|Eyelid Surgery, Laser Skin Resurfacing, and Botox Injections
What Happens to Our Eyelids as We Get Older?
As we age, several changes occur in our eyelids. The thin skin
of our eyelids stretches and becomes more redundant, resulting in excess
folds of skin that may actually hang down over the edge of the upper
eyelids. This condition is called dermatochalasis.
The muscles beneath the skin
also grow weaker, allowing fat to protrude through and cause "bags",
which are particularly noticeable in the lower eyelids. This is referred
to as herniated orbital fat. Also, the levator muscle that lifts the
upper eyelids can become weak, causing the upper eyelid to droop. This
problem is called ptosis, pronounced TOE-SIS.
Fine wrinkle lines and creases
appear in the delicate skin around the lids. Sun damage, minor
injuries, acne, and other skin conditions may also leave blemishes.
What Can Be Done?
The problems caused by excessive eyelid skin and herniated
orbital fat can be corrected by a common procedure called
blepharoplasty, in which the excess skin and/or fat are removed. If the
only problem is bags beneath the eyes, they can actually be removed
without a skin incision. Correction of ptosis involves reattaching or
shortening the levator muscle.
These procedures are performed
on an outpatient basis, under local anesthesia. The surgery is usually
painless and patients may resume normal quiet activities the same day.
Wrinkles, creases, and damaged skin can be smoothed, softened, and diminished by laser skin resurfacing.
As an ophthalmologist with
extensive experience in eyelid plastic surgery, Dr. Andrew Henrick is
uniquely qualified to operate on the delicate tissues around the eye. He
can do most of these procedures under local anesthesia, often right in
Are These Procedures for Me?
Our eyes are our most
noticeable feature. Excess eyelid skin, which naturally develops in all
of us over time, can obscure the pleasing natural features around the
eyes. You may be perceived as having a tired, sleepy, or sad look. Women
may find it difficult to apply make-up. You eyes may be so tired by the
end of the day that you cannot read or watch TV in the evenings because
you simply cannot keep your eyes open. Your vision may even be
partially obscured, particularly to the sides and when looking up. If
you have any of these symptoms, eyelid surgery may be helpful for you.
What Can These Procedures Do for Me?
- Noticeable, Attractive Eyes
- Natural and Vital Look
- Rested and Vigorous Expression
- Improved Side Vision
- Ease of Applying Make-Up
- Restored Natural Eyelid Contour
Do They Hurt?
These eyelid procedures can help you look and see better
safely and without discomfort. Dr. Henrick does most of the procedures
described on this page under local anesthesia, even when more than one
procedure is required. Hospitalization is not required and the procedure
can often be done right in our office. There is no pain during the
procedure and very little post-operative discomfort. In fact, most
patients are surprised how comfortable they feel after surgery. Although
the area around the eyes may be swollen, "black and blue", or red, for
one to two weeks after surgery, sunglasses will successfully camouflage
this until it disappears.
Laser Skin Resurfacing
|How does the laser work?
Guided by your surgeon, the laser uses light pulses to
accurately and precisely vaporize damaged or aged tissue layer by layer.
The light impulses remain on the skin for very short periods of time,
so that surrounding tissue is not damaged.
The area to be treated is
marked preoperatively. The laser's low power beam is then applied to the
skin, and microscopic layers of skin vaporized. The beam itself is
absorbed by the water in the skin's cells causing them to dry. The dead
cells are then greatly wiped away from the treated area.
The laser's fine control
offers a safe, more predictable result without bleeding, minimizing the
risk of complications. The procedure usually takes anywhere from thirty
minutes to two hours depending upon the area to be treated.
Laser skin resurfacing may also be performed in conjunction with eyelid surgery.
Laser Skin Resurfacing offers many benefits, including:
- Smooth wrinkles
- Softens creases
- Restores sun damaged skin
- Diminishes fine lines around the mouth and eyes
- Minimizes acne, accident and surgery scarring
- Usually pain-free procedure
|What is involved in recovery after Laser Skin Resurfacing?
Your physician will prescribe an after care regimen to keep
the healing area moist. Immediately after the procedure the treated skin
will be red, and some swelling may occur. This usually fades within a
few weeks and can be covered with make-up. It will be important to use
sunscreen to protect your new skin from damaging ultraviolet rays. Sun
exposure causes changes in pigmentation, and it will be best to avoid
sun exposure for several months following your procedure.
