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A blog about cosmetic and reconstructive surgery of the face, including non-surgical procedures and skin cancer.

Prosthetic Eye and Socket Reconstructive Surgery with an Oculoplastic Surgeon

An anophthalmic socket is a term used to describe an eyeless orbit. Usually, anophthalmia is acquired, not congenital. The precipitating event that leads to the eye loss causes the patient emotional distress and insecurities. As an oculoplastic specialist in NYC, Dr. Schwarcz can reconstruct the eye socket and eyelid before an ocularist makes a prosthetic eye. The surgeon uses several techniques to restore function to these structures:

Causes of Anophthalmia

People of all ages can have an anophthalmic socket. Common causes of anophthalmia are blunt injuries, infections, genetic mutations and prenatal deformities. When an injury is to blame, the patient should visit an oculoplastic surgeon who will work with him or her to create a surgical plan. To determine the best course of treatment, the surgeon must first examine the site of injury at the surgeon’s office. Dr. Schwarcz has two practices where he routinely sees his patients in New York.

Post-Operative Care

Patients should expect a recuperation period of several weeks after their anophthalmic socket surgery. Hygiene is crucial during this time. Patients who are given a prosthetic eye must clean it with water and soap every day. Children who have an ocular prosthesis typically require several fittings since their facial structure changes as they grow.

Choose a Certified Oculoplastic Surgeon

People should seek a cosmetic surgeon who specializes in reconstructive facial surgery involving the tear drain system, orbit and eyelids. The surgeon should be an American Society of Ophthalmic Plastic and Reconstructive Surgery member, which demonstrates that the surgeon is a board-certified ophthalmologist trained in the areas of ophthalmic cosmetic and reconstructive surgery. Dr. Robert Schwarcz is a board-certified ophthalmologist and ASOPRS member who has a comprehensive background in socket surgery and knows the structure and anatomy of the orbit and eyelid. Those who want to find out what treatment options are available for their anophthalmic socket should contact Dr. Schwarcz’s office in New York City or Scarsdale.

Orbital Tumors and Cellulitis

Orbital cellulitis is an infection that occurs behind the orbital septum. This infection usually develops when there are issues with the eyelids or sinuses, which are adjacent to the orbits. Orbital cellulitis is dangerous and life threatening, so immediate treatment is essential. Those who have this infection need antibiotics and may require surgery. Dr, Robert Schwarcz is an experienced oculoplastic surgeon in New York City who can treat the problem.

Information about Orbital Tumors and Infections

Orbital tumors are often congenital, but people can also acquire them later in life. The tumors can be either benign or malignant. In addition, they can also be either painful or painless. Both adults and children can suffer from an orbital tumor. Sometimes, orbital tumors are subtle and grow slowly. Unfortunately, they can also grow rapidly and interrupt a person’s life. For example, patients may experience pressure, eye irritation, swelling, double vision and proptosis.

Why Do Eye Socket Tumors Occur?

Most tumors arise from adjacent structures to the eye socket. If left untreated, the tumor can impair a person’s vision and cause his or her eyes to protrude. The most common orbital tumors that form in children are hemangiomas and dermoid cysts. Adults commonly develop orbital lymphomas, metastatic disease and cavernous hemangiomas. Sometimes, people may have another condition that mimics a tumor. Infections, inflammation and Graves’ disease can all lead to eye problems.

What are the Symptoms?

Those who have an orbital tumor or infection commonly develop exophthalmos, which is protrusion of the eye. Patients commonly experience vision loss, blurred vision or double vision. When the tumor is small, the two main symptoms are headaches and pressure feelings near the eye socket. Small tumors can also cause moderate vision issues.

How do Doctors Detect Orbital Tumors?

Those who are having problems with their eye socket should visit an oculoplastic specialist in New York City. The specialist can take CT or MRI scans of the orbits to detect a problem. If the doctor suspects that a tumor is present, then the patient may need to undergo a biopsy. A biopsy is necessary because it confirms the diagnosis and helps the doctor learn more about the tumor.

Those who have an orbital tumor may require radiation, chemotherapy or surgery. Treatment options vary based on the tumor. For instance, radiation is the main treatment for eye socket lymphoma. Surgical removal is the primary way to treat a cavernous hemangioma. Cosmetic surgeon Dr. Schwarcz discusses all options beforehand so that his patients can make an informed decision.

