Cosmetic/Eyelid Center

Surgery to improve the eyelids is called blepharoplasty. The goal of blepharoplasty is to give the eyes a more youthful look by removing excess skin, bulging fat, and lax muscle from the upper or lower lids. If the sagging skin obstructs peripheral vision, blepharoplasty can eliminate the obstruction and expand visual field.

Excess skin and fat are removed from the upper lid through an incision hidden in the natural eye lid crease. If the upper lid is droopy, the muscle that raises the lid can be tightened. The incision is closed with fine sutures.

Fat in the lower lid can be removed or repositioned through an incision hidden on the inner surface of the eyelid. Laser resurfacing or a chemical peel can be performed at the same time if desired, to smooth and tighten the lower lid skin.

If there is excessive skin in the lower lid, the incision is made just below the lashes. Fat can be removed or respositioned through this incision, and the excess skin is removed. The incision is then closed with fine sutures.

After Surgery

Cold compresses are applied to reduce swelling and bruising. Antibiotic ointment or drops may be prescribed. Strenuous activity should be minimized for several days. Warm compresses may be recommended after several days to increase blood flow to the area and promote healing.

Discomfort is generally mild. Non-aspirin pain relievers are usually all that is necessary post-operatively. Aspirin products, non-steroidal anti-inflammatory medications like ibuprofen, and other blood thinners should be avoided before and after surgery as they may increase the risk of bruising and bleeding. Most patients are able to return to regular activities within several days.

Ptosis is a medical term for drooping of the upper eyelid, a condition that may affect one or both eyes. When the edge of the upper eyelid falls, it may block the upper field of your vision. The ptosis may be mild - in which the lid partially covers the pupil, or severe - in which the lid completely covers the pupil. Ptosis that is present at birth is called congenital ptosis.

What are the Causes?

In children, the most common cause is improper development of the levator muscle, the major muscle responsible for elevating the upper eyelid. With adults, it may occur as a result of aging, trauma, or muscular or neurologic disease.

As you get older, the tendon that attaches the levator muscle to the eyelid stretches and the eyelid falls, covering part of the eye. It is not uncommon for a patient to develop upper eyelid ptosis after cataract surgery.

Ptosis can also be caused by injury to the oculomotor nerve (the nerve that stimulates the levator muscle), or the tendon connecting the levator muscle to the eyelid.

What are the Symptoms?

Symptoms of ptosis include difficulty keeping your eyes open, eyestrain, and eyebrow aching from the increased effort needed to raise your eyelids, and fatigue, especially when reading. In severe cases, it may be necessary to tilt your head back or lift the eyelid with your finger in order to see out from under the drooping eyelid(s).

What are the Treatments?

Congenital ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle.

Ptosis surgery usually involves tightening the levator muscle in order to elevate the eyelid to the desired position. In severe ptosis, the levator muscle is extremely weak and a "sling" operation may be performed, enabling the forehead muscles to elevate the eyelid(s).

The main goals of ptosis surgery are elevation of the upper eyelids to permit normal visual development and full field of vision, and symmetry with the opposite upper eyelid. It is important to realize that when operating on an abnormal muscle, completely normal eyelid position and function after surgery may not be possible to achieve.

Children with ptosis should be followed closely, before and after surgery, with exams on a regular basis to ensure that their vision is developing properly.

Surgery in adults and older children is usually performed as an outpatient procedure under local anesthesia, and with the patient lightly sedated with oral and/or intravenous medications. Some surgeons prefer to use general anesthesia especially with younger children, in which case the patient will sleep through the operation.

What is BOTOX® Cosmetic?

It is a purified protein administered in a simple, nonsurgical procedure that temporarily improves the appearance of moderate to severe frown lines between the brows in people aged 18 to 65.

How can I be sure I'm getting real BOTOX® Cosmetic?

Only licensed and trained healthcare professionals have the experience necessary to administer BOTOX® Cosmetic. Allergan, Inc., the maker of BOTOX® Cosmetic, is the only source for healthcare professionals to purchase the product, and each label has the "Allergan" hologram.

How long has BOTOX® been used?

BOTOX® has been used therapeutically for over 15 years to treat a variety of medical conditions. It is approved in more than 75 countries. BOTOX® for therapeutic use remains one of the most widely researched medicines in the world. The same product with dosing specific to glabellar lines was approved in 2002 as BOTOX® Cosmetic.

What is the difference between BOTOX® Cosmetic and fillers?

Frown lines are caused by overactive facial muscles. Fillers correct the wrinkle by adding volume around the muscle with intradermal injections. BOTOX® Cosmetic is intramuscula~ blocking the chemicals that cause facial muscles to contract, thereby relaxing them. While there are many options available for fillers, BOTOX® Cosmetic is the only product of its type that affects the muscles that cause wrinkles between the brows.

Have patients been happy with their results?

According to a recent survey of 204 dermatologists and plastic surgeons, BOTOX® Cosmetic has the highest satisfaction rating of all physician-administered treatments in 2003 and 2004.*

And for the past 3 years, BOTOX® Cosmetic was the most popular physician-administered cosmetic procedure in the United States (surgical and nonsurgical combined), The American Society for Aesthetic Plastic Surgery also estimates that almost 3 million people were treated with BOTOX® Cosmetic in 2004 alone.

