Scheduling a Consultation

The process starts by calling, texting, or emailing the office to schedule a consultation. Our office staff will help get an appointment scheduled and can help answer any questions about the process. You can call or text the office at 978-393-5437 or send an email to office@bostoneyelids.com.

We have a busy office and usually schedule consultations 2-3 months from your initial call. That being said, we have a very active waiting list and can often get patients in sooner if they are flexible on times. Another trick is to call the office on Monday morning at around 8:00 AM – Monday cancellations are common, and we might be able to fit you in on short notice.

The Initial Office Visit

During this visit to our Wellesley office, you will meet Dr. Kapadia and our office staff.

What to Expect During Your Consultation

• The Initial Consultation: This is where Dr. Kapadia will discuss your aesthetic goals and concerns. We want to understand what bothers you most and what you hope to achieve.
• Discussing Your Goals: Be open and honest about your expectations. We’ll help you set realistic goals and explain what blepharoplasty can and cannot do.
• Medical History Review: We’ll go over your complete medical history, including any eye conditions, allergies, and current medications (prescription, over-the-counter, and herbal supplements).
• Physical Examination: We will assess your specific anatomy to plan the most effective and safest procedure for you.
• Procedure and Anesthesia Recommendations: If you are a candidate for surgery, we will discuss what we hope to accomplish as well as what types of anesthesia options are available.
• Surgical Quote: If you are a candidate for surgery, we will provide you with a written quote which details the costs of surgery as well as any treatments that we recommend before and after surgery.
• What to Expect: We will provide you with detailed information about what to do before surgery, what to expect on your surgery day, and what you need to do after surgery. Knowledge is power. We want you to be as prepared as possible with no surprises.

Eyelid Surgery: The Procedure, Recovery, and Longevity

Our aim is to make your surgical experience as comfortable and efficient as possible.

Fast Facts on the Procedure and Recovery

• Outpatient Procedure: Eyelid surgery is performed on an outpatient basis, allowing you to recover in the comfort of your own home.
• Anesthesia Options: Upper eyelid surgery can be performed awake with local anesthesia (numbing injections) or with intravenous sedation. Lower blepharoplasty is generally performed under general anesthesia.
• Typical Surgery Duration (30-75 mins): The procedure itself usually takes between a half hour and 75 minutes, depending on whether you’re having upper, lower, combination surgery, and/or laser resurfacing.
• Post-Surgery Swelling and Bruising: It’s normal to experience swelling and bruising around your eyes after surgery. This typically lessens significantly within 14 days, though individual healing times vary. The vast majority of patients can return to in-person work in 14 days, though makeup is sometimes needed.
• Working From Home: Most patients can return to working on a computer the day after upper eyelid surgery and within 3-4 days after lower eyelid surgery. You are probably going to need your camera off during video calls for about 2 weeks.
• Post-Op Care: We will provide detailed instructions for post-operative care. This typically includes applying ice packs to your eyes, sleeping with your head elevated to reduce swelling, and using prescribed medication. You’ll need to avoid strenuous activity and rubbing your eyes. Pain is usually minimal – patients are surprised at how little it hurts.

Understanding the Results and Longevity

The results of eyelid surgery can be truly transformative, offering a refreshed, more youthful appearance that can significantly boost self-confidence.

• A More Rested and Youthful Appearance: Many of our patients tell us they feel more self-confident and that friends and family remark on how rested and refreshed they look, often without realizing surgery was involved. This aligns perfectly with our philosophy of natural, subtle improvements.
• Increased Self-Confidence: When your outer appearance reflects how you feel on the inside, it naturally leads to greater self-assurance.
• Results Are Long-Lasting: For most patients, results usually last about 10-15 years. Surgery doesn’t stop the aging process – it just moves it backwards.
• Scars Are Hidden in Natural Creases and Fade Over Months: Our expert eyelid plastic surgeons carefully place incisions in the natural creases of your eyelids, minimizing their visibility. Scars usually fade to a barely visible, faint line over time.
• Protecting Skin From Sun Exposure is Key: After surgery and throughout your life, protecting your delicate eyelid skin from sun exposure with sunglasses and sunscreen is crucial to maintaining your results and preventing further signs of aging.

Navigating the Costs and Potential Risks of Eyelid Surgery

Making an informed decision about eyelid surgery involves understanding both the financial investment and the potential risks involved. We believe in complete transparency to help you feel confident in your choices.

A Breakdown of Eyelid Surgery Costs

The cost of eyelid surgery can vary, and it’s important to understand what contributes to the total fee:

• Factors Influencing Cost (Surgeon’s Fee, Facility Fee, Anesthesia Fee): The total costs for surgery can include the surgeon’s professional fee, the cost for the surgical facility where the procedure is performed, and the anesthesiologist’s fee. In our office, we will give you a total fee which includes all these costs. We believe in full transparency so there are no financial surprises in our office.
• Geographic Location: Costs can vary by region. In metropolitan areas like Boston, fees may be higher due to the cost of living and operating expenses compared to the Midwest.
• Complexity of the Procedure: Revision surgeries are often more complicated than primary surgeries and may have a higher cost.

Is Eyelid Surgery Covered by Medical Insurance?

Cosmetic surgery is never covered by medical insurance in the United States. In some cases, upper eyelid surgery may be covered by insurance if it is severe enough to cause a significant loss of peripheral vision. Lower eyelid surgery is not typically covered by insurance.

Our office, Boston Eyelids, does not accept any medical insurance.

Why don’t we accept medical insurance? Our goal is to provide our patients with the highest level of care and a world-class experience. Medical insurance typically pays less than 20% of the full cost of upper eyelid surgery. We are unable to provide quality of care at that price. You get what you pay for. If your goal is an optimal cosmetic result, you should consider paying out-of-pocket for surgery. If your goal is to improve your peripheral vision with less concern about how it looks, you can consider seeing a doctor that accepts medical insurance.

Scheduling Surgery

After your consultation with Dr. Kapadia, you will meet with our office staff. As mentioned above, we will provide you with a detailed quote for your surgery. We will also ask you to sign a financial agreement at that time. The financial agreement provides a breakdown of cancellation and rescheduling fees and is not an obligation to proceed with surgery.

