examined regularly to check for other vision problems including amblyopia, refractive errors and muscular diseases.

  Link: Ptosis

• Revision Eyelid Surgery

  After undergoing an eyelid surgery, or blepharoplasty, if the results are not up to the patients expectations, it can be disappointing. It is always prudent to wait a few months, after the procedure, to determine how the eyes will truly look once the swelling has gone down and healing has taken place. If a patient is still not satisfied at that point, however, a consultation can help them explore their options for an eyelid revision procedure. Complications that may occur after a blepharoplasty procedure, include some of the following: Lower eyelid retraction Discomfort or pain Blurry vision Exposure keratopathy Lack of symmetry Every patient and each case is different. In cases of overcorrection, in which too much tissue was removed, the remaining eyelid skin can often be redistributed to improve the result. When an undercorrection is the problem and not enough tissue was removed, another blepharoplasty procedure may need to be performed to achieve the patient‘s desired appearance.

  Link: Revision Eyelid Surgery

• Endoscopic Tear Duct Surgery

  Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. When an obstruction exists, tears cannot properly drain from the eyes and may well up on the surface of the eye and overflow on the eyelashes and eyelids. The eyelids may also become red and swollen with yellow or green discharge. If this blockage cannot be effectively treated through conservative methods, surgery will likely be recommended. A procedure known as dacryocystorhynostomy or dacryocystorhinostomy (DCR) will be performed to construct a new tear drain. This type of surgery is usually performed as an outpatient procedure, either using local anesthesia and sedation or general anesthesia. Causes Of A Blocked Tear Duct A blocked tear duct may be the result of the following conditions: Infection Inflammation Injury Tumor A blocked tear duct almost always is correctable, but the treatment depends on the cause and your age. Symptoms Of A Blocked Tear Duct The symptoms of a blocked tear duct may include: Excessive tearing Discharge from the eyes Crusty eyelashes or eyelids Blurry vision Pain Bloody tears An abscess in the inner corner of the eye The Endoscopic Tear Duct Procedure No incision is necessary when undergoing an endoscopic DCR. With the traditional form of this surgery, the doctor would make an incision on the side of the nose, which would leave a scar. With the endoscopic approach, the surgeon uses an endoscope-a thin, flexible, lighted tube with a microscopic camera on the end. The camera helps the doctor guide other tiny instruments, used in the procedure, through the nasal opening to access the tear duct area. A new tear drain opening is then created, providing a fresh route between the eyes and nose avoiding the obstruction. A tiny stent may be placed in the new tear drain and kept there for several months after the procedure ensuring the duct will remain open. In cases in which the tear drain blockage cannot be cleared, a small drain, known as a Jones tube, may need to be inserted in the area. This offers a permanent solution to keeping the tear duct clear. Advantages Of Endoscopic Tear Duct Surgery A major advantage of having an endoscopic DCR is that no incision is made, meaning no scar will form on the face. It is also a less invasive method of surgery, so the recovery is generally both shorter in duration and more manageable. After the surgery, there is a standard recovery time of one week. Most patients require a nasal decongestant spray and antibiotic ointment or drops to prevent infection. You may experience bruising or swelling in the eye region, which typically resolves within two weeks. Endoscopic DCR has a very high success rate and is considered a safe, low-risk procedure. However, all surgical procedures do carry some risk of complications. Those associated with a DCR are typically bleeding, infection and problems stemming from use of anesthesia

