So what would be some areas as to how one would correct these eyelid problems? The upper lid is really straightforward. There is an incision in the upper eyelid crease a conservative amount of extra upper eyelid skin is removed, you don’t want the eyelid too tight, and a small amount of upper eyelid fat is removed. You don’t want a hollowed out appearance, so it’s just a conservative amount. With the lower eyelid it’s much more complex. There are many more variables. The lower eyelid can be loose. In other words it can cause you dry-eye problems, you can get redness and inflammation of the lower lid because the lower eyelid has lost its attachment really to the bone of the corner of the eye. That’s corrected by tightening that ligament right back to the bone. The fat pads of the lower eyelids used to be taken out all the time. That turned out to be the exact wrong choice. It gives a hollowed out appearance, it gives an aged appearance and we’ve found out that to be youthful you need to retain fat in your face. Very interesting. Now can these procedures be done comfortably say under local anesthesia? Some can be done under local anesthesia and some cannot. The simple ones just taking extra skin from the upper or lower eyelids, maybe tightening up the corner of the eyelid that can be done under a local anesthesia comfortably. When I’m actually taking the fat and leaving it attached but flipping it over the bone into the hollows of the cheek you probably want to asleep for that. It doesn’t take very long but it is not comfortable. Best to be under during that procedure. Best to be under during. Afterwards you feel great.
Rocko in our first set of pictures this is strictly laser resurfacing of the lower eyelids. The lower eyelids in the before picture are wrinkly, the skin is irregular maybe from the fat pads underneath but really when I look at this patient the problem I see that the lower eyelid skin has become thin, the callogen has become thin, the elasticity of the lower eyelid has gone. I didn’t even make a single incision. I just vaporized the outer layer of skin delicately with a CO2 laser and that was it. Within about a month, two months, the skin of the lower eyelid turns back to white from its sort of light sunburned pink and the lid becomes smooth. The second picture is obviously an Asian woman who has lower eyelids that have sort of sunken in. They’ve become a little elongated, by elongated I mean their height from lash line down to where the eyelids stop on the cheek has become too long. It’s no longer youthful. In the after picture which is taken only a couple months after surgery you can see she still has a tiny bit of swelling of the lid but the lid height is short again, which is a sign of youth, the loose skin the sunkenness the tiredness is gone. She is much more bright eyed.
What is the typical recovery time that one would be looking at? Well typical recovery time again varies by how extensive the procedure is that I am doing in the first place. I would say that sort of the standard Tummy Tuck with the incision going across the abdomen, the muscles being tightened, some light liposuction maybe of the upper abdomen. Patients walking around, they go home the same day. They’re walking around the next day. They’re not driving perhaps ten days, two weeks. And very strenuous exercise like a pilates class would be six weeks away.
In the beginning, patients need to tell their doctor that if they are having a Tummy Tuck are you on any herbal medication, are you taking any over the counter medications because you don’t want your doctor to get in there and have you bleed and not clot well and have issues related to that. Afterwards it’s just very important to listen to what the limitations are in your instructions. Surprisingly, the patients feel very well by about a week out and they might tend to overdue it. So they just have to be cautious, let everything heal properly, increase the activity slowly as the doctor instructs you and enjoy your new figure.
You’re sort of also like a Picasso if I may use that term for the simple fact that you’re really working with the patient obviously as to what they want, what that individual wants he or she, you’re really working with them and sculpting it and certainly making it lighter and firmer as opposed to the sagging breasts that we’ve seen in the pictures and you’ve described here. Well there’s no doubt there is a cosmetic improvement that comes with it although most women that come to me that really is their secondary interest. Although afterwards they’re very appreciative for the attractiveness that the breasts now have. Now what is the typical recovery time? I’d say the typical recovery time such as time back to work is probably about a week and again it’s not because of discomfort because usually by the second or third day they’re in the mall actually looking at new clothes and feeling quite good. But there are sutures and there are incisions and I think it’s just better to have somebody off work for about a week to allow healing to progress a bit before they go back. A common question they ask is in the future are they gonna be able to breast feed. And with this technique, the technique that I use, which is the central pedicle technique, the nipple is left attached to the breast tissue and really it’s the extra skin as we saw in the operative shots that’s removed along with the breast tissue. So the central breast tissue and nipple are intact. That usually preserves sensation to the nipple, blood supply to the nipple, and the milk ducts to the nipple.
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