TEPEZZA® Infusions for Thyroid Eye Disease: What to Expect Thyroid eye disease (TED) is an autoimmune disease that causes inflammation in the fatty tissue and muscles behind your eyes. While it’s not common in the general population, it affects about 40% of people with Graves’ disease — a condition marked by an overactive thyroid. While TED symptoms can be bothersome both physically and emotionally, effective treatment is available. At our offices in Scarsdale and the Upper East Side of Manhattan, New York, board-certified cosmetic surgeon Robert Schwarcz, MD , and his team offer TEPEZZA® infusions to improve your eye health and correct or prevent thyroid-related vision problems. Here’s what to expect from TEPEZZA treatment. Thyroid eye disease symptoms The inflammation brought on by thyroid eye disease can cause a range of symptoms that range from relatively mild to quite severe in intensity. Signs you may be dealing with TED include: A gritty sensation in your eyes Bags under your eyes Blurred or double vision Bright light sensitivity Eyes that appear to be constantly staring or bulging Difficulty moving your eyes Dry or watery eyes Pain in or behind your eyes Red eyes and eyelids Swelling or puffiness in your upper eyelids You should see a doctor immediately for severely blurred vision, double vision, and worsening symptoms. How TEPEZZA infusions can help TEPEZZA infusions are unique in that they address the underlying cause of thyroid eye disease versus merely addressing your symptoms. The special formulation blocks IGF-1R, an insulin-like growth factor receptor that fuels TED, so inflamed tissues behind your eye improve and present fewer symptoms. In a study involving 31 patients with chronic TED, 28 patients had little to no eye pain, redness, or swelling after completing a standard series of TEPEZZA infusions. For 18 of the participants, symptoms completely diminished post-treatment. What to expect during TEPEZZA treatment Dr. Schwarcz partners with oculoplastic surgeon Dr. Raymond Douglas to offer TEPEZZA to reduce symptoms and your risk of serious complications. If you’re approved for the treatment, you can expect the process to take about five months . Doctors commonly prescribe eight infusions, or one every three weeks. During the infusion appointment, which takes 60-90 minutes, you relax in a comfortable chair as you receive the medication intravenously. Your care team monitors your well-being during your treatment and can slow or stop the infusion if you should have a reaction to the medication. After about two treatment sessions, you can expect reduced double vision and less eye-bulging, and your symptoms should continue to improve over the course of treatment. To learn more about TEPEZZA infusions for thyroid eye disease or find out if you’re a good candidate, book a consultation at Robert Schwarcz, MD, today. Call the office convenient to you or request an appointment online. REQUEST AN APPOINTMENT

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. REQUEST AN APPOINTMENT

How Rhinoplasty is Performed Rhinoplasty is a type of cosmetic procedure used to reshape the nose to improve its structure . Patients often have this procedure done to correct a deformity. For example, a person can have a nose job done to eliminate a bump on his or her nose, alter the size or shape, or to correct a birth defect. During a rhinoplasty procedure, a board-certified cosmetic surgeon can also alter a patient’s nasal shape so that he or she can breathe easier. Who are the Best Candidates for Nose Surgery? Those who are under the age of 16 should wait until their nose becomes more fully developed. In addition, this cosmetic surgery option is not ideal for those who smoke or drink. Both smoking and drinking reduces blood flow, which means that less oxygen reaches the skin. Necrosis can occur if the skin does not get enough oxygen during the wound-healing process. Open Rhinoplasty Technique vs. Closed Technique Board-certified cosmetic surgeons can choose from two different procedures. If the patient’s nose only needs minor alterations, then the surgeon can make incisions within the nose to reshape it. Patients who need more drastic reshaping will undergo open rhinoplasty. During this procedure, the surgeon must create a vertical strip between the nostrils so that he or she can see the entire nasal structure. During a Rhinoplasty Procedure The surgeon will start by placing incisions around the nose based on the alterations requested before the procedure. The surgeon will dissect the nasal skin, create a new structure and then drape the skin back over the area. During most rhinoplasties, the surgeon must use a nasal splint to help stabilize the nose’s anatomy. The purpose of rhinoplasty is to change facial features in a subtle way that blends in with the rest of the face both symmetrically and proportionally. After the procedure, patients must take care of their nose so that it can heal properly. The healing process occurs gradually, so patients may experience inflammation and minor bleeding after surgery. It can take up to one year for the healing process to finish. Those who plan to undergo additional facial procedures should ask their surgeon about having them done all at once. For example, a board-certified cosmetic surgeon can conduct a chin augmentation in conjunction with a nose procedure. Having multiple cosmetic surgeries done at once can help the surgeon maintain facial balance. REQUEST AN APPOINTMENT