How do I know if I am a candidate?
We will take into consideration your age, skin
pigmentation, medical history, and your desired results to determine if
Laser Skin Resurfacing or other eyelid procedures are appropriate for
you. Prior chemical peels or dermabrasions, sensitivity to the sun,
viral infections or healing problems should be discussed with your
|What is Botox?
Throughout history, people have looked for ways to achieve a
younger, more vibrant look by improving their facial appearance. A
procedure utilizing Botox® (Botulinum Toxin) is used for the treatment
of facial lines and wrinkles. Botox® has been safely used for certain
medical conditions for more than a decade. This procedure, sometimes
referred to as cosmetic denervation, has been widely used and is
considered a safe and effective way of treating aging skin. It is used
to eliminate or reduce worry and frown lines, "crow's feet", laugh lines
and other wrinkles sometimes called dynamic wrinkles.
The procedure works by
physiologically weakening facial muscles beneath the skin that are
related to expression lines. The contractions of those muscles result in
wrinkles. Botox® works by blocking the impulses from the nerve to the
facial muscles thereby relaxing them. The result is that the pull of the
underlying facial muscles relax causing the skin to flatten. This
results in a smooth, unwrinkled look.
Prior to treatment
Some physicians may recommend avoidance of alcoholic
beverages, anti inflammatory medications and aspirin one week prior to
A sedative or local anesthetic is not used because the
pain associated with the procedure is minimal. A small amount of
discomfort is felt when the needle is inserted and the liquid injected.
This sensation lasts approximately 5 seconds.
Botox® is injected into
various locations on the face. The needle is extremely small and only a
tiny amount of liquid is injected at one time.
Following the procedure
Because there is no sedative or anesthetic used, patients
can return to normal activities immediately after the procedure. It is
possible to experience a mild headache after the procedure. The
physician may recommend acetaminophen if this should occur. The
physician may also recommend that the patient not lie down for 3 or 4
hours following treatment. Some facial exercises may be recommended. The
treatment takes three to eight days to take effect. The benefits will
last from three to six months. A touch-up may be necessary 1 to 2 weeks
after the initial treatment.
When the toxin begins to wear off, the wrinkles begin to
reappear; however, they frequently are not as deep as the original ones.
it usually takes two or three injections each year to maintain the
smooth, youthful appearance that is desired. Clinical studies suggest
that, after several rounds of treatment, the patient may require
injections less often.
Before Botox® Injections - Crows Feet
After Botox® Injections - Crows Feet
Possible side effects
There are no serious side effects associated with this treatment. There may be
a small amount of bruising around the treated areas; however, this is temporary.
On rare occasions, the needle may puncture a blood vessel
which can result in a black and blue bruise around the treated area.
This disappears in a few days. Another side effect that occurs only
rarely is a slight drooping of the eyebrow or upper eyelid. Fortunately,
when this occurs, it corrects itself in two to three weeks. There are
no other visible signs of the treatment.
Prior to treatment, the physician discusses with each patient the side effects connected with the procedure.
The best candidates for the procedure
The best candidates for the procedure are those between
the ages of 30 and 65. in many cases, wrinkles in people over 65 are not
caused by muscle pull but rather by sun damage; however, each person is
different and must be evaluated by the physician.
Some wrinkles of the face are not caused by the muscles
pulling on the skin and therefore are not disposed to this treatment.
These include wrinkles caused by the structure of the skin which are the
result of trauma, scarring, or sun damage. The procedure works best on
the wrinkles appearing in the upper one-third of the face, because its
use on the lower two-thirds might cause distortion of a person's smile
or facial expression.
What results can be expected?
This procedure will smooth wrinkles that are caused by
frown and worry lines, "crow's feet", and laugh lines; however, it is
not designed to take the place of the standard facelift or other facial
surgical procedures. It is often used in conjunction with other
Botox® injections may not be suitable for persons with
pre-existing medical conditions or allergies. The physician will take a
complete medical history to determine if the patient is a good candidate
for the treatment.
if you are interested in learning more about the Botox®
treatment, please contact our office and we will be happy to answer your
Before Botox® Injections - Frown Lines
After Botox® Injections - Frown Lines
Dermal Wrinkle Fillers
When facial wrinkles are not completely removed by Botox, or are in an area not suitable for Botox
injections, they can be filled with a variety of substances to “erase”
them. These are injected directly into or just under the skin and cause
it to swell, thus minimizing the wrinkle indentation.
