Boston Plastic Surgeon - Articles - Zimbio

Cure Puffy Eyes

Mon, 3 Jun 2008 11:16:32 GMT

posted by wianno168

Expecting eye creams to remove eye bags or puffy eyes is like putting an aspirin on top of your head to cure a headache!

Eye bags and puffy eyes are caused by a structural problem beneath the eyelid, and eye creams just cannot reach the cause of the eye bag or puffy eye and thus cannot correct eye bags or puffy eyes.

Nearly everyone over 30 begins to notice eye bags, puffy eyes and dark circles under their eyes, Billions of dollars are spent each year on skin creams to remove eye bags, puffy eyes and dark circles under the eyes and plastic surgery, called blepharoplasty which is done to remove eye bags and puffy eyes is the third most common plastic surgery operation done in the United States.

What Causes Eye Bags, Puffy Eyes and Dark Circles under the Eyes?

Eye bags, also called eyelid bags, puffy eyes, tired eyes, and dark circles under the eyes, are caused by protrusion or herniation of the fat which lies beneath the eyelid and which normally is held directly beneath the eyeball. The reason the fat is beneath the eyeball is that it acts as a shock absorber preventing the eyeball from coming into contact with the bone of the eye socket. The eyelid is positioned directly over this supporting fat pad and holds the fat in place directly below the eyeball so that the fat can serve its function.

The problem of eye bags and puffy eyes occurs as we age because as the skin of the eyelid ages it loosens, becomes less elastic, and begins to sag and lose tone. As the eyelid loses tone it cannot hold the fat within the bony orbit or eye socket beneath the eyeball, and the fat pushes forward against the undersurface of the weakened eyelid and creates the eye bag , puffy eye, or eyelid bag.

This pushing forward on the eyelid and creating an eye bag, eyelid bag or puffy eye is technically called fatty orbital herniation, because the fat herniates or protrudes from the bony orbit or eye socket and creates a bulge or eye bag or puffy eye. To herniate means to project through an abnormal opening, like the bulge produced by a hernia on the lower abdomen. Eye bags or puffy eyes are a hernia of the eyelid.

The other eyelid aging sign is called dark circles under the eyes. Technically this is called the arcus deformity and is caused by a tethering of the dark circle skin from underneath the eyelid skin by a structure called the arcus marginalis, which is discussed below. The dark circles under the eyes are essentially a shadow created by the overhanging eye bag or puffy eyelid.

How Are Eye Bags and Puffy Eyes Removed Traditionally?

Eye bag removal has traditionally been done with a plastic surgery operation called a blepharoplasty. During the traditional eye bag surgery the plastic surgeon made an incision on the lower eyelid just beneath the eye lashes, exposed the underlying fat causing the eye bag or puffy eye, and removed the fat and also removed some of the skin which had been stretched into the eye bag. Although the blepharoplasty does remove the eye bag or puffiness, there are several problems with this traditional eye bag or puffy eye surgery.

First, the incision through the eyelid weakens the eyelid skin and muscle which supports the eyelid and holds the eyelid tight against the eyeball. As a result of weakening of the support for the eyelid, the eyelid often turns down or sags after a lower eyelid blepharoplasty. Technically this is called an ectropion or scleral show, but in lay terms it is referred to as the sad eyed look or hound dog eyes. It is a terrible stigma of the old scalpel blepharoplasty operation. The ectropion can also have serious implications for the eye ball itself. When the ectropion is severe, the eyeball can dry out, develop a corneal ulceration, and threaten the eye. Often corrective surgery called a canthoplasty is required.

Because of these serious complications from traditional eye bag and puffy eye surgery new modern blepharoplasty techniques have been developed to remove eye bags and puffy eyes without damaging the support of the eyelid. The newer, more modern blepharoplasty technique is called a transconjunctival blepharoplasty. The conjunctiva is the pink part of the lower eyelid on the inside of the lower eyelid, and during the transconjunctival blepharoplasty the incision is made on the inside of the lower eyelid and the fat exposed and the tissues tightened. The transconjunctival blepharoplasty can be used to remove eye bags and puffy eyes without damaging the outer supporting eyelid muscle and tissues and thus the eyelid support remains in tact and there is little risk of ectropion or hound dog eyes after removal of the eye bags and puffy eyes.

