Eyelid Surgery (Blepharoplasty)

What is oculoplastic surgery?

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.

What is cosmetic eyelid surgery?

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.

How can Dr. Weiss remove the bags and shadows without a skin incision?

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.

How is ptosis (droopy eyelid) correction different from cosmetic eyelid surgery?

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.

What is cosmetic eyebrow surgery?


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.

What are the advantages of outpatient surgery?

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.

Will I feel anything during eyelid surgery?


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.

How can bruising be minimized?

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.

How much recovery time do I need?

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!

When do the sutures come out?


They are removed between 5 and 10 days.

Will I have any bruising and swelling? And for how long?

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.

When can I resume contact lens wear?

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.

Do I need a driver?

Yes.  If a friend or family member is not available, you are welcome to use a taxi service or a ride-sharing app such as Lyft.

Will I be able to see right away and are there any bandages?

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.

How can I find out if I am a candidate for cosmetic eyelid surgery?


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

What conditions are treated with laser skin resurfacing?

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.

What areas of the face are most commonly treated?

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.

How does the laser remove wrinkles?

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.

What type of lasers does Dr. Weiss use?


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.

Why does Dr. Weiss use two lasers?

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.

What is the recovery period and how long will the treated area remain pink?


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.

How long will the results last?

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.

If I only have one site done will the texture and color be even with the rest of my face?


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.

What kind of anesthesia is used?

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.

Can men be treated with the laser?


Yes!  Men can be 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.

Are laser procedures more effective than dermabrasion and chemical peels?

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.

When can makeup be worn again?

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

How long has laser skin resurfacing been performed?

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.

How long has Dr. Weiss been doing laser skin resurfacing?

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.

How long do I have to stay out of the sun?

 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.

What are the possible complications or side effects?

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.

Are there skin types that are not ideal for laser skin resurfacing?

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.

Does everyone need a laser test before surgery?

 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.

How much does laser skin resurfacing cost?

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.

How can I find out if I am a good candidate for laser skin resurfacing?

 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.


How does Botox work?

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.

What exactly is Botox?

 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.

Are Botox treatments safe?

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.

What is the treatment like?

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.

Are there any side effects?

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.

What results can I expect?

 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.

What are the limitations of Botox injections?

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.

What is the difference between Botox and filler injections?

Cosmetic injectable fillers ( like 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.

How can I find out if I am a candidate for Botox?

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.