If you are ready to schedule surgery, we will give you a list of available dates. If you are not ready to schedule, that’s totally fine as well. There is no sales pressure in our office. Feel free to go home and think about it more. You will potentially need to make arrangements with taking time off work and having a family member drive you on surgery day, so it’s important to pick a day that works.

Once you are ready to schedule a date, we will collect a booking fee of $1,000. This confirms your spot in our schedule. Note that there is a rescheduling fee of $500 if you need to change your date after booking. Full payment is due one month prior to surgery, and there are hefty fees to reschedule after that time. We need to pay our staff for a full day of work even if you cancel your surgery, and the fees are designed to cover these costs. If you have an urgent medical issue which requires you to reschedule surgery, we can usually waive some of these fees with a doctor’s note.

Surgery Day and Post-Op Care

Arriving for Surgery

If you are having surgery under local anesthesia only, we will ask you to arrive in our office about 30 minutes before your scheduled surgery time. You will be able to leave right after your procedure (typically around 60 minutes), though you will need a ride home. Because you will be awake and not drowsy, an Uber or taxi is totally fine – you just can’t drive yourself.

If you are having surgery under systemic anesthesia, we will ask you to arrive at least an hour before your surgery. You won’t be able to eat or drink anything after midnight. Our nursing team will help get you changed into a surgical gown and get you prepared for surgery. After surgery, you will need to be in our recovery room until you are awake enough to be discharged. A family member or friend will need to drive you home that day and be with you for several hours until the anesthesia is out of your system and you are fully awake.

Post-Op Appointments

A full list of post-op appointments will be provided to you along with detailed postoperative instructions. Your first post-op visit is typically one week after surgery.

The post The Patient Journey: From Scheduling a Consultation to Final Results appeared first on Boston Eyelid Surgery.

• Extensive, specialized training in eyelid plastic surgery – preferably an ASOPRS-certified oculoplastic surgeon, see discussion below 
• Experience and expertise in cosmetic eyelid surgery – a surgeon who performs hundreds of cosmetic eyelid surgeries annually and has done thousands in their career. Most plastic surgeons focus on reconstructive surgery – its not the same thing. There are only a small subset of surgeons who devote their careers to cosmetic procedures.
• Referrals. If a friend or family member had a good experience with a particular doctor, that’s obviously a great sign. If you don’t know anyone who has had eyelid surgery, your primary care doctor, hairdresser or aesthetician are also great resources for recommendations. 
• Before and after photos of the surgeon’s own patients. You want to make sure your aesthetic goals and what the surgeon can do are aligned. If you don’t like the before and after photos you are probably not a good match with that surgeon’s sense of aesthetics and should keep looking. We have such an extensive collection of photos in our office that most local patients in the Boston area can find someone they know in our photo library!
• Online reviews. While all surgeons have occasional unhappy patients, it’s worth taking the time to look through online reviews to see if there are common themes. What is the ratio of good reviews to bad reviews? Were there a lot of people unhappy with surgery, or were most of the bad reviews from patients the doctor turned away?

After making contact with the surgeon’s office and scheduling a consultation, there are a number of additional factors to consider. 

• • Surgeon personality. Were you and the surgeon on the same page during the consultation? Does the surgeon feel like someone you can trust? Does the surgeon seem as experienced as your online research suggests? Even if a surgeon has a great reputation, they may not be a good fit for you from a personality perspective. This is the start of a relationship that continues after surgery – you need to trust the surgeon and feel comfortable approaching them if you have concerns about the healing process.
  • Office staff. What was your experience like when you called to make an appointment or when you went to the office? Does the office staff know how to answer your basic questions? Are they friendly and patient or in a rush to get to the next person. Remember, the same people will be answering the phones when you have a question or concern after surgery.
• Trust your instincts. If your gut is telling you to run away you probably should. 

Why choose an oculoplastic surgeon to perform your eyelid surgery?

Your eyes are irreplaceable. The skin around them is delicate, and the muscles that control eyelid movement are intricate. One wrong move during surgery can affect your vision, your ability to close your eyes comfortably, or leave you with an unnatural “surprised” look that screams “I had work done.”

This is why choosing the right surgeon isn’t just important, it’s everything.

Oculoplastic surgeons (aka oculofacial plastic surgeons) are fully trained board-certified eye surgeons who have completed 4-5 years of training focusing on surgery of the eyes and eyelids. 

The difference matters. When you’re looking for subtle improvements—a refreshed look that makes you appear more rested, not radically different—you need someone who understands that less is often more. You need a surgeon who won’t remove too much skin and won’t change the shape of your eyes. The goal is to help you look younger and more refreshed without looking overdone.

This guide will help you understand what sets top eyelid specialists apart, what questions to ask during consultations, and how to find a surgeon whose philosophy aligns with your goals for natural, lasting results.

The Oculoplastic Surgeon: An Expert in Eyes and Eyelids

What truly sets a specialized oculoplastic surgeon apart and makes them ideally suited to perform eyelid plastic surgery? It’s their profound, almost obsessive, understanding of eye anatomy and function.

• Specialized training in both eye anatomy and plastic surgery techniques: This dual expertise is critical. Oculoplastic surgeons spend three years learning about the intricate structures of the eye itself before dedicating additional years of training to plastic surgery techniques of the eyelids and face. This means they understand how surgical changes will impact not just aesthetics, but also vision, tear production, and eye health.
• Deep understanding of delicate eye anatomy: The eyelids are incredibly thin and complex, containing numerous muscles, nerves, and glands crucial for eye protection and function. A specialist knows precisely where to make incisions, how much tissue to remove, and how to preserve these vital structures.
• Focus on preserving eye function and health: For an oculoplastic surgeon, aesthetics are never prioritized over the health and function of your eyes. They aim to maximize aesthetic results while ensuring the health and safety of your eyes. This is a crucial distinction.
• Expertise in micro-surgery for natural results: The precision required for eyelid surgery is immense. Oculoplastic surgeons are trained in micro-surgical techniques, allowing them to make minute, precise adjustments that yield natural-looking results without an “operated” look. Their goal is to restore and refresh, allowing you to retain the unique character of your face.