Remove Eye Bags but Avoid Hollow Eyes and Correct dark Circles Under The Eyes!

Another serious drawback to traditional blepharoplasty for eye bags and puffy eyes is that often the surgeon removes too much of the fat that was causing the eye bag. The result of too much fat removal during blepharoplasty is that after removal of the eye bag the patient is left with a hollow eye appearance. This is a very distressing problem for patients, so distressing that many patients choose to have additional surgery to transplant fat back into the eyelid to correct the hollow eye appearance after eye bag and puffy eye removal.

Newer more modern blepharoplasty techniques for eye bag and puffy eye correction do not remove fat but reposition the fat or graft the fat into a better position to create a more youthful eyelid look and remove dark circles under the eyes. When a person has eye bags and puffy eyes there is almost always a dark circle under the eye directly below the eye bag. These dark circles are called the naso-jugal fold or tear trough deformity and is caused by the attachment of a small structure called the arcus marginalis. The arcus marginalis is attached to the bone of the eye socket and is also attached to the underside of the lower eyelid just below the eye bag. The arcus marginalis holds the lid down or tethers the lower eyelid to the bone right at the dark circle, creating the tear trough deformity, so the upper part of the lower eyelid, the eye bag falls over the dark circle or tear trough, and makes the dark circle shadow worse.

Newer more modern blepharoplasty involves a transconjunctival blepharoplasty, which avoids ectropion, followed by release of the arcus marginalis, which releases the dark circle or tear trough deformity. Next, the protruding eyelid fat is not removed, but the bulging fat is placed beneath the dark circle, to plump the dark circle or tear trough, reduce the shadow, reduce the eye bag and puffy eye and avoid the hollow eye.

This is a new technique for removal of eye bags, puffy eyes and dark circles under the eyes and not widely practiced by plastic surgeons yet. As always there will be a 10 year delay between this new medical discovery and the adoption of the technique by the majority of surgeons. That is just the way new technology develops in surgery.

Festoons Can Look Worse After Old Style Blepharoplasty for Eye Bags and Puffy Eyes.

A festoon is often mistaken for an eye bag or puffy eye. In fact a festoon is a puffy swelling on the cheek just below the lower eyelid and is not an eye bag or puffy eye as many people think. The festoon is cheek skin and cannot be removed during a blepharoplasty. It is a puffy swelling at the top of the cheek just below the dark circle under the eye just below the eye bag. he technical term for a festoon is a malar bag.

Most people do not understand what a festoon is and mistakenly believe that the festoons can be corrected by the blepharoplasty for eye bags or puffy eyes. In fact, after a blepharoplasty for eye bags or puffy eyes is done, the festoons can look more prominent and make the face look worse!

For many years there was nothing that could be done to remove festoons, however new technology holds promise that we may soon be able to significantly improve festoons. A lateral eyelid /cheek lift can often remove festoons. New laser skin tightening technology may also soon be used to remove festoons.

The Modern Blepharoplasty for Removal of Eye Bags, Puffy Eyes, and Dark Circles Under The Eyes- Transconjunctival laser arcus marginalis release with preservation and repositioning of orbital fat.

I have used the laser exclusively to perform all of my blepharoplasty operations for the past 12 years, over 2300 cases. The new modern way to remove eye bags and puffy eyes is to use the laser to perform a transconjunctival blepharoplasty with arcus marginalis release to release the dark circles under the eyes and correct the tear trough deformity, and fat grafting to plump the dark circle and prevent the hollow eye look. This technique prevents ectropion, sad eyed look, and hound dog eyes and gives the lower eyelid a very young, smooth look with no eye bags and no change in eyelid shape. The results of my experience are published in the Journal Plastic and Reconstructive Surgery. The benefits of using the laser transconjunctival blepharoplasty with Arcus marginalis release and Fat grafting are:

No bleeding
Minimal bruising
quicker recovery
No visible scar on the eyelid
no change in the beautiful eyelid shape
quicker surgery with less anesthesia time
Correct the Tear Trough deformity or dark Circle Under the Eye
Avoid Hollow Eyes
Remove Eye Bags and Puffy Eyes
Excellent Results

