FAQ’s

Eyelid Surgery (Blepharoplasty)

Ophthalmic plastic and reconstructive surgery (oculoplastic surgery) is a unique specialty combining training in ophthalmology and plastic surgery. This specialty has developed because of the amount of knowledge, expertise and special techniques needed to treat patients with conditions involving the eyelids and eyebrows, the lacrimal (tear drainage) system, the orbit (the bony socket around the eye), and the area of the face adjacent to the eye.

The primary difference between general and ophthalmic plastic and reconstructive surgery is on the emphasis of the health of the eye and preservation of vision. Oculoplastic surgeons have a special awareness of the importance of function as well as appearance This subspecialty came in to existence because of the delicacy involved in operating on the area surrounding the eye, and has resulted in significant surgical advances. Additionally, this highly specialized field provides expertise in revising and repairing unsatisfactory results from previous cosmetic or reconstructive surgeries surrounding the eye.

This field is divided into two areas: cosmetic and reconstructive surgery.

Cosmetic oculoplastic surgery is concerned with improving the appearance of the eyelids, eyebrows, forehead and face. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat, usually along with excess skin and muscle, from the upper and lower eyelids. Tendons that have shifted out of place with age or trauma may be moved and repositioned so that they will function more naturally. Eyelid operations make the person look younger, and it also allows women to take better advantage of makeup. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision.

Reconstructive oculoplastic surgery involves the correction of defects caused by aging, trauma, tumors and congenital abnormalities. Most of these conditions can detract from appearance and cause discomfort. Certain conditions – such as eyelid tumors, eyelid position problems, thyroid disease and congenital ptosis (droopy eyelids), can cause significant permanent damage if left untreated.

Cosmetic eyelid surgery (technically called blepharoplasty) is a procedure to remove fat – usually along with excess skin and muscle – from the upper and lower eyelids. Eyelid surgery can correct dropping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision. However, it won’t remove crow’s feet or other wrinkles (see Juvederm or Botox) or lift sagging eyebrows (see endoscopic brow lifts). While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.

In many cases, Dr. Weiss utilizes a procedure for improving the appearance of the lower eyelid that avoids a skin incision altogether, which he has been popularizing since 1986 when it was first introduced among oculoplastic surgeons. In a transconjunctival blepharoplasty (TCB), a tiny incision is made inside the lower eyelid and fat is removed from behind the eyelid without a skin incision. The incision is closed behind the eyelid with a single dissolving suture.

Ptosis (droopy eyelids) is a condition in which the position of the upper eyelid margin is abnormally low; it usually results from the aging process, trauma, or is present from birth. This is a completely different problem than extra skin in the upper eyelids, although both of these conditions may be present in the same patient. Ptosis is corrected by shortening the tendon which raises the eyelid. Brow elevation and ptosis procedures are sometimes covered by insurance if excessive skin or the eyelid is obscuring vision, weighing down the lashes, or causing a feeling of discomfort or brow ache because of difficulty keeping the eyelids open.

Because relaxation of the eyebrows may compound the sagging of the upper eyelids by crowding the eye and producing an abnormal appearance of fatigue and premature aging, an operation to elevate the brows is recommended for some patients.

The most recent advance in brow elevation is called the endoscopic brow lift or upper face lift. Tiny incisions (about one-half inch) are made just behind the hairline and the procedure is performed by inserting an endoscope through these incisions, similar to endoscopic knee surgery. In addition to elevating the eyebrows, the endoscopic approach is effective in reducing the crow’s feet or laugh lines, the frown lines between the eyebrows, and forehead furrows – resulting in a more rested, youthful appearance.

Outpatient surgery is less costly and time consuming, and far more convenient – you can return home the same day of surgery. The pleasant ambiance and non-institutional setting of our surgical facility is also more comfortable for the patient. Your only concern should be what type of music that you want to listen to over our state of the art surgery suite sound system – or ask Dr. Weiss to play you one of his own piano recordings of Chopin waltzes or jazz standards.

Eyelid surgery is commonly performed under local anesthesia – which numbs the area around your eyes – along with oral sedatives. In some cases you may elect to have more sedation, including general anesthesia, but it’s usually not necessary. You’ll be awake but relaxed and insensitive to pain during the surgery, although some people may feel occasional tugging or mild discomfort. Music of your choice will be playing in the background to relax you even further. More complicated or extensive procedures do require general anesthesia or IV sedation.