Training and Certification for Oculoplastic Surgeons

In cosmetic surgery, board certification is your gold standard for quality and safety. But know what kind of board certification truly matters, and there are different types of board certifications and training. The training to become an oculoplastic surgeon is quite extensive. The path to become an oculoplastic surgeon is outlined below.

• College and Medical School: Oculoplastic surgeons, like all physicians typically complete four years of college after high school and then go through another four years of medical school.  Medical school involves training in general topics such as anatomy and pharmacology as well as an introduction to different specialties. Medical school culminates with earning an “M.D.” degree.
• Internship. The next step after medical school is to do an internship year in medicine, surgery or a combination of the two. This involves general training on how to be a practicing doctor and allows licensure to most state medical boards.
• Residency. After internship, oculoplastic surgeons complete a three year residency in ophthalmology where they study all aspects of eye health and disease. Surgery on and inside the eye is an important part of this training. Doctors can become board-certified in ophthalmology after completing this training and passing both written and oral exams.
• Fellowship. After training in ophthalmology and eye surgery, oculoplastic surgeons then go through another 1-2 years of subspecialty training in oculoplastic surgery. This involves extensive training in all things around the eyes including eyelid plastic surgery, orbital tumors, fractures and tear duct surgery. This training involves performing hundreds of surgeries under supervision.
• After fellowship. After fellowship training, ASOPRS candidates must pass a rigorous written and oral exam. In addition, a scientific thesis advancing the field must be reviewed and approved by peers before becoming ASOPRS certified. 
• Certifications: Look for board certification by the American Board of Ophthalmology (ABO) followed by fellowship training and certification by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). 

In the entire United States, only about 30 surgeons complete this type of specialized certification each year! 

Do other types of doctors perform eyelid surgery?

• Many other types of doctors perform eyelid plastic surgery. Not all of them are even surgeons!
• There are three main types of plastic surgeons: general plastic surgeons, facial plastic surgeons and oculoplastic surgeons.
• General plastic surgeons have the most training in body surgery and typically specialize in tummy tucks and breast surgery.
• Facial plastic surgeons are initially trained in Ear, Nose, and Throat surgery. These surgeons usually specialize in rhinoplasty (nose surgery) and facelifts. 
• Oculoplastic surgeons are initially trained as eye surgeons and have the most specialized training in eyelid plastic surgery.
• Remember – Most plastic surgeons perform eyelid surgery but only a small subset have the specialization to be an ASOPRS-certified oculoplastic surgeon.
• “Cosmetic surgeon” is not a specialty recognized by the American Board of Medical Specialties (ABMS). Be wary of this specialty as there is much less quality control and the standards of training can vary considerably.

Remember – many surgeons perform eyelid surgery, but only a small subset are ASOPRS-certified oculoplastic surgeons.

Questions to Ask Your Potential Eyelid Plastic Surgeon

Your initial consultation is your opportunity to interview your potential surgeon and ensure they are the right fit for you. We encourage you to be thorough and ask probing questions.

• What is your specific training in eyelid surgery? Ask about their fellowship training, particularly if they are an oculoplastic surgeon. This demonstrates their specialized focus.
• Are you board-certified in ophthalmology? This confirms their foundational medical training and ensures they can deal with most eye specific issues after surgery.
• How many cosmetic eyelid surgeries do you perform each year? Experience is paramount. A surgeon who performs hundreds of eyelid procedures annually will have a deeper understanding of nuances and potential complications than one who does only a few.
• Can I see before-and-after photos of patients similar to me? This is crucial. Look for natural results, not just dramatic changes. Pay attention to eye shape, symmetry, and scar visibility. There should be patients your age.
• What is your philosophy on achieving a natural look? A top eyelid plastic surgeon should prioritize results that make you look like a refreshed version of yourself, not someone entirely different. Our philosophy at Boston Eyelids, for example, centers on natural results and avoiding “over-doing” surgery.
• Where will the surgery be performed? Ensure the facility is accredited and meets safety standards.
• What type of anesthesia do you typically use for eyelid surgery?  If a surgeon performs all their surgeries with patients awake, this may not be the best option for you.
• What are the common potential risks and complications after surgery, and how do you treat them? The surgeon should have tools such as lasers to treat common post surgery problems such as prolonged redness, thick scars, etc.
• How often do you need to refer patients to another surgeon for issues that arise after eyelid surgery.  A surgeon should be able to handle most issues that can arise after surgery.
• Does the surgeon perform revision eyelid surgery. This shows particular expertise in eyelid surgery. You want to go where other doctors send their complicated patients, even if you are not a complicated case.
• How do I communicate with the office? Is there always a doctor available if there are issues after surgery? How do I get in touch?

Conclusion

Choosing an ASOPRS certified eyelid plastic surgeon is a decision that profoundly impacts both your appearance and your well-being. By prioritizing a board-certified specialist, you are investing in safety, expertise, and the highest likelihood of achieving a beautiful, natural outcome that doesn’t look “overdone.” A surgeon with a philosophy of personalized care will work with you to improve your unique features, leaving you looking like the best version of yourself.

At Boston Eyelids, we are dedicated to our philosophy of natural results and personalized patient care. We believe in enhancing your inherent beauty, ensuring you look like yourself, only more rested and refreshed. We understand the delicate balance between aesthetic improvement and functional preservation, especially in the sensitive eye area.

Ready to explore how we can help you achieve a refreshed, natural look? Schedule your consultation to discuss your goals.

The post Boston’s Best Eyelid Surgeons: Your Guide to Choosing a Doctor for Eyelid Plastic Surgery. appeared first on Boston Eyelid Surgery.

Puffiness under the eyes, also known as eye bags, can give patients a tired look even when they are well rested. Almost all patients with under-eye bags look much better when excess fat is removed under the eyes, but the lower eyelids can sometimes have a hollow appearance after surgery, also known as a tear trough deformity. This problem can be present in some very young patients even without surgery. I hate the term tear trough deformity since there is no real “deformity” and I will just refer to this problem as lower eyelid hollowing in the rest of this article.

This article goes through different methods for optimizing the results of lower blepharoplasty surgery by minimizing lower eyelid hollowing after surgery. Different eyelid surgeons will have different opinions on what they think works best. My goal is not to disparage anyone else’s technique or opinion – I’m just presenting my point of view, which other surgeons I hold in high regard will completely disagree with. There are a lot of surgeons who do things differently and have great results.