Add The Lux2940 Fractional Laser Peel of The Lower Eyelid for Eyelid Wrinkle Removal and Total Eyelid Rejuvenation

All blepharoplasty procedures for eye bags and puffy eyes still do not totally rejuvenate the lower eyelid unless something is done to correct the eyelid wrinkles, brown spots, “crêpe” skin and other eyelid aging skin changes. The new Lux2940 Fractional Laser Peel is a revolutionary new eyelid skin peeling technique that removes eyelid wrinkles, sun damage, and aged skin and creates new fresh youthful looking skin on the eyelid. This new ActiveFX peel can be done at the same time as the blepharoplasty so that true eyelid rejuvenation is possible, removal of eye bags, puffy eyes, dark circles under the eyes, and removal of wrinkles and eyelid skin aging changes.

This is the modern approach to eyelid rejuvenation, Total Laser Eyelid Rejuvenation for removal of eye bags, puffy eyes, dark circles under the eyes, eye wrinkles, and sun damage, all with no change in eyelid shape, no hound dog eyes, no sad eyed look, no hollow eyes, all with the help of the laser and the newest most modern eyelid rejuvenation techniques, the laser and the ActiveFX.

To learn more, contact me or read Save Your Face or follow this link.

Dr. Seckel,

Boston, Massachusetts

Concord, Massachusetts

978-369-4499

Eyelid Enhancement (Blepharoplasty)

Thu, 18 Jul 2008 16:07:00 GMT

posted by ebturntable
Raleigh Plastic Surgeon Dr. Michael Law discusses:

Upper Blepharoplasty (Upper Eyelid Enhancement)

The eyes are the primary facial feature that communicates tiredness or exhaustion (and, likewise, energy and vitality). Your cheeks and your neck don't really reflect whether or not you've had a good night's rest. But miss a night of sleep and your eyes will make it obvious to everyone.

Aesthetic plastic surgery of the eyelids can produce a dramatic rejuvenating effect, literally taking years off of a person's appearance. Interestingly, many patients find that following eyelid surgery friends will say 'You look great!', but they usually cannot pinpoint exactly why.

Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.

Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume can dramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like surgery - it just looks youthful.

In some individuals the upper lids appear heavy and 'droopy' because of descent of the lateral brow. A lateral browlift can reduce or even eliminate the need for excision of upper eyelid skin in patients with lateral brow descent.

Best Boston Plastic Surgeon

Sat, 25 May 2008 11:34:47 GMT

posted by wianno168

Boston Magazine:Best Docs 2007: The Specialists

By J. L. Johnson

Plastic Surgery

Dr. Brooke Seckel

Vital Stats: Private practice, Concord; 26 years in practice.
Clinical Notes: As baby boomers put the squeeze on the healthcare market as a whole, Seckel—who founded the Lahey Clinic’s Center for Cosmetic and Laser Surgery before striking out on his own—says he’s been surprised to find a different group filling his waiting room lately: 30-to-45-year-old women who’ve had their kids and are busy getting back into shape. He’s also noticing more and more men looking for tighter tummies and smoother skin. “I love it—seeing these tough guys, even construction guys, coming in and having their faces done, and they don’t blink an eye.”
What’s Hot, What’s Not: New laser therapies have made a big dent in harsher traditional procedures like chemical peels and dermabrasion, and Botox has made the brow-lift operation virtually obsolete. Meanwhile, partly due to the recent re-introduction of the silicone gel implant, the popularity of breast enhancement is holding steady.
What’s Next: Technology that allows doctors to remove fat without making an incision, eliminating the need for liposuction (currently one of plastic surgery’s most common procedures). Researchers are experimenting with using infrared, radio frequency, and ultrasound to dissolve fat under the skin; Seckel, who’s consulted on tests using potbellied pigs, predicts we’ll see this become reality in the next two years.
Doctor’s Orders: Well-kept skin will delay the need for a facelift, so steer clear of the sun and smoking. Keep a lid on your stress level, too, as high amounts of cortisol, a.k.a. the “stress hormone,” have been shown to damage collagen—not to mention clog arteries, which sets the scene for heart attacks, strokes, and high blood pressure. So get yourself to a yoga class, already!

