Ophthalmic plastic surgery, or oculoplastics, is a subspecialty of ophthalmology that deals with disorders of the eyelids, orbits (bones around the eyes), eyeball and lacrimal (tear) system.
Plastic surgery of the eyelids and brow can help patients see more clearly as well as look younger and rejuvenated. By removing excess tissue and tightening the skin, cosmetic and functional eyelid surgery and browlifts can not only increase the visual field but also “turn back time” by reducing the appearance of wrinkles, lines and sagging skin that make you look angry or tired. It can also correct defects such as ptosis (droopy eyes) and dry eyes. These surgeries are typically performed as outpatient procedures with local anesthesia. Complications are rare.
By removing excess fat, skin and muscle from the upper and lower eyelids, blepharoplasty can rejuvenate puffy, sagging or tired-looking eyes. It is typically a cosmetic procedure but can also improve vision by lifting droopy eyelids out of the patient’s field of vision. Blepharoplasty cannot be used to raise the eyebrows or reduce the appearance of wrinkles, crow’s feet or dark circles under the eyes, but the procedure can be combined with others such as a facelift and BOTOX ® treatments to achieve these results.
The procedure is usually performed in an office with local anesthesia and lasts 45 minutes to a few hours depending on how much work is done. Incisions are made along the eyelids in inconspicuous places (in the creases of the upper lids, and just below the lashes on the lower lids). The surgeon removes excess tissue through these incisions and then stitches them closed with fine sutures. In the case that no skin needs to be removed, the surgeon will likely perform a transconjunctival blepharoplasty, where the incision is made inside the lower eyelid and there are no visible scars.
Stitches are removed after three or four days and most people return to work in ten. Contact lenses may not be worn for two weeks. Eyes can be sensitive to light and wind and may be slightly irritated for a short while; your surgeon may prescribe eye drops and cool compresses to counteract these discomforts.
Complications from the procedure are uncommon, and can include: infection, reaction to anesthesia, double or blurred vision for a few days, temporary swelling of the eyelids, tiny whiteheads, and difficulty closing eyes when going to sleep. Uneven healing and scarring, and ectropion (pulling down of the lower lids) are very rare and may require surgical correction. Patients with thyroid problems, dry eye, high blood pressure, diabetes, detached retina, glaucoma or other health problems should consult with an ophthalmologist about eligibility.
A browlift, also known as a forehead lift, is a surgical procedure performed to reduce the appearance of wrinkles and furrows in the forehead. When performed using endoscopic techniques, a browlift produces noticeable results through a minimally invasive procedure.
An endoscopic browlift is performed on an outpatient basis under local anesthesia with sedation or general anesthesia. Several small incisions are made within the scalp, into which an endoscope and tiny surgical instruments are inserted. The skin in the forehead area is lifted, while excess fat, muscle and skin are removed. Your doctor may use temporary screws or sutures to hold the skin and muscle in place during the healing process.
After the incisions are closed, the head is wrapped with a bandage. Any stitches or staples can be removed within a week, while screws are removed after two weeks. The entire procedure takes one to two hours to perform, with patients able to return home the same day.
Botulinum toxin, sold under the brand name BOTOX® Cosmetic, is a synthetic chemical that can be used to block nerve signals for treatment of a wide range of conditions. Although most commonly known for its cosmetic applications, BOTOX Cosmetic injections are an effective treatment for many medical conditions, including muscle spasm disorders such as blepharospasm, which results in forcible closure of the eyelids.
BOTOX Cosmetic injections are administered, with no need for anesthesia, directly into the affected muscle. The injection effectively blocks nerve signals sent to the muscle to prevent it from contracting and to reduce pain.
Patients may need anywhere from 1 to 10 injections during a single treatment session in order to successfully block nerve signals. The results of treatment are often most effective during the first 2 to 6 weeks after the injection and, according to the manufacturer, will last for up to 4 months. Results can be maintained through routine follow-up injections.
JUVÉDERM® Injectable Gel
JUVÉDERM® XC is a new U.S. Food and Drug Administration-approved version of the effective JUVÉDERM dermal filler. Like the original JUVÉDERM, JUVÉDERM XC is a smooth-consistency gel that, when injected, restores volume to the skin, and smooths away moderate-to-severe facial wrinkles and folds. JUVÉDERM XC, however, contains lidocaine, a local anesthetic, to minimize the mild discomfort sometimes caused by the injections.
As a result, this new JUVÉDERM formula eliminates the need for a topical anesthetic, as well as the up-to-30-minute wait for it to take effect. The lidocaine in the injection takes only seconds to spread across the treatment area. Results may last 6 to 9 months, and, in some cases, up to year. However, additional touch-ups may be needed to maintain optimal results.
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