The goal of lower blepharoplasty surgery is to improve the appearance of the lower eyelids by treating the skin and underlying fat. The goal is a smoother contour from the eyelid to the cheek creating a younger, less tired appearance.

The Modern Approach to Lower Blepharoplasty

Traditionally, lower eyelid surgery involved the removal of excess fat under the eyes through an incision on the outside of the eyelid, under the eyelash line. A more modern approach to this surgery involves an incision on the inside of the eyelid so there is no visible scar. This can be done in conjunction with CO2 laser resurfacing of the lower eyelid skin to improve skin texture without a visible incision. In my experience, this is the best approach for the vast majority of patients in their 20s-60s. Older patients may sometimes require skin removal and eyelid tightening.

In some patients, removing the excess fat under the eyes can create a hollow appearance. In most cases, this is because the bone under the eyes (inferior orbital rim), which was previously covered with fat, becomes more visible.

A variety of different techniques have been developed to treat this issue. Patients often ask why you can’t just remove less fat, which sounds great in theory but doesn’t work in actual practice. The problem is that any excess fat will sit on top of the bone and still cause an under eye bag. There is too much volume above the bone and not enough volume along and below the bone. Also, if a patient is still a little puffy right after surgery, this problem is likely to get a lot worse over the next few years leading to poor longer term results.

Hollowing after lower blepharoplasty surgery can be prevented or treated using different methods. All of them have advantages and disadvantages and none are perfect. I’ll explain the pluses and minuses of each of these techniques and why I do what I do. Currently, the most technique used by the most eyelid surgery specialists is fat repositioning. While I do think this is a good technique in some patients, my preferred technique is to remove the fat and add postoperative fillers when needed. Let me explain why.

Lower Blepharoplasty with Fat Repositioning

In lower eyelid surgery with fat repositioning, the excess fat in the lower eyelids is moved (repositioned) instead of removed. After the fat pads are exposed, additional dissection is performed across and below the bone and the excess fat from the lower eyelid is pulled down into this cavity.

The Drawbacks of Fat Repositioning

Theoretically, this approach makes the most sense. In my personal experience, it doesn’t work as well in practice. What are the main issues with fat repositioning?

• There is sometimes a limited amount of fat to reposition. If there is not enough fat to efface the contour of the bone completely, then there is still residual hollowing after surgery.
• Fat repositioning works better on the inner 1/3 of the eyelid than the outer 2/3. The lateral fat pad can sometimes be repositioned but is too friable in many patients and falls apart before it can provide enough integrity to efface the bone.
• The fat that’s pulled down over the bone can sometimes pull back and lead to recurrent under eye bags.
• If the fat really survives in its new position, what will this look like 20-30 years from now? I treat a lot of really young patients and worry about this issue a lot. I don’t want to do anything now that will cause a problem later. No surgery lasts forever – when I remove fat and it comes back 10-20 years later I know I can easily go back and remove some more. When it’s in a different spot it’s harder to get to if it looks too puffy.
• There is more dissection and manipulation of the tissue leading to more swelling and a longer recovery time.
• The surgery takes longer so I have to charge considerably more for the extra time.
• I am a perfectionist. Even when I reposition fat there is often some hollowing that I want to treat with fillers and I ask myself why I did all this extra work (with additional cost to the patient) when I still want to add fillers later.

Lower Blepharoplasty with Fat Transfer

In lower blepharoplasty with fat transfer, the excess fat in the lower eyelids is either removed or repositioned and liposuction from the belly or thighs is used to harvest fat that is used as a natural filler to treat hollowing.

I love the idea of this. In theory, it sounds so much better to use a natural substance like your own fat instead of an artificially manufactured filler and I get that point. I try to eat healthy foods and avoid processed products too, but here are the issues with fat transfer.

Challenges and Risks of Fat Transfer

• Survival of Fat Cells: Fat is not an inert substance and needs nutrients from blood to survive. When you inject fat into an area it needs to “take”. This means it needs to develop a blood supply so that the injected cells receive enough nutrition to survive.
• Variable Results: How much of the injected fat will take? There is no way to know for sure before surgery. Most surgeons realize that 40-60% of the injected volume will persist so injecting fat requires a lot of purposeful overcorrection. Most surgeons inject fat assuming 60% will take so most patients will be undercorrected if they reach the average of 50%. That’s not the main issue – what about if 70% takes and your whole face looks really puffy? I don’t like things I can’t control, and I can’t control how much injected fat will take.
• Difficult to Remove: Injected fat is extremely difficult to remove. When too much fat is injected or too much takes, it’s very difficult to remove it. There are tiny globules of fat all over the place which are almost impossible to find if you go in surgically to try to remove them. Large lumps that you can feel can usually be removed with additional surgery but this can leave dents. The tiny globules are almost impossible to remove.
• Weight Sensitivity: The injected fat can be very weight sensitive. If you ever gain or lose weight that fat can grow and shrink a lot more than your normal facial fat, especially eyelid fat. Remember that this fat was taken from your belly or your thighs. This fat is much more weight sensitive than the fat in your face. When I gain five pounds I see it in my belly before anywhere else and notice that my pants and belt are tighter than usual. Body fat tends to be a lot more weight sensitive than face fat. With fat transfer you are taking belly fat and putting it into your face. What will your face look like if you gain 20 pounds later in life? If you have fat transfer it’s really important that you maintain your weight for the rest of your life. Unfortunately, many women find that they gain weight during pregnancies or menopause that’s really hard to lose. When patients gain weight after fat transfer they look really puffy and there is not much that can be done. Their initial surgeon has often retired or moved to another state and I don’t have much to offer them to help besides telling them to lose the weight. It’s not a good situation. As I explained above, it’s really hard to remove injected fat.

Adding Under Eye Fillers

Why would you want to inject an artificially manufactured substance instead of using your own fat? The reason is that in practice (at least in my hands) it works a lot better and more predictably than the other options.

I’m the last person to tell you that my way of doing things is perfect. I am a perfectionist and this technique is not perfect – I definitely wish it was. I’ll tell you about not only the pluses of doing things my way, but the negatives as well. As I already mentioned, it’s not perfect.

