Looking Tired? Maybe it’s your eyelids

April 7, 2011

Cosmetic eyelid surgery (Blepharoplasty) is the third most common cosmetic surgical procedure performed in the US. That’s not surprising, because for many people eyelid surgery is one of the best ways to improve your appearance. Our eyes are the windows to our souls. They also are the part of our face that people look at the most. There is a lot to talk about when it comes to eyelid surgery so we’ll start with this post. You could call this post eyelid surgery 101.

First there are some terms that you should know.

Ptosis- that is when your upper eyelids are actually droopy. In other words the part of your eyelid with the lashes sits too low when your eyes are open. That is due to a problem with the muscles or nerves that open the eye (usually the muscles)

Dermatochalasis- that is when you have extra skin & or fat around the eyes. It can be extra skin hanging over your upper eyelids or sagging skin and fat on your lower eyelids.

Fat prolapse- This is what people call bags. Usually people think of this as a lower lid problem, but some people have fat prolapse or excess fat in their upper eyelids as well.

Cosmetic eyelid surgery addresses any or all of these problems, depending on the needs of the patient.

Let me tell you what to expect when you have eyelid surgery.

1. First you will need a consultation with your cosmetic surgeon. At that time he/she will ask you what you would like to improve about your appearance. Then, after an exam, you’ll find out if eyelid surgery is a good idea for you and what will be corrected at the time of surgery.

2. At that point you can decide if you want to schedule surgery, or go home and think things over. Cosmetic surgery can be great, but it is elective. You should only go ahead if you are completely comfortable with what you have learned, and with your doctor.

3. If you decide to proceed, the surgery is performed at an accredited surgical center as an out- patient. Prior to surgery you will need to discontinue any medications that thin the blood (aspirin, motrin, Vit E, and others). Always check with your family doctor to be sure that it is safe for you to stop your blood thinning medication before proceeding with this elective surgery. Depending on your age you may also need to have some pre-operative tests (like blood work and an EKG).

4. You should not have anything to eat or drink after midnight before the day of surgery. In the morning you can take your regular medications with a sip of water (except for medications that thin the blood).

5. You’ll arrive at the surgical center about 1 hour prior to your surgery. First you’ll be examined by a nurse as well as the anesthesiologist. In case you have any last minute questions, you’ll also have a chance to talk to your doctor before the procedure

6. Surgery is usually performed under sedation (twilight sleep). The surgery usually takes between 1-2 hours but the time goes by very fast, because you will be asleep for the surgery.

7. After the surgery you will awaken in the recovery room. There will be ointment in your eyes, so your vision may be a little bit blurry. There will also be ice cold compresses on your eyes to help prevent bruising.

8. Once you are fully awake you will be able to go home (you’ll need a driver). At home you should take it very easy for 4 days. During that time you will apply medication to you eyes and use cold compresses frequently. You may need pain medication the first day. But it is rare to have any significant discomfort after the first day. Bruising happens over the first few days after surgery. You’ll probably have some bruising, but less is better. Taking it easy and using cold compresses helps reduce bruising. It is also helpful to sit with your head elevated (above your heart) when you are awake.

9. You will see your doctor over the next few days. If you have stitches they will be removed in about 6-10 days depending on the type of surgery that was performed.

10. Most patients are back to their near normal routine one week after surgery. You may not be able to put on makeup near your eyes for about 2 weeks (depending upon which procedure you have). You also need to avoid the sun until your skin returns to normal.

11. Most people start to see the results by about 2 weeks. But you’ll still look like you had surgery at that point. If you want to be “camera ready” (like for a wedding) you should plan to wait about 6 weeks to be safe.
So that is the basics. We’ll talk a lot about eyelid surgery specifics in future posts.

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Posted by Dr. Cohen

Dermal Fillers: A real game changer in cosmetic surgery

March 10, 2011

Of all our posts, the one that has gotten the most buzz was about Botox 101 (First There Was Botox) So, in this post we’ll cover dermal fillers 101.  Hopefully you will find this one interesting as well. We’ll use this post as a springboard to talk about many interesting topics related to fillers .

Botox started a revolution in cosmetic surgery in the 1990′s. Dermal fillers started a revolution of their own in the mid 2000′s. Here’s the scoop on dermal fillers.