To avoid the potential for increased bleeding, patients who will be undergoing cosmetic eyelid surgery are instructed to avoid taking aspirin or any over-the-counter products containing aspirin for two weeks before surgery. Cigarette smoking, vitamin E, and certain spices in Szechwan food are also known to increase the potential for bleeding and are to be avoided before surgery. In addition, a combination of pre-operative vitamins, Bioflavonoids, antioxidants, holistic medications (see nutritional medicine section), and meticulous surgical technique markedly reduces post-operative bruising.

You should be able to read or watch television after two or three days. However, you won’t be able to wear contact lenses for about two weeks. Most people feel ready to go out in public (and back to work) in a week to ten days without makeup. Healing times vary from patient to patient, but generally you will be able to ride down the elevator after having the stitches removed after six days and no one will know that you had surgery!

They are removed between 5 and 10 days.

Because of Dr. Weiss’ special surgical techniques and pre- and post-operative care, about half of his patients have almost no bruising or discoloration at all (there is always mild to moderate swelling). Bruising, when it does occur, usually resolves completely in 7-10 days and can be covered with makeup well before that. Swelling or slight puffiness is also 85%-90% improved within 7-10 days after surgery, although occasionally a small amount of tissue swelling may persist for weeks or months.

You can try to put them in a week after surgery. If it doesn’t feel right remove them and wait a few days longer.

Yes.

Except for occasional watery eyes, your vision is unaffected. No bandages are needed, although you will be asked to wear some protective shields over the eyes at bedtime for the first week.

If you would like to learn more about cosmetic eyelid surgery, or find out if you would benefit from this procedure, please call our office at 949-720-1400 to schedule a private complimentary consultation with the doctor.

Laser Skin Rejuvenation

Currently the carbon dioxide and erbium lasers are used for skin resurfacing procedures including wrinkle removal, acne scar removal, treating skin discoloration and uneven pigmentation, and for the treatment of sun damaged skin.

Dr. Weiss most commonly treats the face, particularly the problem areas around the eyes, including the upper and lower eyelids and “crow’s feet” areas, and the mouth, chin forehead frown lines. Although single areas of the face can be treated separately, it is often preferable to treat the whole face as one unit. When the whole face is treated at once, there is very little chance of a noticeable demarcation line between the area treated and the area not treated.

The new development in laser technology (represented initially by the Ultrapulse CO2 laser, then with the Erbium lasers, and more recently with fractional CO2 lasers) that has allowed the recent advances in skin resurfacing, is the ability to apply the laser energy very quickly before the heat can spread to the underlying tissue and cause thermal damage. The laser target tissue is water, which is the main component of every cell in the body. The laser removes tissue by rapidly heating and vaporizing the water within the cells of the superficial skin surface. The remaining protein of the cell is then precisely removed layer by layer by actually gently wiping the wrinkles away, much as one would wipe away the dead skin off the ankle after being in a warm bath. In addition, laser energy seems to cause collagen shrinkage that actually “tightens up” the skin surface.

Dr. Weiss’ preferred method in most cases is the combined use of the Coherent Ultra Pulse CO2 and one of the Erbium lasers. However, individual cases vary and sometimes either laser alone is used. More recently, a variety of Fractional CO2 lasers can be used without general anesthesia to produce similar results while decreasing the risks and recovery period.

Here is the theory. The pinkness of the skin during the recovery period after laser skin resurfacing is thought to be due to a thin (80-100 microns or about a tenth of a millimeter) layer of thermal inflammation caused by the CO2 laser, which gradually disappears. The Erbium laser light is about one hundred times more effectively absorbed by water and leaves less thermal inflammation than the CO2 laser, which is why it causes so much less pinkness when used alone (unfortunately, it is also less effective when used alone). Dr. Weiss uses several passes of the Erbium laser immediately after the CO2 laser treatment in an attempt to reduce the amount of residual thermal inflammation present and lessen the total recovery time.