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. REQUEST AN APPOINTMENT

Reconstructive Surgery for Orbital Tumors and Fractures When trauma or injury to the orbital socket or area near or around the eyes occurs , the consequences can be significant. If left untreated, one can inevitably lose or tarnish their eyesight as a result. Dr. Schwarcz recommends repair and/or reconstructive surgery depending on the circumstances and nature of the condition. If an orbital tumor metastasizes, it can be one of the following: Optic Gliomas Osteomas Hemangiomas and Lymphangiomas Sarcomas Fibrous Histiocytomas Retinoblastoma Meningiomas Schwannomas/Neurofibroma If an orbital tumor is present, cosmetic plastic surgeon Dr. Schwarcz will surgically remove the tumor by small incisions near the eye. Contact our practice to schedule your appointment to learn more about orbital tumor and fracture removal . REQUEST AN APPOINTMENT

Complications of a Facial Fracture Just like all bones throughout your body, bones in your face are vulnerable to fractures. While a broken nose is the most common , you can also break your forehead, cheekbones, jaw, and eye sockets. And once you have one or more facial fractures, you run the risk of complications that can affect your appearance and physical function. Board-certified oculofacial plastic surgeon Robert M. Schwarcz, MD , provides orbital and facial reconstructive surgery to help minimize the effects of facial fractures . In this post, we take a closer look at facial fractures, including potential complications and repair procedures. Facial fracture causes and complications Most any impact that affects your face can lead to a facial fracture. Especially common causes include: Car accidents Falls Physical fights Domestic violence Sports injuries Workplace accidents At most any point, even after a broken facial bone has healed, you can end up with various complications. Some complications are on the milder side, such as bruising or swelling, and they resolve on their own with healing. For more serious injuries, severe complications can occur. Depending on the location and severity of your facial fracture, you could experience: Facial disfigurement, such as sunken-in eyes or flat cheeks Limited function, such as having a hard time fully opening or closing your jaw Eye damage or vision problems, such as blurriness, double vision, or blindness Brain damage Recurrent nosebleeds from a broken nose You also may suffer from lingering pain or altered sensation, such as numbness. Facial fracture treatment Treatment for facial fractures aims to restore normal function and appearance that you lost with the injury. Oftentimes, initial treatment for a facial fracture involves medications to minimize pain and swelling. If you have a high risk of infection, you’ll also need antibiotics. Some facial fractures can be treated with a closed reduction, which resets the break without exposing the bone. If needed, open reduction is a surgical procedure that accesses the bones to reposition them so they’re properly aligned. Complex facial fractures that involve multiple bones require reconstructive surgery . When considering surgical repair for the effects of a facial fracture, it’s important to consult with a qualified expert promptly. Rather than wait for full healing, aim to talk to a specialist as close to the injury date as possible. To learn more about facial fracture corrective surgery, call one of our offices — in the Upper East Side of Manhattan and in Scarsdale, New York — to book an appointment with Dr. Schwarcz. You can also request a consultation using our online scheduling tool. REQUEST AN APPOINTMENT

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. REQUEST AN APPOINTMENT

My Drooping Eyelids Are Affecting My Eyesight: Can You Help? Some 11.5% of people experience eyelid drooping at some point. And for many, it’s more than a cosmetic concern. When your eyelids sag below an ideal place, they can limit your field of vision. And when you can’t see fully or comfortably, your quality of life can suffer, too. Thankfully, there’s a solution. At our offices in Scarsdale and the Upper East Side of Manhattan, New York, board-certified oculofacial plastic surgeon Robert M. Schwarcz, MD , provides eyelid blepharoplasty to restore a more youthful look and reduce related complications such as affected eyesight. What causes drooping eyelids A range of factors can lead to or worsen eyelid drooping, which often involves weakness in the muscles that control your eyelids or nerves that aren’t functioning quite right. Potential contributors to sagging eyelids include: Aging Eye surgery complications Injury to your eyelid Poorly placed neurotoxin injections Over-stretching your eyelid ligaments or muscles You can also experience a drop in your eyelids due to a medical condition, such as third nerve palsy, muscular dystrophy, Horner syndrome, or myasthenia gravis. How blepharoplasty can help Blepharoplasty, also known as an eyelid lift, is a surgical procedure that restores a healthier, more natural-looking appearance in your eyelids. The two types include: Upper eyelid blepharoplasty, which involves an incision in the crease of your upper eyelid to remove excess fat and skin and reshape surrounding muscle Lower eyelid blepharoplasty, in which an incision inside or on the outside of your lower eyelid allows for the removal of excess skin and fat In both cases, Dr. Schwarcz takes special care to place the surgical cuts strategically to minimize any visible scarring. Recovery tends to take about 1-3 weeks , after which you can enjoy fuller vision. To keep you comfortable as you heal, our team may recommend gently applying cold compresses, lubricating your eyes with a provided ointment, and taking approved over-the-counter pain medication, such as acetaminophen. Ideal candidates for blepharoplasty You may be a strong candidate for an eyelid lift surgery if you’ve noticed puffy eyelids, you have tired-looking eyes, or have experienced vision problems because of the droopiness. You should be at least 18 years old, in generally good health, and have realistic expectations of the surgery’s results. To learn more about treatment for drooping eyelids or to find out if blepharoplasty is right for you, call one of our offices to book an appointment with Dr. Schwarcz today. You can also request an appointment through this website using our online scheduling tool. REQUEST AN APPOINTMENT