Almond Eye Surgery

Almond eyes are characterized by a slightly raised outer corner or canthus and a lower eyelid that sits at the lower edge of the iris. While all eye shapes can be beautiful, almond eyes create an attractive, youthful, and somewhat exotic appearance. Some individuals have almond eyes naturally because of genetics or their ethnicity. For those with a rounded outer canthus or a lower eyelid that is rounded or low allowing the sclera to show, surgery may help improve the shape and appearance of the eye.

Who Is a Candidate for Almond Eye Surgery?

Patients considering almond eye surgery should consult a board-certified oculoplastic surgeon to ensure that they have a clear understanding of the type of outcome that they can expect based on their current eye shape and anatomy. In some cases, a lateral canthoplasty is performed to tighten or reposition the outer canthus of the eye. In patients with a lower eyelid that is too low or that is retracted to expose part of the sclera, additional procedures may be necessary to adjust the position and tension of the lower eyelids. It is common for patients to combine almond eye surgery with a brow lift, blepharoplasty surgery, and other cosmetic procedures to achieve their desired result. Almond eye surgery is a very delicate procedure that can be even more complicated in patients who have had prior eyelid surgery or who have protruding eyes, so consulting a specialist in oculoplastic surgery is essential. Dr. Robert Schwarcz of New York is an oculoplastic surgeon and specialist in surgeries involving the eyes. His practices offer surgical services at both the Scarsdale and New York City locations.

What to Expect:

The procedure is performed under local anesthesia, and patients are released the same day. While conscious sedation may be used, the patient still needs to be able to open their eyes during the surgery. Mild discomfort is to be expected for the first day following surgery; however, this is normally easily managed with medication. Some bruising and swelling are normal for the first week to 10 days. While most patients return to their normal activities within a week, complete healing can take several weeks to months.

Tear Trough Treatment and Sunken Eye Treatment

Tear trough deformities often occur in those who have certain genes or thin faces. This hollow area under the eyes gives the appearance of dark circles, making the eyes look tired or sunken. Some people may also have bags under the eyes, which worsens the appearance of dark circles.

People who have mild tear trough hollowness can cover the area with makeup or temporary plumping moisturizer, but these approaches do not provide an effective, long-lasting solution. Luckily, patients in New York have other options. Dr. Schwarcz, a board-certified oculoplastic surgeon, can treat sunken eyes and tear trough hollowness with surgery and cosmetic treatments of the eyes, such as hyaluronic acid gel filler injections, fat transfer injections, tear trough implants and lower blepharoplasty procedures.

Hyaluronic Acid Fillers

A cosmetic surgeon can safely inject hyaluronic acid fillers to treat sunken eyes and tear troughs. This non-invasive, reliable procedure only takes several minutes. To prevent discoloration and maintain a natural look, the surgeon will inject a conservative amount of filler into the area below the patient’s lower eyelid. The pain is minimal, and the results can last up to two years. After receiving a hyaluronic acid gel injection, swelling and bruising may last for a couple of days.

Fat Transfer Injections

Another sunken eye and tear trough treatment approach is a fat transfer injection. By manually suctioning a minimal amount of fat from the medial thighs or stomach and transferring the fat to the eyelid via an injection, the surgeon can fill the hollow under-eye area. Bruising and swelling may last up to 10 days; however, the recovery process is painless. The effects of a fat transfer injection are often permanent. Residual hollowness may occur; however, the surgeon can inject a touch-up filler if necessary.

Tear Trough Implants

A tear trough implant is a safe, effective, permanent way to correct tear trough deformities and sunken eyes. While under conscious sedation, the surgeon makes an incision inside the patient’s lower eyelid. Then, the surgeon places the silicone implant. Although tear trough implant procedures are more invasive than other surgery and cosmetic treatments of the eyes, the results create a natural appearance.

Lower Blepharoplasty Procedures

Patients who have excess fat bags may benefit from a lower blepharoplasty with fat repositioning. This procedure involves redistributing the fat bags to make the under-eye area look smooth. To reposition the prolapsed fat without causing a scar, the surgeon will make a transconjunctival incision.