The recovery period will vary from patient to patient and will depend on the amount and extent of treatment performed. Typically, patients will be quite red post-operatively for 5 to 10 days. During that period you will be instructed to keep the treated area(s) well lubricated and moist with cold compresses. The redness will generally fade to light pink within 2 weeks. Because Dr. Weiss uses a more advanced and extensive newer technique first described by an Australian dermatologist which includes the simultaneous use of both the carbon dioxide and the erbium lasers, the pinkness will usually fade completely in 4-8 weeks, rather than the 3-6 month recovery period of older methods. The recovery period is much shorter with the Fractional CO2 lasers.

Based on our patients experiences, the results will last from 5 to 10 years or longer. Results vary between individuals and depend on genetics, age, baseline skin condition, and subsequent skin care and sun exposure.

Additional treatments are sometimes required for maximum results, particularly in patients with significantly sun damaged skin. Very deep, stubborn lines may be retreated after approximately 2 months. It is rare to require more than one CO2 laser treatment. Re-treatments may occasionally be required with the Fractional CO2 lasers.

Once the skin is completely healed, the treated area(s) will in the majority of cases blend naturally into the untreated areas. With medium to darker skin types, there does exist the possibility of slight skin lightening in the area that is treated. To minimize this risk, full face resurfacing is often preferred in many patients.

The procedure can be performed with intravenous sedation and local infiltration anesthesia in certain patients, and in others general anesthesia with a board-certified anesthesiologist and a controlled airway is preferred. Fractional CO2 laser treatments can be performed in the office with only a topical anesthetic cream.

Men are sometimes very good candidates for laser procedures. In fact, men’s thicker skin heals much faster and with less redness than women’s more delicate skin. However, in men, full face treatments are strongly preferred because makeup is usually not an option in the post treatment period.

Yes. Lasers allow physicians to selectively peel wrinkles without damaging the area around them, giving the physician more control over the tissue that is being treated. Laser skin resurfacing is much more accurate and precise than other methods. It is also safer and there are not as many side effects. Other advantages include decreased post-operative pain, a decreased rate of infection and often a reduction in operative time.

Patients can begin wearing makeup to cover the treated area(s) 5 to 10 days after the procedure.

Carbon dioxide lasers have been used in medicine for removing skin lesions since the late 1960’s. The current era of laser skin resurfacing began in about 1994, and was made possible by the advent of the Ultrapulse CO2 laser. Laser skin resurfacing has rapidly achieved widespread use among cosmetic surgeons because of its ability to safely and predictably produce dramatic improvement of skin wrinkling. Fractional CO2 lasers began to appear in 2007.

Dr. Weiss has been using medical lasers since 1980, and has been performing laser skin resurfacing since May of 1995. Since then, he has been at the forefront of developing safe methods of increasing efficacy and decreasing the recovery time with various newer modifications of technique.

Common sense is the rule here. With sunscreen applied to the skin, patients can be in the sun relatively quickly, in most cases by the second week. Of course, sun bathing is strongly discouraged for several months. The treated areas should be particularly well protected with sunscreen until the pinkness is completely gone.

Possible side effects of the laser include mild skin lightening or darkening, infection, herpetic outbreaks, and scarring. Dr. Weiss has not seen any scarring within his practice. The laser is a tool, and when used correctly in properly chosen patients, the risk of complications is rare. In any case, these risks are less than those associated with dermabrasion and deep chemical peels.

Yes. People with darker skin pigment are done with caution. In rare cases it is preferable to treat a test area with the laser before proceeding with the full treatment.

No. Typically a test is only performed on people with darker skin pigment. When a test is performed, it is usually done behind the ear or on the forehead just beneath the hairline.

The cost for laser skin resurfacing will vary depending on how large the area is being treated, how many areas are being treated, the condition of the skin and the depth of the wrinkles. The total cost to the patient including all pre- and post-operative visits, initial dressings and medications, surgeon’s fee, anesthesiologist fee and facility fee will range from $1200 to $5000.

If you would like to learn more about laser skin resurfacing and to see how you could benefit from this procedure, please call 949-720-1400 to contact us to schedule a private, complimentary consultation.

BOTOX

Botox reversibly blocks impulses from the nerve to the tiny facial muscles that are related to expression lines. Botox does not directly act on the nerve or the muscle itself, but has the effect of relaxing the muscles so they do not contract. After treatment, the overlying skin remains smooth and unwrinkled while the untreated facial muscles contract in a normal fashion, allowing normal facial expression to be unaffected.