  Link: Endoscopic Tear Duct Surgery

• Dry Eye

  Dry eye is a common condition in which the eyes are insufficiently lubricated, leading to itching, redness and pain. The eyes can become dry and irritated because the tear ducts are not producing a sufficient number of tears, or because there is a chemical imbalance in the tears themselves. Natural tears require a particular chemical balance to lubricate the eyes efficiently. Alleviating the symptoms of dry eye is important. Left untreated, they have the potential to damage vision. Dry eye can be diagnosed after a thorough examination of the eyes, and a Schirmer tear test to evaluate tear production. Causes Of Dry Eye People usually begin experiencing dry-eye symptoms as they age (they are more common in people older than 50), but they can also result from certain medications, medical conditions or injuries. Dry eye tends to affect women more than men because of the hormonal changes that take place during pregnancy and menopause. Oral contraceptives can also affect the consistency of tears. Other causes of dry eye include the following: Antihistamines, decongestants and blood-pressure medications Rheumatoid arthritis, diabetes, Sjögren‘s syndrome and thyroid disease Environmental conditions such as smoke, wind or excessive sun Long-term contact lens use Eye injury Eye or eyelid surgery Inflammation of the eye (conjunctivitis or keratitis) Any of these factors, alone or in combination, can affect the frequency or consistency of tears, either of which can lead to dry eye. Symptoms Of Dry Eye The symptoms of dry eye typically occur in both eyes, and include the following: Stinging, burning or scratchiness Eye fatigue Sensitivity to light Difficulty wearing contact lenses Excessive tearing Blurry vision Dry eye can damage eye tissues, leaving tiny abrasions on the surface that can impair vision. There are, however, many treatments for relieving dry-eye symptoms, restoring eye health and protecting vision. Treatment Of Dry Eye Treatment for dry eye depends on its cause and severity, as well as the patient‘s overall health and personal preference. Nonsurgical Treatments Nonsurgical treatments, which include the following, are often effective: Deliberately blinking Increasing humidity levels at home or work Using artificial tears or a lubricating ointment Avoiding environmental irritants Eliminating medications that may be responsible Adding Omega-3 fatty acids to the diet or taking them as supplements In many cases, simple lifestyle changes can alleviate dry-eye symptoms. Surgical Treatments If less invasive methods are unsuccessful, surgical treatments, which include the following, may be an option: Insertion of punctal plugs to limit tear drainage Punctal cautery to permanently close the drainage holes Treatment of an underlying disease If an eyelid condition is causing dry eye, eyelid surgery may be recommended. If dry eye is left untreated, it can lead to complications that include pain, corneal ulcers/scars or vision loss. Preventing Dry Eye There are steps that can be taken to prevent dry-eye symptoms. Simple lifestyle modifications such as wearing protective glasses on windy days, and giving the eyes a break during reading or other tasks that require intense focus, can effectively reduce the frequency and severity of symptoms.

  Link: Dry Eye

• Trichiasis

  Trichiasis is a common condition that occurs when the eyelashes grow inward, towards the eye, rubbing against the cornea, conjunctiva and the inner surface of the eyelid. Causes Of Trichiasis The most common causes of trichiasis include the following: Chronic blepharitis Trauma Herpes zoster Epiblepharon Skin disorders Autoimmune conditions Symptoms Of Trichiasis The typical symptoms of trichiasis are redness, irritation, tearing, the sensation of a foreign body in the eye and sensitivity to light. Eventually, the contact of the eyelashes on the eye may result in corneal abrasions and the formation of ulcers. A diagnosis of trichiasis is made upon an examination of the eye. Treatment Of Trichiasis Treatment of trichiasis generally relies on the removal of the incorrectly positioned eyelashes. When there are relatively few lashes growing toward the eye, the doctor may pluck them out using forceps, but they often grow back the same way. For more permanent relief, electrolysis, radiofrequency, laser or cryotherapy treatments may be used to destroy the follicle so no regrowth can occur.

  Link: Trichiasis

• Blepharospasm

  Blepharospasm is a condition in which the eyelids spasm, closing involuntarily, forcing the patient to blink abnormally. Blepharospasm is a form of focal dystonia or abnormal contractions of the eye muscles. Patients with blepharospasm have normal vision, but the disturbance interferes with visual perception and may, in severe cases, result in functional blindness. Causes Of Blepharospasm While the underlying causes of blepharospasm are unknown, the disorder is associated with a dysfunction of the basal ganglion, the part of the brain that controls the muscles. In some cases, there seems to be a genetic component to blepharospasm since there is evidence of family history of this disorder or other types of dystonia. There are two types of blepharospasm, primary and secondary. Primary Blepharospasm Primary blepharospasm develops spontaneously. The official name for primary blepharospasm is benign essential blepharospasm or BEB, meaning that the condition is not life-threatening and is of unknown cause. Secondary Blepharospasm Secondary blepharospasm may be due to exposure to certain drugs or may develop in connection with other disorders, such as Parkinson‘s disease or Wilson‘s disease. Symptoms Of Blepharospasm Blepharospasm is progressive, usually beginning with excessive blinking and eye irritation in the presence of stress factors such as bright lights, fatigue or emotional distress. Almost always present in both eyes, as the condition progresses symptoms occur more and more frequently, interfering with daily activities. Symptoms of blepharospasm do not occur during sleep and patients may experience a period of relief from symptoms upon waking. When the disorder becomes extreme, patients may be unable to open their eyes for hours at a time. As times blepharospasm may occur with dystonia affecting the mouth and jaw, or oromandibular dystonia. In oromandibular dystonia, the patient involuntarily grimaces, clenches the jaw muscles and sticks out the tongue. When blepharospasm and oromandibular dystonia occur concurrently, the disorder is called Meige‘s syndrome. Patients with blepharospasm may experience continuing sensitivity to bright light and dry eyes. Diagnosis Of Blepharospasm At present, there is no specific test for blepharospasm and, in most cases, laboratory results in patients with the disorder are normal. Blepharospasm is typically diagnosed on the basis of: Patient history Physical examination Neurological evaluation Medical diagnosis is necessary to distinguish blepharospasm from other conditions affecting the eyelids, such as infection, allergy, and other conditions resulting in muscular weakness or contractions. Treatment Of Blepharospasm There is no current cure for blepharospasm but there are treatment possibilities. These include: Oral Medications Several medications have been found to be helpful in some cases of blepharospasm. These medications are in many different medication categories and are sometimes used off label since many have not yet been FDA approved for treating blepharospasm. They hold out hope, however, for effective treatment of this troubling disorder. Some of these medications may include: clonazepam, also known as Klonopin, lorazepam, also known as Ativan, haloperido, also known as Haldol, diazepam, also known as Valium, and zolpidem, also known as Ambien. Injections Injection the affected eye muscles of botulinum toxin ( BOTOX®), incobotulinumtoxinA (XEOMIN®), or abobotulinumtoxinA (DYSPORT®) is currently the most successful treatment for blepharospasm. Surgery If medications and injections prove ineffective in treating blepharospasm, surgery may be recommended. The surgical procedure for this condition is called a myectomy. It involves removing portions of the affected muscles to relieve symptoms. Injections of botulinum toxin may be required after the surgery. Deep Brain Stimulation While still experimental, this method of treatment has demonstrated important possibilities in the treatment of blepharospasm. Alternative Treatments Sometimes alternative treatments are used, either alone or combined with prescribed medications or injections, to combat the symptoms of blepharospasm, . These treatments may include: acupuncture, chiropractic care, biofeedback and nutritional therapy.