The Advantages of Hyaluronic Acid (HA) Fillers

Hylaluronic acid (HA) based fillers have been around in the United States since the early 2000s and were used in Europe for years prior to US approval by the FDA. Hyaluronic acid is a natural substance in your body and skin. The problem is that when you inject straight hyaluronic acid it looks great but gets degraded within a few days. Your body has enzymes which break down hyaluronic acid and build it back up constantly. Hyaluronic acid fillers use a process called cross-linking to make them last longer. Are they completely natural – definitely not. Are they close to what’s naturally in your body? Definitely.

When adding volume using HA fillers you can use as much or little as you want. After the initial swelling subsides, the filler tends to hold 80-90% of its initial volume so the final result looks a lot closer to what it looks like as you put it in compared to injected fat. The final outcome is more predictable.

The single biggest advantage to using HA fillers is that they are reversible. There is an enzyme called hyaluronidase which dissolves HA based fillers. The dissolving can be done at any time, including many years later.

Why Under Eye Fillers Sometimes Get a Bad Reputation

Fillers have gotten a bad reputation because they have been overused and used incorrectly. Injectors have been putting way too much filler in people and using it in the wrong ways. There are very good injectors with lots of experience out there, but they are in the minority. A lot of injectors go to a weekend course and claim they are “certified” to do injections. That just means the injector was certified by the people who run the course. The courses are almost always given on a for profit basis, so basically everyone who takes the course is certified. There is no way to learn how to inject fillers well in a few hours. It takes years of training and experience to be good at injecting fillers and there is always more to learn.

Under eye fillers have specifically gotten a bad rep, but this is mainly because of patient selection. Under eye fillers are a great tool in the right situation, but the vast majority of patients who are seeking this treatment are not a candidate based on their anatomy. You know the saying that “when you have a hammer everything looks like a nail”? For many people who make their living injecting fillers, they push fillers as a solution to every problem on the face, and this is where poor results come from.

The most common scenario I see is that a patient has real under eye bags, which an injector tried to camouflage with fillers. In my experience, this rarely works for the long-term. It may look good for a few weeks or a few months, but the amount of filler needed to camouflage an under eye bag almost never looks natural as it settles out.

What Are Fillers Actually Good For?

Fillers are great at treating hollowing. If patients look a little hollow after lower blepharoplasty surgery, under eye fillers are a great way to treat this problem.

In lower blepharoplasty surgery, excess fat under the eyes is removed, but this sometimes makes the underlying bone more prominent, leading to a slightly hollow appearance. Adding a small amount of filler along the bone helps smooth out the eyelid-cheek junction and optimize surgical results.

Can’t you just remove less fat to reduce hollowing? In practice, this doesn’t really work. The main issue is that the excess fat is above the bone so leaving some excess fat in place just looks like the surgery was done half way and patients still have under eye bags.

Why I Prefer Fillers After Under Eye Surgery

Why do I prefer using fillers in lower eyelid surgery patients instead of fat repositioning or fat transfer?

• Fillers are reversible: There is an enzyme called hyaluronidase which dissolves fillers. If we ever don’t like the way fillers look we can always remove them with a few simple injections in the office.
• Fillers are done after we see the surgical results: During surgery, I remove excess fat and we let it heal. If it looks a little hollow later, we add back filler at the 3-4 month mark once most of the swelling is gone. Even though I have been doing this for 20 years, I can’t always predict who will need fillers after surgery. Some people who I think will need fillers look great with fat removal alone and we don’t need fillers. Other times, I look at a patient and don’t think they will need fillers but 3-4 months after surgery I decide a little filler would help. If I had to make the decision whether or not to inject fat (which is usually done at the same time as surgery) I’m not sure I would always make the right decision.
• Volume predictability: When I am injecting under eye filler, it’s an artistic process and I can visualize how the filler is working while I am injecting. In my experience, the final result is almost always about 90% of the volume I see while injecting. This is a lot more predictable than injecting fat, which can vary from about 40-60% take.
• Shorter surgery time and quicker healing: Fat removal takes less time than fat repositioning or injection. Less time means less anesthesia and usually less cost to the patient. Fat removal also causes a lot less swelling and, in my experience, patients are back to work more quickly.

What Are the Disadvantages to Using Post-Surgery Fillers?

As I’ve mentioned before, there is no perfect solution to volume issues after surgery. Fillers have their downsides as well, but in my experience are still the best option for most patients. I offer post-surgery filler injections to about 25-30% of lower blepharoplasty patients. Many of these patients are so happy with the results they don’t feel the need to have filler placed and we don’t bother.

The main downside to using fillers is chronic swelling. Fillers are made from a material that’s very similar to what’s naturally in your body, but a small subset of patients’ bodies don’t tolerate under eye fillers. When used after lower eyelid surgery, this type of chronic swelling is really uncommon, probably somewhere around 2-3% of patients where I inject fillers after surgery. Since less than 30% of patients even need fillers, this issue only arises in about 1 in 100 patients having lower blepharoplasty surgery. The good thing is that we can always dissolve the filler and the swelling goes away.

What happens if you end up in this 1% of patients? Almost everyone still looks much better than before surgery and doesn’t want to do anything else after we dissolve the filler. Hollowing after surgery is usually mild and still looks a lot better than puffiness for almost everyone. If someone doesn’t tolerate fillers and feels they really want the extra volume, they can always have fat injections but these aren’t perfect either as I’ve explained above.

Summary

Lower eyelid hollowing can sometimes be an issue post lower blepharoplasty surgery. It’s important to discuss lower eyelid hollowing with your surgeon as well as what he/she does to minimize this issue. The main ways to treat lower eyelid hollowing are fat transposition, fat transfer and filler injections. None of these techniques are perfect, but for the reasons outlined above, injecting fillers when needed after surgery is my preferred technique. I have lots of happy patients who have allowed me to show their photos in my photos gallery – feel free to look through these photos as a guide for what types of results can be accomplished with this technique.

The post The Truth About Lower Eyelid Surgery: Fat Transfer, Repositioning, and Fillers Explained appeared first on Boston Eyelid Surgery.