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Scarless Facial Rejuvenation

Mon, 20 May 2008 00:21:55 GMT

posted by romow

One of the earliest signs of aging is the descent of facial fat into the jowls and beneath the chin. By contouring this fatty tissue along the jawline and beneath the chin, the plastic surgeon can create for the patient a thinner, more tapered, and younger-looking face.

A conventional face-lift involves incisions around the ears and back down the hairline. This procedure can produce outstanding results for many patients. However, it requires recovery time of about three weeks for most people.

A newer and highly effective technique for sculpting the fatty tissue along the jaw and chin areas involves the use of liposuction. Tiny incisions are made at the base of each ear and one under the chin point. These incisions result in only tiny scars which are virtually undetectable. Inserting a specially designed cannula through these incisions, the plastic surgeon removes the fat in parallel tunnels from along the jawline and beneath the chin.

With the fat removed, the tissue tightens and contracts as it heals. This tightening effect creates a more well-defined jawline and chin. As a secondary benefit, it also tends to enhance the appearance of the cheeks. This procedure is not just for women. It works particularly well on men.

Ultrasound is an effective technique that can be employed with liposuction. Ultrasound-assisted liposuction creates a smoother end result. It also provides a little more stimulation to the skin which heightens the tightening/contraction effect.

Unlike a conventional face-lift, most patients can recover from scarless facial rejuvenation over a weekend. There is very little swelling or bruising from the procedure. Some patients may experience slight irregularities in the skin along the jaw or beneath the chin, but this smoothes out nicely over time.

Patients who have very thin faces are not necessarily good candidates for scarless facial rejuvenation. The reason for this is that as we age, fat not only descends, we also lose fat. So the plastic surgeon must be very careful not to remove too much fat.

An excellent complement to scarless facial rejuvenation is laser resurfacing of the skin. The plastic surgeon can use a laser to remove the sun-damaged surface layers of the skin. This procedure is most often used to remove wrinkles in the cheek area, the little lines around the mouth, and the transverse lines in the forehead.

Most patients need about a week to 10 days to heal from laser resurfacing. At that point the new skin is pink. It is recommended that patients wait about 10 days before using makeup. After several weeks or a month, the new skin takes on the color of the surrounding skin.

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Dear Dr. Seckel, I had breast implants several years ago and I have bumps on my implants that I can feel. Sometimes in the right light I can see a bump or fold along the bottom of my breast that feels like the implant. Should I be concerned? Thank you, Mary, Boston, Massachusetts.

Fri, 12 Apr 2008 13:24:57 GMT

posted by wianno168

Dear Mary,

You should have your doctor examine you to be sure you do not have a breast lump.

It is common especially after breast augmentation with saline breast implants to feel folds or bumps in the breast implants. Sometimes they are visible. The breast implant bump or fold is usually a fold in the saline implant and is not dangerous. Causes of breast implant bumps after breast augmentation can be:

The valve used to fill the saline breast implant
A fold in the shell of the breast implant
A capsule or scar tissue around the implant.
A very loose pocket around the implant so the implant is not held firmly in the breast
Very thin skin with minimal breast tissue-inadequate coverage of the breast implant
Breast implant placed beneath the breast gland instead of beneath the chest muscle-again less tissue covering the implant.

The breast implant bumps or folds are not dangerous but do bother patients very much especially if they are visible.

You can minimize the chance of breast implant bumps or folds during breast augmentation by:

Use silicone gel implants-they are less likely to fold
Place the implant beneath the chest muscle-this provides more coverage for the implant
If the breast implant pocket is too large, an operation can be done to tighten the pocket. If this is done I recommend replacing the saline implant with a silicone gel implant
Massage the breast implants daily

Of course it is important to have your doctor examine your breasts to make certain the bump you are feeling is not a breast lump. If this is the case you will need a medical work up to make certain the breast lump is not dangerous.

Breast implant bumps or folds are almost impossible to avoid when using saline implants in thin women with minimal breast tissue.

Today I most often use the new silicone gel breast implants for breast augmentation which usually, but not always, do not form breast implant folds or breast implant bumps.

The results can be excellent.

For more information on breast implants contact me. Be sure to sign up for my free email newsletter.

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massachusetts