Botox (Botulinum toxin A) is a purified biological protein that is produced by Allergan pharmaceuticals, under rigorous laboratory conditions, by the growth of Clostridium Botulinum bacterium. Botox is then diluted to an extremely weak solution before being used.

Botox injections have been used safely and effectively for over twenty years to treat many ophthalmologic and neurological disorders. It is now the most commonly performed cosmetic procedure around the world, and it is also known to be the safest.

Botox is a simple and safe procedure. Using a tiny micro-needle, a small amount of Botox is precisely injected into several locations on the face. Because the needle is so fine and only a small amount of liquid is used, the discomfort is minimal. Most patients compare the sensation to a bug bite or they don’t feel it at all. No sedation or local anesthetic is required, and you can resume normal activities immediately. You can even drive yourself home or back to the office. Some patients experience a slight temporary bruising at the injection site. This can be covered with make-up.

Dr. Weiss has been using Botox since 1989 and has never seen a lasting or serious side effect, even with repeated injections. Temporary bruising is the most common side effect. In some cases, the toxin can migrate and cause a temporary weakness of nearby muscles. In rare cases, there can be a temporary drooping of an eyelid or asymmetry of facial expression. The risk of any side effect depends on the muscles injected. Your doctor will discuss this with you at length before your treatment. Because the effects of Botox are completely reversible, any side effects are temporary, lasting only a few weeks.

If dynamic wrinkles make you look older than you are, Botox treatments can smooth these out and give you a more youthful and pleasant appearance. However, this procedure cannot improve wrinkles due to aging and sun-damaged skin since they are unrelated to facial muscle contractions. Botox injections will not improve sagging skin or replace the need for a facelift, brow lift or eyelid surgery.

The effects of Botox injections are temporary, lasting from three to six months. If you like the results of the treatments, you will need to have injections about two to three times a year. The duration of effect varies form patient to patient and may be less effective for those over 65 years of age.

Cosmetic injectable fillers ( Juvederm and Voluma) improve the appearance of deeper, discrete wrinkles by filling in the depression. Botox is not a filling substance, but reduces the motion of the underlying muscles, reducing or eliminating the overlying wrinkles.

If you would like to learn more about your cosmetic options, or find out if Botox treatments might work well for you, please call our office at 949-720-1400 and schedule a consultation with the doctor.

Cosmetic Eyelid Surgery (Blepharoplasty) Glossary

Alternate terms: baggy eyelids, eyelid bags, lower lid bags, under eye bags.

This term usually refers to excessive fullness in the lower eyelids, but sometimes is also used to refer to upper eyelid fullness. The cause of the baggy eyes or eyelids is prominent orbital fat. The bags can be removed with either a transcutaneous (through the skin) blepharoplasty or a transconjunctival blepharoplasty (no skin incision).

Blepharoplasty cost can vary widely depending on the amount of surgery needed. Blepharoplasty prices also can be dependent on several other factors. Blepharoplasty surgery cost sometimes reflects the facility fee and is more expensive in those cases where general anesthesia is needed for adjunctive procedures such as endoscopic brow lifts and laser skin resurfacing. Fortunately, upper eyelid and transconjunctival blepharoplasty cost is less because these procedures can most safely and accurately be performed in the office operating room with local anesthesia. Please call 949-720-1400 to schedule an appointment for a personalized financial estimate.

A blepharoplasty surgeon is a cosmetic surgeon that performs cosmetic eyelid surgery. Blepharoplasty surgeons can be from various medical specialties, but the best blepharoplasty surgeons are generally those with the most experience and training. There is no ‘best ptosis surgeon’ or ‘best blepharoplasty surgeon’, but the surgeons who have the most experience and training with blepharoplasty tend to be ophthalmic plastic surgeons (also known as oculoplastic surgeons). They are trained in special techniques to give the best cosmetic result while protecting the health of the eye itself.

See blepharoplasty surgeon.

Alternate terms: blepharoplasty, cosmetic eyelid surgery, cosmetic blepharoplasty, eye tuck, eyelid tuck

Cosmetic eyelid surgery (blepharoplasty) refers to the removal of excess eyelid skin and fatty tissue to improve the appearance of the eyelid and orbital area of the face. Occasionally, this also includes lower eyelid tightening, endoscopic brow lifts, and ptosis (droopy eyelid) surgery.