Treat Your Excessive Sweating with Botox An estimated 2.8 percent of the American population, or about 8 million people, suffer from a condition called hyperhidrosis. These people sweat heavily from their armpits, soles of the feet, or palms of their hands. This sweating occurs regardless of the weather or the person’s emotional state. Hyperhidrosis or excessive sweating can be embarrassing by producing visible dampness and sweat odors through clothing. It can also damage clothes, and when present in the feet it can produce an environment conducive to athlete’s foot and other infections. Treatment for hyperhidrosis usually involves antiperspirants and medication, with surgery as a last resort. However, there’s a non-surgical treatment your cosmetic surgeon can help you with. Botox has recently been approved by the FDA as a treatment for hyperhidrosis in the armpits, and many doctors use it to treat Blepharospasm and any involuntary twitching as well. In addition, Botox is commonly used on the neck and face. How Botox Controls Hyperhidrosis Botox is primarily known as an anti-wrinkle treatment . It works by temporarily paralyzing the nerves in the affected area. In the case of hyperhidrosis, Botox is injected to block the nerves that send signals to the sweat glands. Botox injections in areas commonly affected by hyperhidrosis, such as the hands, armpits, and groin, is a relatively simple procedure that should not be painful. The injections do not need to penetrate deeply, so a small needle is all that is needed, minimizing discomfort. Using Botox on the feet is somewhat more difficult because the skin of the feet is thicker than the armpits or hands. A larger needle and some form of anesthesia, such as a nerve block, may be required. Effects of Botox Injections for Hyperhidrosis You should see immediate results from your Botox injections. There should be no recovery or downtime necessary. The effects of the injection should last approximately eight months. However, that may vary depending on your own body chemistry and the area to be treated. Your cosmetic plastic surgeon will help you assess how well the injections are working for you and create a schedule of injections to keep you sweat-free. REQUEST AN APPOINTMENT

Understanding the Different Types of Skin Cancer Your skin is your largest organ and the organ most vulnerable to cancer, especially if you spend time in the sun without protection, if you have light skin and eyes, or if skin cancer runs in your family. Every day in the United States alone, 9,500 people are diagnosed with a type of skin cancer , meaning that if you have it, you’re far from alone. Thankfully, even the most aggressive form is typically curable with early detection and treatment. Board-certified cosmetic surgeon Robert M. Schwarcz, MD , is pleased to provide such treatment, including Mohs surgery . Read on to learn about the three most common skin cancer types and how Dr. Schwarcz and his team can help. Basal cell carcinoma More people are diagnosed with basal cell carcinoma than any other form of skin cancer. In fact, 3.6 million people in the U.S. learn they have it each year. It derives from uncontrolled, abnormal growth of basal cells within your skin and tends to grow slowly without spreading to other tissues in your body. During this growth, it destroys skin tissue in its path, leading to raised red or pink bumps that are often flaky. These symptoms typically appear on areas of your skin that have been repeatedly exposed to UV rays, such as your arms, ears, face, and legs. Squamous cell carcinoma Rays from the sun also play a role in squamous cell carcinoma, but typically only in people who have a compromised immune system. Unlike basal cell skin cancer, this form is highly aggressive and more likely to spread to your lymph nodes or organs without treatment. The most common sign is a rough growth on your skin, known as actinic keratosis, which progresses into a crusty-edged, inflamed ulcer. Melanoma Melanoma only accounts for about 1% of skin cancer cases , but it results in the most skin cancer-related deaths. Highly invasive and aggressive, melanoma starts out as a mole caused by sun exposure and can rapidly spread to your blood and lymphatic system. Genetics may also play a role in whether you develop it. The melanoma mole may appear asymmetrical, have an irregular border, and change colors. It can also appear anywhere on your body, even under your fingernails or in your eye. Treatment for skin cancer Early diagnosis is important when you have skin cancer, particularly when you have melanoma. The sooner you receive needed treatment, the better your outcome will be. Treatment usually involves removal of cancerous cells. Dr. Schwarcz can also remove precancerous lesions , preventing the disease on that area of skin. Dr. Schwarcz has extensive experience in Mohs surgery. This specialized way of removing skin cancer cells — guided with detailed mapping and a microscopic exam of your skin — best protects surrounding tissue and leads to minimal scarring. Mohs surgery is considered the most effective and precise skin cancer treatment, resulting in a 99% success rate . For more advanced and serious skin cancers, such as later stage melanoma, you may also need radiation therapy, chemotherapy, targeted therapy, or immunotherapy. If you’re concerned about skin cancer or precancer, call our office or request a consultation using our online scheduling tool to book an appointment with Dr. Schwarcz. REQUEST AN APPOINTMENT