Eyelid Surgery

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 the office.

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
  • *YouthfulAppearance
  • *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.

Botox Injections

<>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 treatment.

The procedure

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 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 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 procedures.

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 questions.

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.

The procedure

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 underneath.

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 cosmetic.

Botox injections are not covered for cosmetic purposes, but may be covered when used to treat tics or twitching of the face and eyelids.

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.