A popular substance for a long
time has been collagen. However, allergic reactions have been reported
and allergy testing should always be done prior to injecting collagen.
Collagen lasts about 3 months before needing to be repeated because it
is absorbed by the body. A more recent addition to these substances is
hyaluronic acid, a molecule normally found between the body’s cells that
acts like a binder. It is purified from roosters’ combs, in the case
of Restylane, or synthesized by bacteria, in the case of Captique.
Both of these have been shown to be safe and do not require allergy
testing. Furthermore, they can persist in the skin for 6 to 8 months
prior to being absorbed. Another injectable substance, Radiesse,
consists of microscopic calcium particles injected under the skin.
These can persist up to 2 years prior to complete absorption. Touch-ups
can be done for any of these substances before complete absorption to
maintain the favorable appearance.
Prior to treatment
It is best to avoid aspirin, ibuprofen, and vitamin E for at least one week prior to treatment to reduce bruising.
An anesthetic cream
is placed on the sites that will be treated at least 30 minutes prior to
the injections. This anesthetic will reduce the sharp pain of the
needle. As the substance enters the skin, burning or aching may be
experienced. Ice applied over the treatment areas just prior to
injection will help minimize the discomfort.
Small amounts of the filler
are injected just under the wrinkles. Multiple skin punctures may be
required to achieve the desired effect. Once the injection has been
completed, the skin may be massaged to help spread and smooth the filler
Following the procedure
Patients can usually
return to normal activities immediately after the procedure. Strenuous
activity should, however, be avoided for 24 hours to minimize bruising.
Some redness and bruising of the treated areas may occur but should
resolve within a few days. Any discomfort may be treated with ice
applications and acetaminophen. Immediately after treatment and for a
few days afterwards, the treated areas may swell. The swelling will
resolve in a few days.
The final result will become
apparent after about a week. Additional touch-up injections may be
performed one to two months later, if desired. As the material is
gradually absorbed, the wrinkles will again deepen after several months.
Possible side effects
Aside from mild
redness, bruising, and swelling, no serious side effects have been
reported. If the treated area appears or feels “lumpy” due to uneven
distribution of the filler, massage can be used to smooth the material
into better position.
The best candidates for the procedure
Dermal fillers are
best suited for the deep wrinkles between the nose and upper lip, on the
sides of the mouth, and any frown lines remaining after Botox
injections. They may also be used to smooth the pucker lines around the
mouth, and to fill in depressed areas between the lower lid and nose
(tear trough). For dynamic wrinkles, those caused by muscle
contraction, Botox should be used first followed one or two weeks
later by dermal fillers for enhancement. Fillers will not take the
place of a face lift to tighten sagging skin, but can be used afterwards
for any remaining fine wrinkles.
Are These Procedures Covered by Insurance?
Insurance will pay for upper eyelid surgery to correct ptosis
or excess upper eyelid skin when the field of vision is affected. In
such cases, the procedures are considered functional and not cosmetic.
We are a participating provider for Medicare and many insurance plans as
well. We will bill your insurance company for you.
If your field of vision
is not affected or if only the lower eyelids are to be done, insurance
companies ill not cover these procedures because they are considered
Laser Skin Resurfacing is also considered a cosmetic procedure, and most insurance companies will not pay for the procedure.
Botox injections are not covered for cosmetic purposes, but
may be covered when used to treat tics or twitching of the face and
If Insurance Will Not Cover My Procedure, How Much Will it Cost?
The cost varies depending on which procedure is required but
our staff can give you the exact cost once Dr. Henrick has evaluated
your condition. He will gladly discuss fees and payment policies with
you. Financing is available. Visa and Mastercard are accepted.
How Do I Learn More?
If you are a new patient to us, your evaluation will begin with
a complete eye examination, with one of our Board Certified
Ophthalmologists. Following this, a free cosmetic consultation with Dr.
Henrick is available. If we have seen you for a complete eye examination
within the last two years, only a short follow-up visit will be needed.
Dr. Henrick can then tell you if eyelid surgery will help you and
exactly what will be required in your case. Free monthly seminars are
given to further answer these and any other questions you may have. To
schedule a consultation or reserve a place at one of Dr. Henrick's
seminars please call us at (949)588-2020. We’ll be happy to answer any
questions and to arrange a consultation at your earliest convenience.