Eyelid Skin Cancer Surgery and Eyelid Reconstruction

Cancerous and benign skin lesions commonly develop on eyelid skin because the skin is thin, and it receives a substantial amount of long-term sunlight exposure. However, many eye-fold lesions are not cancerous. Dr. Robert Schwarcz, a board-certified oculoplastic cosmetic surgeon, can easily remove these lesions.

Common Eyelid Cancers

Squamous cell carcinoma and basal cell carcinoma are the two most common types of eyelid cancers. Basal cell cancer grows slowly, but it does not metastasize. Contrastingly, squamous cell cancer is more likely to spread. Any patient in New York City who has an ulcerated or bleeding lesion or nodule that will not heal should be examined and biopsied by a board-certified oculoplastic cosmetic surgeon. While rare, eye-fold melanoma calls for an aggressive treatment approach.

Basal Cell Tumors

Approximately 90 percent of tumors on the eyelid are basal cell tumors. Basal cell tumors may present as pearly nodules that eventually ulcerate. While basal cell tumors do not spread, they can grow into the surrounding tissue. An oculoplastic reconstructive surgeon can remove these tumors and reconstruct the affected area.

Squamous Cell Tumors and Melanoma

Squamous cell tumors are more aggressive than basal cell tumors, so they require a more complex skin cancer surgery technique than basal cell carcinomas to ensure the tumors have not spread. The surgeon will coordinate any further treatment with the patient. The severity and size of the tumor will dictate the next step in treatment.

Mohs Surgery for Eyelid Skin Cancer

A board-certified cosmetic surgeon has to meet three goals to achieve a successful eyelid skin cancer surgery outcome. The first goal is to remove all tumors. The second goal is to restore the eyelid’s functionality. Lastly, the third goal is to make the area look aesthetically pleasing. To reach these three goals, the surgeon will utilize the Mohs surgery technique. Mohs surgery is designed to carefully excise the cancerous tumor one skin layer at a time without removing a large amount of healthy tissue.

Depending on the complexity of the patient’s condition, the surgeon may need to either graft skin from another area of the patient’s body or simply suture the area. If the patient requires a skin graft, the treated area may need to be reconstructed in stages. Staged reconstruction is usually reserved for the most severe eyelid skin cancer cases.

What Is Asian Blepharoplasty?

The crease, shape and eye-fold corners of Asian people’s eyelids differ from those of Caucasian people’s eyelids. In those who are of Asian descent, the orbital fat of the upper eyelids is more prominent, and the upper lids have either lower or non-existent creases. Approximately one-half of Asians have single eyelids, which are eyelids without a crease. The other one-half of Asians do have upper eyelid creases, or double eyelids. These creases may be broken, continuous, complete, parallel, partial or tapered. In contrast, Caucasians usually have semi-lunar creases. Many Asian patients also have a Mongolian fold, or epicanthic fold. A Mongolian fold is a common term used to describe upper eyelid skin that covers the eye’s inner corner.

To alter the appearance of the patient’s eyelids, a board-certified oculoplastic surgeon like Dr. Robert Schwarcz who specializes in eyelid blepharoplasty can perform double eyelid surgery to alter the eyelids’ appearance. During the double eyelid surgery, the surgeon may also perform an epicanthoplasty, which is designed to change the appearance of a Mongolian fold.

The Eyelid Blepharoplasty Procedure

Dr. Schwarcz is a New York oculoplastic surgeon who specializes in blepharoplasty and is skilled in creating the appearance of double eyelids in patients who have asymmetric creases or non-defined creases by using a non-incisional procedure or incisional surgical technique. The incisional surgical technique produces more long-lasting and predictable results than the non-incisional technique. However, those who undergo the non-incisional surgical procedure recover faster. Regardless of the type of surgery performed, the surgeon gives the patient local anesthesia. In some cases, the patient will need to be sedated. Most patients experience bruising and swelling during the 10-day recovery period.

The ideal goal of blepharoplasty is to give the patient’s eyes a symmetrical look while preserving the characteristics of their top eye skin, so the patient’s eye creases still appear naturally Asian. Our practices are located in New York City and Scarsdale, New York. To schedule a blepharoplasty consultation with Dr. Schwarcz, contact one of our offices today.