Our office takes care of many patients who choose to travel for surgery from across the US and overseas. I want to start by saying that traveling for surgery is not ideal, as it is hard to pop back into the office if any issues arise. With that being said, many patients are not able to find someone locally who they feel confident with and decide to travel. I always recommend patients obtain at least one consultation locally before deciding to travel for treatment. Feel free to email us to see if we know anyone local to you or at least within driving distance. If you end up really liking that person and feel comfortable with them, you should go for it. If you decide you still want to travel, keep reading.

The process starts when Dr. Kapadia examines photos that are sent by email to mitesh@bostoneyelids.com. Please also send a description of what bothers you and where you are located. If the photos aren’t adequate, he will ask you to send additional photos. It’s much better to ask someone else to take photos instead of taking selfies, which often have weird angles. For evaluating the upper eyelids, the lighting is less crucial, but it’s important to be looking straight ahead and not up or down to determine how much hooding is present. To evaluate the lower eyelids, it’s important to take photos without a camera flash using overhead lighting. Photos should be taken looking straight ahead as well as looking upward with your head straight. If Dr. Kapadia thinks you are a candidate for surgery, he will ask you to schedule a video consult so I can discuss your specific case with you and answer questions. The cost for a video consultation is $500 and is applied to the cost of any treatments performed within one year of the consultation. If additional questions come up, we can always communicate by email or with a second call.

If you decide to schedule surgery, a non-refundable deposit is required to hold your spot. We have never had this happen thus far but there is always a chance that something is found during you in person examination which would require cancelling your surgery. If this happens, your deposit will be refunded, but we are not responsible for any of your travel expenses.

Surgery is not guaranteed until you are examined in person. We usually set up an in-person consultation the day prior to surgery so Dr. Kapadia can examine you. If we are scheduling upper eyelid surgery only, the surgery can usually be performed as an office procedure under local anesthesia (if you want to be fully awake for the surgery) or with intravenous sedation. Lower eyelid surgery is usually performed under general anesthesia, but this can be discussed at the time of your video consultation.

The Wellesley office is about 15 miles (a $40-$50 Uber ride) from Boston each way. Please check with us on times available for consultations, surgery, and post-op appointments prior to booking your flights.

There are several hotels within driving distance of the Wellesley office. We recommend the Westin hotel in Waltham or the Mariott Courtyard in Natick. You will really need a car if you are staying in the suburbs. There are lots of hotels in Boston where you can uber back and forth when needed if you want to avoid renting a car.

If you are having surgery with intravenous sedation or with general anesthesia, someone will need to take you to your hotel after surgery and stay with you for 6-8 hours to recover from anesthesia. There are several visiting nurse services in the area which can help with this requirement if you are travelling alone. If you are having upper eyelid surgery only under local anesthesia (without sedation), you can take an Uber or taxi back to your hotel and do not need anyone with you.

Patients having upper eyelid surgery only can fly home 8 days after surgery. The advantages and disadvantages of each can be discussed at the time of your consultation. Patients having lower eyelid surgery can fly home 10 days after surgery.

For upper eyelid surgery, the remaining post-op checks can usually be done by email or video call and it’s not always necessary to return to Boston. Filler injections are sometimes needed to optimize the results of lower eyelid surgery. If needed, we would discuss an optimal time to return to Boston by email, but this would be at least 3 months after surgery. One vial of under eye filler is included in the cost of lower eyelid surgery if needed.

Of course, if there are any surgery related issues, additional trips to Boston may be required. This is not usually the case, but it’s important to keep this in mind before traveling for surgery. Sometimes there are things can be done to optimize surgical results, such as 5-FU injections for hypertrophic scarring or tightness or lasers to treat redness or thickened scars that need to be done in person. These are not always practical if you need to take a flight to get to the office.

Surgery takes time to heal. Here are my general guidelines – everyone heals at their own pace and one side often heals faster than the other. I recommend at least two full weeks off work due to bruising and swelling if you need to go into an office or meet with other people. If you can work from home, you should be fine to work within a few days after surgery. Most patients look acceptable to go to work two weeks after surgery or earlier. Makeup may be needed to cover residual bruising. It takes 6 months to see the full results of surgery and about 24 months to mature the scar at any incision.

Patients having upper eyelid surgery will usually have an incision across the entire eyelid crease. The crease is hidden when your eyes are open but will look bumpy when your eyes are closed. By 24 months, the incision fades to a faint line in most patients. Most patients having lower eyelid surgery will only have an incision on the back of their eyelid, so there is no visible scar to heal. If skin removal is required, an incision under the eyelash line may also be required, which will also take time to heal.

If you are having surgery prior to a big event such as a wedding, I recommend having surgery at least three months prior, but the longer the better to give your eyes time to heal.

There is always a chance a revision (usually minor) will be needed to optimize the results. If needed, revisions are usually performed at no cost to you but may require additional trips to Boston.

Eyelid surgery is usually easy to cover with large sunglasses. Patients often feel comfortable seeing sights around Boston and going to restaurants with sunglasses on within a few days after surgery. Boston is a beautiful city, and you should explore New England while you are in town. Feel free to contact us with any questions.

The post Traveling For Eyelid Surgery appeared first on Boston Eyelid Surgery.

Upper blepharoplasty surgery can sometimes be covered by medical insurance. This article will discuss the similarities and differences between medical upper eyelid surgery and cosmetic upper eyelid surgery.

Medical upper blepharoplasty and cosmetic upper blepharoplasty are similar but not identical procedures, and there are important differences prospective patients should know about. The main goal of medical upper eyelid surgery is to remove excess skin so the eyelids open better to improve vision. The main goal of cosmetic upper blepharoplasty surgery is to make patients look younger and less tired by maximizing aesthetic improvement. Medical upper blepharoplasty patients often, but not always, look better than they did before surgery, but the overall cosmetic improvement isn’t necessarily optimized.

When is Upper Blepharoplasty Surgery Covered by Insurance?

Upper eyelid surgery is covered by some, but not all, medical insurance plans if a number of specific criteria are met. Each insurance company has different specific criteria, but these are the general guidelines:

1. A patient has significant difficulty with daily activities such as reading, driving, or working on a computer due to the eyelids drooping.
2. The upper eyelids do not open to a normal position – the distance between the middle of the pupil and the upper eyelid has to be 2.5mm or less. Your doctor can measure this during a consultation.
3. A field of vision test has to demonstrate that at least 20-30% of the upper field of vision is obstructed by your eyelids. Again, this is a test that can be done during a consultation.