See ptosis surgery.

Alternate terms: Endoscopic brow lift, endoscopic brow lift surgery, eyebrow ptosis surgery, browlift, brow lift surgery, brow ptosis surgery

Endoscopic brow lift is a method of elevating an eyebrow that has descended with age (eyebrow ptosis or droopy eyebrow). The endoscopic browlift is a relatively minimally invasive and safe procedure which is performed by inserting instruments and a small video camera through tiny incisions in the scalp (there is no hair loss because the incisions are made between the hair follicles) to free up the forehead and elevate it to its former natural position. The endoscopic brow lift surgery recovery time is literally a matter of days and the is usually no bruising because the dissection plan is subperiosteal – where there are no blood vessels. It is also very safe because there are also no nerves or other structures in this area. Endoscopic brow lifts are commonly performed in conjunction with cosmetic eyelid surgery to obtain the best and most lasting cosmetic result.

Endoscopic brow lift cost is a little more expensive than eyelid surgery alone. The endoscopic brow lift surgery prices include the surgeon’s fee as well as the facility fee and the anesthesiology fee. Please call 949-720-1400 to schedule an appointment for a personalized financial estimate.

Alternate terms: eyelid lift, eyelid surgery, eyelid tuck, heavy eyelids, lower eyelid lift, ptosis eyelid surgery

Eyelid surgery refers to any type of surgical procedure performed on the eyelids. This could include all types of cosmetic eyelid surgery (blepharoplasty) and reconstructive procedures such as ptosis surgery (droopy eyelid surgery), ectropion, entropion, and eyelid tumor surgery (basal cell and squamous cell carcinoma of the eyelid).

Alternate terms: Cosmetic eyelid surgery cost, cosmetic eyelid surgery price, eyelid surgery cost, eyelid surgery prices.

Eyelid surgery cost will vary depending on the procedures needed and the extent of the problem. Since it is best performed with just local anesthesia, cosmetic eyelid surgery prices are substantially lower than procedures that require general anesthesia. Please call 949-720-1400 to schedule an appointment for a personalized financial estimate.

Alternate terms: ptosis procedure, ptosis surgery procedure, droopy eyelid surgery, heavy eyelid surgery

Ptosis surgery is a special procedure that elevates an eyelid that has descended because of either a muscle weakness or problem with the tendon that raises and lowers the eyelid. It is almost exclusively performed by ophthalmic plastic surgeons. It is often confused with blepharoplasty (cosmetic eyelid surgery) but is a separate and distinct procedure. The ptosis surgeon must shorten the levator tendon and ensure that both eyelids are not only elevated, but are symmetric and have the same contour. It is sometimes but not always performed with blepharoplasty. True ptosis surgery is usually covered by medical insurance.

Alternate terms: Ptosis cost, ptosis price, ptosis surgery cost

Ptosis surgery cost is covered by medical insurance when the level of the eyelid needs to be elevated by shortening the tendon and the droopy eyelid is interfering with vision and activities of daily living.

Alternate terms: baggy eyelids, under eye puffiness, heavy eyelids

See baggy eyelids.

Alternate terms: Transconjunctival blepharoplasty, tcb, tcb surgery

Transconjunctival blepharoplasty (TCB) is an eyelid surgery that is performed from behind the eyelid through the conjunctiva (the mucosal surface that lines the eyelid) without a skin incision. It is usually cosmetic and involves either the removal or transposition of eyelid fat to enhance the cosmetic appearance and remove the bags that are causing the shadows or dark circles under the eyes. This procedure should be persormed by a TCB specialist who is usually an ophthalmic plastic surgeon. TCB surgery cost is usually less than surgery through the skin. TCB gift certificates are available at Weiss Cosmetic.

Alternate terms: upper blepharoplasty, upper eyelid blepharoplasty, upper lid blepharoplasty, eyelid tuck, eye job, cosmetic eyelid surgery

Upper eyelid blepharoplasty refers to cosmetic eye lid surgery of the upper eyelid. See cosmetic eyelid surgery.

Upper blepharoplasty prices vary with the condition and whether eyebrow surgery or ptosis surgery also needs to be performed. Please call 949-720-1400 to schedule an appointment for a personalized financial estimate.