Are you a cookie cutter lower lid cosmetic patient? The old adage, “When all you’ve got is a hammer, everything is an anvil” is also quite true in lower blepharoplasty. There are countless ways to perform lower blepharoplasty, some ways…
Being a specialist, I don’t often get the chance to perform comprehensive eye care. In fact, I have very little interest in performing comprehensive eye care! I’ll stick with eyelid and eye socket surgery, thank you very much. Nevertheless, I…
This 81 year old gentleman came to see me because he had poor vision from a drooping brow, and discomfort from a folded out lower lid. He had a significant history of sun exposure throughout his life and developed an…
This 51 year old patient presented with complaints of upper eyelid tissue obscuring her vision. She also was unhappy with the appearance of her lower lids. She had significant laxity of the lower lid tissue that mandated an open lower…
This patient is seen 5 months after reconstruction of a left lower lid defect. The tumor was removed with the Mohs technique, performed by a specially trained dermatologist. The reconstruction was performed by Dr. Walrath.
Office injections are a huge part of my practice, whether they are cosmetic injections of Botox or fillers, injections in the periocular region to remove or biopsy lesions, or injections prior to major surgical procedures like upper and lower blepharoplasty.…
Frontalis suspension is a specialized technique used to correct upper lid ptosis when the upper lid function is very poor: in certain cases of congenital ptosis, or neuromuscular disease, or mitochondrial disease. In these cases, the lids do not function…
Upper lid surgery can be confusing. Let’s demystify! The following panels explain the difference between ptosis repair and upper blepharoplasty. Basically, think of upper blepharoplasty as removal of tissue. There is nothing else to it. Sure, there are nuances, specifically…
Many patients cannot close their eyes properly, due to surgical complications or paralysis or aging. This video demonstrates that, in patients with some degree of eyelid function intact, it is often possible to leverage that function with a lid tightening procedure known as a canthoplasty. In these cases, I often prefer to use a drill hole for fixation. This is particularly important for patients who have had multiple cosmetic surgeries, because the tissue itself is abnormal and unreliable. The fixation with a drill hole improves the durability of the procedure.
The video presented is in a gentleman with weakness of eye closure from a partial paralysis. This happens in some people, is a fairly random event, and may be due to some type of common viral infection that comes and goes but leaves the facial nerve damaged. This is called Bell’s palsy.
Preoperatively, closure is poor. However, there is some function. Canthoplasty is my first line of treatment; I reserve upper lid weight implantation if the patient is still having problems after canthoplasty surgery.
Notice that the left upper lid does not close fully, and barely moves during a normal spontaneous eyelid blink. After surgery, spontaneous blink is significantly better and forced closure is complete.
Triad Lower Blepharoplasty I present intraoperative photos of this advanced lower blepharoplasty technique. The technique is suitable for anyone who wants simultaneous fat transfer to the under-eye “hollows”. In my opinion, it is mandatory for anyone with significant laxity of the lower…
I am happy to report that I have completed another Medicare audit, this time of 34 patients who underwent surgery in 2014, and all of the surgeries reviewed were deemed medically appropriate for coverage by Medicare. More to the point, patients haven’t…