  Link: Blepharospasm

• Botox Cosmetic

  BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. Applications For BOTOX Cosmetic Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following: Forehead furrows Frown lines Crow‘s feet Skin bands on the neck According to Allergan, BOTOX Cosmetic has been “extensively researched, with approximately 2500 studies.” BOTOX Cosmetic Procedure And Results Using a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals. Side Effects Of BOTOX Cosmetic Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Normal activities may be resumed immediately after receiving injections.

  Link: Botox Cosmetic

• Dysport Injectable

  Prescription Dysport® injectable is a U.S. Food and Drug Administration-approved treatment for temporarily lessening or eliminating moderate-to-severe frown lines between the eyebrows. Like BOTOX® Cosmetic, Dysport injectable is placed directly into the muscle underneath a furrow, weakening the muscle to the point where it cannot contract. Dysport, also known as Reloxin, is made from a neurotoxin produced by the bacterium Clostridium botulinum; it is the same neurotoxin used in BOTOX Cosmetic. Applications For Dysport Injectable Medically, Dysport injectable is used to treat excessive underarm sweating; symptoms of cervical dystonia, which include neck pain and abnormal head position; and muscle spasms. Cosmetically, Dysport injections are used to treat the following: Forehead furrows Frown lines Crow‘s feet Skin bands on the neck Dysport Injectable Procedure And Results Using a very fine needle, Dysport injectable is placed directly into facial muscles that are causing furrows and lines. No anesthetic is required, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to 4 months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals. Candidates For Dysport Injectable According to the manufacturer‘s website, candidates for Dysport injectable are “adults less than 65 years of age” who want “temporary improvement in the look of moderate-to-severe frown lines between the eyebrows (glabellar lines).” It may not be suitable for those with the following: Allergies to Dysport injectable or its ingredients An allergy to cow‘s milk protein Surgical facial changes Very weak muscles in the treatment area A face that looks very different on each side Inflammation or infection in the area to be injected Droopy eyelids or sagging eyelid folds Deep facial scars Thick, oily skin Wrinkles that cannot be smoothed when spread apart Anyone who is pregnant or breastfeeding, or has a neuromuscular disease, should not receive Dysport injectable. Differences Between Dysport Injectable And BOTOX Cosmetic Although made from the same bacterium, there is anecdotal evidence that Dysport injectable may last longer, spread farther and take effect more quickly than BOTOX Cosmetic. Side Effects Of Dysport Injectable Side effects of Dysport injectable are usually mild and temporary, and normal activities may be resumed immediately after receiving injections. Injection-site side effects include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Eyelids can droop when Dysport injections are made in the glabellar region; they usually return to normal within 3 weeks. Side effects of Dysport injectable are the same as those of BOTOX Cosmetic.