What is the BOTOX® Cosmetic procedure like?

It's a simple, 10-minute treatment consisting of a few tiny injections. You may resume normal activity immediately. The doctor decides exactly where to administer BOTOX® Cosmetic for best results.

Is the procedure painful?

It causes little discomfort; most patients compare the sensation to a bug bite. Overall, the discomfort is minimal and temporary.

When will I start to see results?

You should start to see a visible improvement in the area between your brows within a few days. The area may continue to improve for up to a week.

How long will the results last?

When administered properly, the effects of BOTOX® Cosmetic treatment can last up to 4 months.

How will BOTOX® Cosmetic affect my facial expressions?

BOTOX® Cosmetic is injected in small doses directly into the muscles that cause those moderate to severe frown lines between your brows to form, allowing that area to smooth out. It won't affect your ability to laugh, smile, or otherwise express yourself.

Is BOTOX® Cosmetic expensive?

It is the least costly facial aesthetic procedure performed in the United States.

How can I find more information?

You can visit the Web site at BotoxCosmetic.com.

Important Safety Information

Patients with certain neurological disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects. Serious allergic reactions have been rarely reported. If you think you're having an allergic reaction such as difficulty swallowing, speaking, or breathing, or other unusual symptoms, call your doctor immediately.

The most common side effects following injection include headache, respiratory infection, flu syndrome, temporary eyelid droop, and nausea.

How are wrinkles corrected?

The appearance of wrinkles and facial folds can be smoothed by adding volume underneath and bringing the skin back up to the surface. Generally, this is done by injecting materials called "dermal fillers" into the skin, to achieve a temporary effect.

What is a dermal filler?

Dermal fillers are compounds that can be safely injected below the surface to raise the level of the skin. Examples of dermal fillers are collagen and hyaluronic acid.

What is hyaluronic acid?

Hyaluronic acid (HA) is a natural complex sugar found in all mammals. It's a major component of the dermis connective tissue matrix.

HA retains water like a sponge, absorbing more than 1000 times its weight. This helps to attract and maintain water, hydrating your skin and increasing its volume and density. HA is also involved with the transport of essential nutrients to the skin's viable cells.

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JUVEDERM™ INJECTABLE GEL

What is JUVEDERM'" injectable gel?

• JUVEDERM'" injectable gel is a family of hyaluronic acid injectable gels from Allergan, Inc. for the correction of moderate to severe facial wrinkles and folds.
• JUVEDERM'" Ultra injectable gel is optimally formulated for versatility in contouring and volumizing wrinkles and folds.
• JUVEDERM'" Ultra Plus injectable gel is a robust formulation for volumizing and correcting deeper wrinkles and folds.

How is JUVEDERM'" injectable gel different?

JUVEDERM'" injectable gel is produced through HYLACROSS'" technology, cross-linking high concentrations of HA and still maintaining a smooth product.

During the cross-linking phase of manufacturing, hyaluronic acid chains are "tied" to each other by chemical bonding; in effect, interconnecting many strands of HA. Unless hyaluronic acid is cross-linked, it will be absorbed by the body and persist for only about a week.

HYLACROSS'" technology results in a smooth-consistency gel, which is a primary factor in the smooth, natural look and feel that is a hallmark of JUVEDERM'" injectable gel wrinkle correction.

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TREATMENT

What happens before treatment with JUVEDERM'" injectable gel?

Your healthcare professional will assess your facial wrinkles and folds and determine if treatment with JUVEDERM'" injectable gel is appropriate for you.

Can this be done in the office?

Yes, wrinkle correction with JUVEDERM'" injectable gel is an in-office procedure.

What happens during treatment with JUVEDERM'" injectable gel?

You sit in a chair while your physician injects JUVEDERM" injectable gel. There can be a bit of discomfort during any wrinkle correction, and you can discuss with your healthcare professional whether you would like pain management during treatment.

How long does treatment with JUVEDERM'" injectable gel take?

It generally takes about 30 to 45 minutes for a consultation and treatment.

What happens after treatment with JUVEDERM'" injectable gel?

Your physician will review with you what to expect following treatment with JUVEDERM" injectable gel. And we will send you home with details for aftercare treatment.

• Generally, you should avoid the following for at least 24 hours:
• Strenuous exercise
• Consumption of alcoholic beverages
• Extended exposure to sun or heat

Exposure to any of the above may cause temporary redness, swelling, and/or itching at the injection sites. If you have swelling at the injection site, you can apply an ice pack for a brief period. Your healthcare professional will inform you when you can apply makeup after your treatment.

Remember that correction is temporary and touch-up injections as well as repeat injections are usually needed to maintain optimal correction with any dermal filler, including JUVEDERM" injectable gel. If you have any questions or concerns about your JUVEDERM'" treatment, contact us.

How long does JUVEDERM'" injectable gel last?

Treatment with JUVEDERM" injectable gel lasts up to 6 months or longer.