If all (not some) of these criteria are met, upper eyelid surgery may be covered by your medical insurance. Note the word “may”. Your insurance can still deny coverage even if you meet all these requirements.

No medical insurance plan in the United States covers cosmetic surgery. If your doctor says you are having cosmetic surgery, and it will be covered by insurance, that is insurance fraud.

Keep reading if you want to know why you may want to pay for surgery as an out-of-pocket expense even if your surgery is “approved” by insurance.

Surgical Goals

The main goal of medical upper eyelid surgery is to remove enough skin so the eyes open fully and there is no visual obstruction. The goal of cosmetic eyelid surgery is to optimize a patient’s appearance. These are different goals and can result in different outcomes. It’s important to discuss your expectations with your surgeon prior to surgery. Patients who have medical upper eyelid surgery may look better after surgery than before, but the improvement isn’t always optimized.

Differences Between Medical & Cosmetic Upper Eyelid Surgery

When upper eyelid surgery is covered by medical insurance, it only pays the surgeon a fraction of the fees for a cosmetic procedure, typically 20% or less. In most cases, you get what you pay for. Most doctors who accept medical insurance will not take the same amount of time, effort, planning, and post-operative care for a cosmetic procedure when they are doing the surgery at an 80% discount.

Meticulous pre-surgical planning is required to optimize the outcome of upper blepharoplasty surgery. Considerations include:

• What shape to make the skin incision
• How much skin to remove in different parts of the eyelid 
• Height and shape of the eyelid crease
• Whether or not ptosis is present and whether or not it needs to be corrected
• How facial bony asymmetry affects the eyelids
• Depth of the superior sulcus and how the skin will fold afterward
• Texture of the upper eyelid skin and how it will affect the results
• Lower eyelid height and how this will affect the overall shape of the eye
• Position of the lacrimal gland and whether or not lacrimal gland prolapse needs to be repaired

Care After Surgery

The care of patients after surgery is often different between medical and cosmetic procedures.

Revision surgery

After surgery has fully healed, a subset of patients may need a “tweak”, a minor secondary procedure to optimize the results. The two sides can sometimes heal unevenly and require additional skin and/or fat removal from one or both sides. In my office, minor revisions are performed at no cost to the patient. Revision procedures are not usually covered by medical insurance if there is no residual visual obstruction.

Surgical scars

Most upper eyelid scars heal very well and fade to a faint line, which is barely visible with time. Maturing the scar is a two-year process. That being said, there can be occasional issues with scars that require additional treatment. Very thick scars in the early postop period can benefit from scar modulators such as 5-FU. If scars stay thick or thicken later, CO2 lasers can help. If a scar is still red 3-6 months after surgery, pulsed dye laser treatments can help reduce redness. Bumps along scar lines may require injections, cautery, or a wound revision. None of these types of procedures are covered by medical insurance, but are performed at no additional cost to patients in my office when needed.

Summary

Medical upper blepharoplasty and cosmetic upper blepharoplasty surgery are similar but not identical procedures and often have different goals and outcomes. My advice to potential patients is to choose an eyelid surgeon who is aligned with your goals and expectations and can provide top-notch care after your procedure. This often means paying out-of-pocket for a procedure, even if another surgeon says it may be covered by medical insurance.

The post What Are The Differences Between Medical & Cosmetic Upper Blepharoplasty Surgery? appeared first on Boston Eyelid Surgery.

Indications & Contraindications

The CO2 laser is used for skin resurfacing. The laser works by delivering energy to vaporize small columns of tissue. As new skin grows back in the vaporized areas, patients may note an improvement in skin texture, wrinkles and/or dyschromia (brown or red spots). Please let Dr. Kapadia know if you any of the following apply to you:

1. Conditions which may predispose to poor wound healing including diabetes mellitus, connective tissue disease, circulatory disorders or radiation/ chemotherapy.
2. Pregnant patients should not receive treatment.
3. Patients who have tanned within the last 30 days.
4. Use of Isotretinoin (Accutane) within the past 12-18 months.
5. Use of medications, herbal preparations, or chemicals causing photosensitivity within the past 4 weeks.
6. Patients with history of hypertrophic scarring or keloid formations.
7. Patients who suffer from epilepsy, heart disease or have a pacemaker.
8. Patients unable or unwilling to follow instructions for postoperative care.
9. Use of glycolic acid products, retinols or treinoin (Retin A) – these should be discontinued at least one week prior to the procedure
10. Use of medications which thin your blood including aspirin (even baby aspirin), Motrin, ibuprofen, naproxen, Aleve, Vitamin E or herbal medicines such as Gingko Baloba. Tylenol is okay to use.
11. Use of doxycycline or minocycline as these can increase skin sensitivity

Pre-Treatment Considerations & Preparations

At the time of your consultation, Dr. Kapadia will examine the areas intended for treatment and explain to the patient the treatment procedure, expected results, and the possibility of potential side effects. It is important to avoid direct sun exposure and wear daily sunscreen containing zinc oxide or titanium oxide for four weeks prior to the procedure.

All patients will have “raw” skin after the procedure, often with pinpoint areas of bleeding. This is from disruption of the epidermis layer of the skin and may take up to 7 days to resolve. Strict adherence to the wound care regimen described below is essential to the healing process. The skin is often red for several weeks after the procedure but mineral based makeup can be worn after the skin has fully epithelialized (usually 4-7 days). Most patients will feel comfortable returning to work and/or social engagements about 10 days after the procedure. Everyone is different and the time it takes you to heal may be faster or slower than another patient. Dr. Kapadia encourages patients to watch YouTube videos on “fractional CO2 laser” so you are prepared for what you will look like after the procedure.

The most common side effects of the laser are prolonged redness or dark patches on the skin (most common in darker skin patients). Less common or rare side effects include hypopigmentation (whitening) of the skin, scarring or infections.