  Link: Dysport Injectable

• Juvéderm XC Injectable Gel

  JUVÉDERM® XC injectable gel is a U.S. Food and Drug Administration-approved dermal filler that, according to its manufacturer, Allergan, Inc., is designed to “temporarily treat moderate to severe facial wrinkles and folds such as nasolabial folds” in people older than 21. Unlike the original JUVÉDERM injectable gel, JUVÉDERM XC is infused with lidocaine to make its injection more comfortable. JUVÉDERM XC is a smooth-consistency gel that restores volume to the skin, and smooths away moderate-to-severe facial wrinkles and folds. It is made of hyaluronic acid (HA), a sugar that occurs naturally in the body. In terms of the skin, HA‘s role is to deliver nutrients and hydration, and act as a cushioning agent. Young, healthy skin contains a lot of HA, but factors that include aging and sun exposure reduce the amount, causing skin to lose structure and volume. JUVÉDERM XC is most effective in improving the appearance of nasolabial folds, the lines that run from the bottom of the nose to the corner of the mouth on both sides of the face. JUVÉDERM XC Injectable Gel Procedure JUVÉDERM XC injections take about 15 minutes to administer in a doctor‘s office. A fine needle is used for the injection, which is given under the skin in the targeted area to add volume or fill in wrinkles and folds. Because JUVÉDERM XC contains lidocaine to improve comfort, an anesthetic may not be needed. However, a doctor may still elect to use a topical anesthetic on the area to be treated before giving the injection. Afterword, the doctor may gently massage the treated area(s). Once treatment is completed, patients can return, with virtually no downtime, to their regular activities. For the first 24 hours after treatment, to reduce the risk of complications, patients should avoid strenuous exercise, excessive sun or heat exposure, and alcohol consumption. Results Of JUVÉDERM XC Injectable Gel The results of JUVÉDERM XC are visible immediately after injection; any swelling and bruising, to which ice can be applied, should subside during the next few days. Results can last 6 to 9 months, and, in some cases, up to year. However, according to its manufacturer, “Results from injectable dermal filler vary and correction is temporary. Supplemental ‘touch up‘ treatments may be required to achieve and maintain optimal correction of . . . wrinkles and folds.” Risks Of JUVÉDERM XC Injectable Gel \Although JUVÉDERM XC is considered safe, there is a risk of side effects. They are usually limited to the injection site, and include the following: Redness Pain or tenderness Firmness Swelling Lumps or bumps Bruising Itching Discoloration Infection For customized treatment, Allergan, Inc., offers two types of JUVÉDERM XC: JUVÉDERM Ultra XC, which is suitable for superficial facial lines and folds, and JUVÉDERM Ultra Plus XC, a stronger formulation that is used for deeper facial folds and lines. JUVÉDERM XC is the first HA filler that is FDA-approved for use on people of color.

  Link: Juvéderm XC Injectable Gel

• Kybella

  One of the most flattering things of a person’s profile is having a chiseled, defined chin. If you have excess fat under your chin or a double chin, then you may feel a bit self-conscious about your profile and overall appearance. But, unless you want to undergo surgery, you may think that you are stuck with your double chin. One thing that you may not realize is that you have another option to choose from including an injection called Kybella. What Is Kybella? Kybella is an FDA approved injectable that is designed to help destroy fat cells under the chin. Once Kybella is injected into the fat under the chin it works to dissolve the fat and leave you with a more defined profile. How Many Kybella Treatments Will I Need? During your initial consultation with our staff, we will better be able to determine just how many treatments you will need. You may receive a total of six treatments, but on average, patients see visible results in just two to four treatments spaced one month apart. Is Kybella Right For Me? Typically, Kybella is good for patients who are otherwise healthy and who: Are bothered by the fat under their chin Feel like their double chin makes them look older or heavier set than they actually are Don’t want to go through surgery Eat well and exercise a lot but can’t get rid of their double chin How Does Kybella Work? The main ingredient in Kybella is synthetic deoxycholic acid which works to naturally breakdown and absorb dietary fat. When injected into the fat beneath the chin, Kybella works to destroy the fat cells and give patients a noticeably thinner profile. How Many People Have Been Treated With Kybella? Kybella has been the central focus in over 20 clinical studies in which more than 1600 people were treated. How Long Does Kybella Last For? One of the many benefits of Kybella, is that because it works to actually destroy existing fat cells, results should be permanent and no further treatment may be necessary for maintenance. Is Kybella Expensive? The cost of Kybella varies from provider to provider but if you want to save money on the overall cost of Kybella then enroll in the Brilliant Distinctions Rewards Program which will allow you to earn points on each treatment and redeem them for savings on future treatments. What Are The Side Effects Of Kybella? The most common side effects of Kybella are swelling, pain, numbness, bruising, redness, and hardness around the treatment site. Additionally, some patients experience problems such as ulcers, hair loss, bruising, trouble swallowing, injury to the jaw that can cause an uneven smile or facial weakness, and necrosis around the injection site. Does Kybella sound like something that you are interested in learning a little more about? Schedule your Kybella consultation and call our office today!

  Link: Kybella