The first safe dermal filler was collagen. Collagen was injected into wrinkles to fill them out and smooth the skin. Collagen was the king of fillers until the mid 2000′s when hyaluronic filers came along.  Hyaluronic fillers last about twice as long as collagen and they are reversible.  For that reason hyaluronic fillers have replaced collagen, which is no longer available.  There are lots of different hyaluronic acid fillers.  The ones we like best are Juvederm and Restylane.  In future posts I’ll talk more about that.

Right around the time that Restylane and Juvederm became available, there was a major paradigm shift in how we view ageing of the face.  Good cosmetic surgeons started to understand that as we age, our faces loose volume.  We used to think that faces fell.  We now know that they deflate and sink inward.  I’ll talk about this in more detail in future posts.  For now just believe me, when we age, our faces loose volume.  That loss of facial volume is the main reason that most of us look older.  So, for most people, the best way to look younger is to add volume.

Before & After Juvederm Treatment

Voila! we have Restylane and Juvederm which are perfect to add volume to your face.  So rather than just using filler to erase wrinkles (which is nothing to sneeze at)  we now can also use them to add volume to our face. Adding volume in just the right places can subtract years from your appearance.

Hyaluronic acid fillers are so effective that they have become the second most popular cosmetic procedure in the US (Botox is number 1).

Let me tell you what to expect when you get a Juvederm or Restylane injection.

  1. First you will need a consultation with your doctor. At that time he/she will ask you what you would like to improve about your appearance. Then, after an exam, you’ll find out if hyaluronic acid fillers are a good idea for you.
  2. At that point, you can decide if you want to proceed with a treatment, or go home and think things over. Cosmetic treatments can be great, but they are elective. You should only go ahead if you are completely comfortable with what you have learned, and with your doctor. 
  3. If you are going to have filler injections, particularly around your eyes, you may bruise.  You can reduce the chance of bruising by stopping medications that thin the blood for a week or two before the procedure.  Some common blood thinners are aspirin, Motrin (and all of its NSAID relatives like Advil), Vit E, and fish oil.  One very important point, if you were placed on a blood thinning medication by your doctor, talk to that doctor before stopping the medication, of course. 
  4. If you decide to proceed, you’ll have numbing cream applied to the areas that will be treated.  If you are going have your lips treated, you may want a numbing injection (like the dentist would give you).  Lips can be very sensitive.
  5. The doctor will then give you a series of small injections. The number of injections and location depends on what you and your doctor are trying to achieve with the treatment.
  6. Then you can go home (or to work, or to wherever). You may have some redness, bruising or swelling right after the treatment.  It is best to avoid strenuous exercise for that day (you can bruise for a few hours after treatment and excercise can make that worse).  By the next day….back to the gym.
  7. In our office we have our patients come back for an evaluation 2 weeks after their first treatment to be sure that everything is optimal. It is worth waiting that long because it make take the filler some time to get into balance with your body.  Initially, there may be some swelling in certain areas that look like lumps.  Those usually go away during the first week or two.
  8. When you come back for your follow-up visit you may want to get a little bit more here or there to have the best possible result.
  9. If there are any small lumps or bumps those can be massaged away by your doctor.  Or they can be instantly dissolved with a small injection of a medication call hyaluronidase.  We’ll talk more about hyaluronidase in future posts.
  10. The Juvederm or Restylane usually lasts at least 6 months, in some areas of the face (like under your eyes) it lasts much longer. When it wears off you have the option to do it again.

That is my review of dermal filler basics. There is plenty of material for future posts. If you would like to learn more right now click here.

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Posted by Dr. Cohen

First There Was Botox

February 15, 2011

If you are taking the time to read this blog, you probably know at least a little about Botox.  In future posts I’ll be talking a lot about Botox.  In this post we’ll cover Botox 101.  That way we can refer back to this as we talk about all kinds of neat Botox topics.  The FDA has created very strict rules about informing people about Botox.  If you would like to read the FDA approved safety information about Botox, click here. 

Botox started a revolution in cosmetic surgery.  It is the mother of all lunchtime cosmetic treatments. When you get Botox, you can walk into your cosmetic surgeons office on your lunch break, get a treatment, have a quick lunch, and still get back to work on time.  The results are fantastic and the treatment is safe.  Are most patients satisfied with Botox? Yes.  Just look at the numbers.  In 2009, there were about 2.5 million cosmetic Botox treatments in America.  That is the most common cosmetic procedure performed in the US….. by a huge margin.  To give you an idea of how huge, Botox is given twice as frequently as the number 2 treatment, Hyaluronic Acid dermal fillers (Juvederm, Restylane, and some others).  Here is another fact: Botox treatments are about 10 times more common than the most popular cosmetic surgical procedure, breast augmentation.