Injectable Treatments

Who Is a Candidate for Facial Injectables?

There are numerous surgical and non-surgical methods available to those living in the New York area to reverse the signs of facial aging. Injectable fillers accounted for approximately 56 percent of all facial rejuvenation procedures performed in 2016. Injectables are a minimally invasive treatment option to achieve a more youthful appearance and are suitable for most patients. Individuals considering injectable cosmetic treatments should consult a board certified cosmetic surgeon to determine if injectables are the right choice to help them achieve their aesthetic and cosmetic goals and treat certain concerns such as fine lines and wrinkles.

How Do the Various Cosmetic Injectables Work?

Facial injectables fall into two basic categories. Dysport and Botox are known as neuromodulators. They work by blocking nerve impulses to the targeted muscles, which temporarily stops the muscle movement that causes the wrinkles to form. Restylane, Juvederm, and Perlane are facial fillers that restore volume to selected areas of the face to plump and smooth the skin. They create a fuller, more rounded appearance by using a natural substance called hyaluronic acid, which is present in young skin.

Are the Results of Injectable Facial Rejuvenation Treatments Permanent?

Surgical and non-surgical cosmetic procedures temporarily reverse the tell-tale signs of aging; however, they do not stop the aging process. As a general rule, the benefits of Botox injections last anywhere from three to six months. Hyaluronic acid fillers can last as long as two years. Most patients choose to undergo periodic maintenance treatments to preserve their enhanced appearance.

Is There Downtime Associated with Cosmetic Injectable Treatments?

The injection procedure itself is performed on an outpatient basis and does not require anesthesia. Depending on the number of injections, the procedure can be completed in under half an hour. It is possible to go back to your normal activities immediately following the procedure; however, there may be some bruising, redness, or swelling at the injection site. It can also take a couple of days for the full results of the procedure to become apparent, so patients should plan accordingly if they have an upcoming special event.

Can Anyone Perform Cosmetic Injectable Treatments?

Although injectables are less invasive and risky than surgery, there is still the possibility of side effects. To ensure the best possible results, patients should look to New York cosmetic surgeon Dr. Robert Schwarcz, who has the qualifications and experience to perform the procedure safely and who will take the time to develop a personalized treatment plan to achieve the desired results.

Blepharoplasty and Eyelid Scar Correction

Lower Blepharoplasty Revision

Dr. Robert Schwarcz in New York City frequently sees patients who suffer from problems such as prolonged chemosis, scarring, missing skin, wrinkled skin, lumps, bumps and an overabundance or lack of eye bags. Revisional lower blepharoplasty can correct these issues. Due to the eyelids’ delicate nature, a careful approach must be used to not exacerbate these problematic conditions. Therefore, Dr. Schwarcz restores the eyelids and overall shape of the eyes with minimally invasive surgical techniques.

When Revision Surgery is Warranted

In the case of one patient, it was determined that she had residual filler and an under-eye fat prolapse. To correct these problems, Dr. Schwarcz performed a transconjunctival lower blepharoplasty, which requires no stitches and leaves no scars, and fat repositioning while the patient was under local anesthesia. After surgery, the lower eyelid was smoother and improved in appearance.

Hollow Eye Revision

Another cosmetic complication from a lower or upper blepharoplasty occurs when an excessive amount of fat is taken from the eyelid. This complication creates an undesirable sunken, hollow look to the eyes. In order to restore the eyes’ fullness and youthfulness, Dr. Schwarcz injects filler or fat around the eyes.

As an alternative to a fat transfer, acid gel filler can be used. After the surgeon injects filler into the upper eyelids or under eyes, the results are instant. The patient can expect these results to last approximately two years. To produce a natural appearance, the surgeon must be knowledgeable in the eyelids’ normal and previous surgical anatomy.

When a hollow eye is corrected by performing a fat transfer with stem cells, fat is taken from the patient’s thighs or stomach and injected into the hollow area. Fat is an excellent, long-term option for hollow eye correction. However, synthetic fillers are more predictable.