So how does it work? Botox works by temporarily relaxing muscles.  By relaxing the right muscles, Botox can help you get rid of wrinkles that come with facial expression.  A great example of this is the vertical lines that form between your brows when you squint, or the crows feet you get when you smile.  Botox also can help with a lot of other things, from raising your brows to getting rid of the little bumps you get on your chin when you frown (we’ll talk about all the neat things Botox can do in another post).  Botox is temporary.  It last, for most people about 3-4 months and then wears off.  If you like the results, you’ll probably want to do it again.  Most people who are really in to it get Botox about 3 times a year. 

Let me tell you what to expect when you get a Botox injection. 

  1. First you will need a consultation with your Botox doctor.  At that time he/she will ask you what you would like to improve about your appearance.  Then, after an exam, you’ll find out if Botox is a good idea for you.
  2. At that point you can decide if you want to proceed with a treatment, or go home and think things over.  Cosmetic treatments can be great, but they are elective.  You should only go ahead if you are completely comfortable with what you have learned, and with your doctor.
  3. If you decide to proceed, the doctor will then give you a series of small injections.  The number of injections and location depends on what you and your doctor are trying to achieve with the treatment.
  4. You’ll feel the injections, but the discomfort should be pretty mild.  In our office we use the smallest possible needle and that helps.  We also use a messaging pillow on your neck to distract your nerves from feeling the injection….it works.
  5. Then you can go home (or to work, or to wherever).  You don’t need to limit your activity or do any special care.
  6. Depending our your biology, Botox will start to work  as soon as 24 hours or as long as 2 weeks.
  7. In our office we have people come back 2 weeks after their first treatment to be sure that everything is a good as possible. Some patient get a little bit more here or there to have the best possible result.
  8. The Botox should last at least 3 months.  In many people it lasts longer.  When it wears off you have the option to do it again.  Be warned…..if you are like most of our patients, you’ll want to do it again.

So those are the basics.   There is a lot of fun stuff we can do with Botox, so there is plenty of material for future posts.  If you would like to learn more right now click here.

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Posted by Dr. Cohen

Welcome. This is the place to learn about cosmetic surgery

January 24, 2011

Dr. Marc Cohen & Dr. Nancy Swartz

 Hi.  Welcome to botoxdocs.  Here you can learn the latest about cosmetic surgery….and hopefully have some fun while you’re at it.  We all know that the web is full of information about cosmetic surgery.  Some of it is even true.  If we do our job right, it will be obvious that this is a place that you can come to get the truth about cosmetic surgery.   We love what we do and feel that, if you are interested, cosmetic surgery can really be a lot of fun. 

This is our first post so let us introduce ourselves and tell you a little bit about who we are.   Our practice is run by two of us,  Marc Cohen, MD and Nancy Swartz, MS, MD.  We are both ophthalmic plastic and cosmetic surgeons, which means that we focus on making people’s faces look better.  At our office we really focus on Botox, Dermal Fillers (Juvederm & Restylane), Cosmetic Eyelid Surgery, and Cosmetic Skin Care.  We have three offices, all in the Delaware Valley (Center City, Main Line, and South Jersey).  We have been in practice for about 20 years, and our office is a very happy place. Oh, one more thing, we’re married which is one of things that makes our practice pretty unique (more about that in later blogs).  If you would like a better mental picture of who we are, you can visit our website http://www.cosmetic-eyes.com or check out this one minute video.

Our goal is to do several things with this blog:

  1. Give you the latest information about cosmetic surgery (we’ll talk about all kinds of things but most of it will be about your face).
  2. Answer the type of questions that we are asked by our patients.
  3. Answer your questions
  4. Entertain you, and have some fun ourselves by telling you things that we find interesting, and think you will too.

You have a lot of great ways to spend your time.  Hopefully taking a look at our Blog now and then, will be worthwhile for you.

If you ever have any questions that you would like to ask us privately, please email us at doctors@cosmetic-eyes.com.

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Posted by Dr. Cohen

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