Eyelid Scar Correction

As an elite oculoplastic surgeon in NYC, Dr. Schwarcz regularly performs eyelid scar correction. Scarring is commonly seen in the lateral canthus and medial canthus. When scarring occurs in these areas, the patient’s appearance is negatively altered, potentially causing the patient a great deal of emotional pain. To hide and revise the scars, the surgeon utilizes minimally invasive techniques like epicanthoplasty with Z-plasty.

Revisional Eyelid Surgery

In some cases, facial and eyelid surgeries like blepharoplasty, a brow lift, canthoplasty and ptosis surgery result in functional or cosmetic problems. Revisional eyelid surgery addresses these issues. The best doctor for revision eyelid surgery and blepharoplasty is experienced and trained in facial, revisional and original eyelid surgery.

Dr. Robert Schwarcz is a member of the American Board of Ophthalmology as well as the American Board of Cosmetic Surgery. Utilizing the knowledge gained from his specialized oculofacial plastic surgery fellowship with the Jules Stein Eye Institute, Dr. Schwarcz focuses on revisional, reconstructive and cosmetic surgery in his New York practices, using a minimally invasive approach for revision canthoplasty. As an oculoplastic surgeon expert of NYC, Dr. Schwarcz has written multiple articles about revisional eyelid surgery, such as fat graft usage in reconstructive surgery and lower eyelid reconstruction.

Revisional Eyelid Retraction Surgery

Eye rounding and lower eyelid retraction with scleral can result from a poorly performed lower blepharoplasty or canthoplasty procedure. This is a common problem among the patients who seek Dr. Schwarcz’s help- specifically revision and correction of eyelid surgery. As a reconstructive surgeon, he is the person to see for these types of corrective procedures. When scar tissue forms on layers of the lower eyelid, the lower eyelid can retract. Eye closure muscle damage and an excessive removal of lower eyelid skin may also contribute to this problem.

The eye’s appearance is not the only issue for a patient’s face. Some people may have serious ocular discomfort along with blurry vision, dry eyes, redness and tearing, resulting from the inability to blink or close the eyes in a normal manner. To correct this significant issue, an oculoplastic surgeon needs to raise the lower eyelid and repair the canthus via the outer eye corner tightening, hidden lower eyelid incisions and a lower eyelid lift.

Sometimes, the surgeon grafts the patient’s skin to replace the fast-healing skin that is missing from the lower eyelid. However, outer eye corner tightening, or canthoplasty, is usually not an adequate approach by itself because of lower eyelid scarring. Therefore, the Madame Butterfly procedure is used to restore the eye’s natural almond shape. During this procedure, the surgeon releases scar tissue, lifts the midface and revises the lateral canthus through a non-visible incision.

Cosmetic Treatments for a Sagging Neck & Face

Sagging skin around the face and neck is typically one of the first signs of aging. Over time, the skin becomes less elastic, and the underlying fat that supports the skin of the face and neck can shift or disappear. Heredity, stress, sun exposure, and smoking can also affect the skin and contour of the face and neck. A trained and experienced oculoplastic facial surgeon like Dr. Robert Schwarcz can use a variety of cosmetic surgery techniques to tighten the skin of the face and neck to create a more youthful and aesthetically pleasing profile.

Facelift:

A rhytidectomy, commonly referred to as a facelift, is typically used to reverse signs of aging involving the face and neck. Facelifts can be used to remove excess fat and tighten the skin of the neck to eliminate a “turkey neck” or double chin. The procedure can also reduce the appearance of jowls and nasolabial fold lines between the nose and mouth.

Neck Lift:

A neck lift is often used in combination with a facelift to improve the contour of the neck. The procedure involves removing excess fat in the neck through excision or liposuction and tightening the muscles of the neck. In some cases, excess skin may also be excised. Since a neck lift requires a detailed restoration of the musculature, patients considering the procedure should consult Dr. Schwarcz, a board-certified cosmetic and reconstructive surgeon to achieve the best possible results.

Mini Facelift:

A mini facelift is a more conservative cosmetic surgery than a traditional facelift. The procedure is focused on reversing signs of aging around the eyes, mouth, and forehead without altering the rest of the face. Although the results are subtle, a mini facelift is often enough to correct minor sagging along the cheeks, neck, and jaw. This procedure is ideal for men and women who want a more refreshed look with less visible scarring and downtime.