What you will need to buy before the procedure:

• Gauze pads – 4×4 size, preferably non-woven, available at any pharmacy
• White vinegar (for vinegar soaks after the procedure)
• Plastic container to store vinegar-soaked gauze
• Prescriptions provided by Dr. Kapadia
• Large tub of Aquaphor ointment
• Ice packs – wet towels in ziploc bags or frozen peas work fine
• Spray bottle with distilled water – helpful to mist your face for comfort
• Hydrocortisone 1% – to have in case there is severe itching
• Benadryl – helpful if there is severe itching
• Tylenol – for pain
• Genteal gel (or other lubricant eye drops) – for use as needed for dry eyes
• Cetaphil cleanser
• Cetaphil moisturizer
• Mineral makeup (for healing phase, best to obtain this prior to the procedure)
• Suncreen (zinc oxide or titanium oxide, SPF 30+)

The Treatment Procedure

Arrive at the office one hour before your procedure as directed. You should not wear any makeup that day. After the paperwork is completed, a numbing cream will be placed on your skin to help reduce discomfort. The actual procedure will take approximately 30 mins to complete. You will need someone to drive you home after the procedure.

After Treatment

General instructions:

• Stay hydrated, eat healthy foods and avoid alcohol
• Always wash hands before touching treated skin
• Avoid exercise for at least seven days after the procedure
• A sunburn-type sensation normally lasts from several hours to one day – use ice packs, vinegar soaks and mist of distilled water from a spray bottle to help with this sensation
• Sleep as upright as possible in a chair or with at least with several pillows for the first two nights to decrease swelling. Line your pillow with paper towels as you will have some bleeding during this time.
• Avoid harsh skin products for at least six weeks after the procedure as your skin will be extra sensitive during this time
• Tylenol can be used as needed for pain. Ibuprofen or motrin can increase bleeding but can also be used if needed.
• Use dry eye drops (e.g. Genteal gel) as needed for eye dryness
• Always wash hands before touching treated skin
• You can not shave your face for 10-14 days after treatment until okayed by Dr. Kapadia

Vinegar Soaks

• Make a vinegar solution of 1 teaspoon white vinegar in two cups of water. Soak gauze pads in this solution and store in a plastic container. Many patients prefer to keep this in the refrigerator as it is more soothing when cold.
• The vinegar soaks help clean the skin and reduce bacterial and fungal elements

Open wound phase – day of treatment until epithelialization is complete (4-7 days):

• When you leave the office, your skin will be an open wound. An occlusive ointment (such as Aquaphor) will be applied before you leave the office and will need to be reapplied frequently. This helps protect your skin while the surface heals. Your face should always be covered with ointment until epithelialization is complete. A silicone based ointment such as Stracel or Skinuva can be used in place of Aquaphor. We normally provide this to you on the day or your procedure.
• Apply cold compresses (ice pack, frozen peas or wet paper towels frozen in A Ziploc bag) for comfort. Do not apply ice directly to skin and beware of detergents used to wash your towels, as these may irritate the skin. The cold compress should feel good – if it hurts then it is too cold. Paper towels are okay to use.
• Clean your skin only with the vinegar soaks. Apply the vinegar soaked gauze dripping wet for 10-15 minutes over the treated area. Avoid excessive rubbing. Reapply Aquaphor ointment (or silicone gel) after the gauze is removed. Vinegar soaks should be done at least 6x/day.
• Itching can be treated with oral Benadryl. If severe, 1% hydrocortisone can be used up to 2x/day. Itching often starts the day after the procedure (day 1) and is much better by day 4. Do not scratch your skin as this can lead to scarring! Vinegar soaks will help.
• You can shower and wash your hair starting the day after the procedure taking care to keep shampoo away from your face.

After Epithelialization

• The skin will re-epithelialize within 4-7 days. You will know this process is complete when there are no more “raw” areas of skin and the heavy peeling is complete. There will likely be some persistent redness.
• Discontinue the vinegar soaks and Aquaphor ointment. If there any scabs, you can spot treat these areas with silicone gel or Aquaphor but you do not need to apply this to the full area.
• Wash the skin twice a day with a gentle cleanser such as Cetaphil followed by a gentle moisturizer.
• Apply a sunscreen containing zinc oxide or titanium oxide daily for at least 4 weeks (after the moisturizer has absorbed). Your skin will be very sensitive to sun for several months after the procedure. Wear a hat if you go outside and avoid prolonged sun exposure.
• Use of mineral based makeup is now okay. Avoid liquid foundation as this may clog pores.

Call the office if you notice:

• Blistering or scabbing of the skin.
• Acne outbreak or outbreak of tiny cysts.
• Significant pain on day 2 or later, or severe pain at any time.

Do not hesitate to call the office at any time if you are concerned or have a question. Dr. Kapadia is reachable by phone at his office during regular business hours at 978-393-5437.

After hours, call the Tufts Medical Center page operator and ask to have Dr. Kapadia or the covering doctor paged at 617-636-5114.

Routine, non-urgent questions can be sent by email to doctorkapadia@gmail.com.

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The post Fractional CO2 Laser – Before and After treatment appeared first on Boston Eyelid Surgery.

Apply ice or a cold pack (most patients prefer a bag of frozen peas) to the area of surgery for the first two days after surgery.  This is essential for reducing the amount of swelling and bruising. We recommend icing at a schedule of 10 mins on and 10 mins off for two full days after surgery. Ice should feel cool but comfortable. If it feels uncomfortable, it’s probably too cold – use a washcloth or paper towels between the ice and your face so its less cold.

For the first 24 to 48 hours after surgery sleep with your head elevated (on at least 2 pillows) or upright in a chair.  This will help decrease the swelling. The more upright the better. Your bruising and swelling will peak (look its worst) within the first 24 to 48 hours after surgery and get better slowly after that time.

Starting three days after surgery, you may apply a warm compress for ­­five minutes at a time as many times a day as need for comfort. If you have dissolvable sutures, its important to perform the compresses at least 3-5//day to help the sutures dissolve. It is normal to have mild bleeding and drainage from the incisions for the first couple of days.

If you have external sutures, apply the prescribed antibiotic ointment to the incisions four times per day for 1 week (you may experience blurriness if the ointment gets into the eyes-this is ok).  This provides comfort to the incision while it heals.  If you develop itching and increasing redness, please discontinue the ointment as this may be a sign of an allergic reaction.

If you have had anesthesia or sedation, do not drive, operate power tools or drink alcoholic beverages for 24 hours after surgery. If you were given a prescription for antibiotics, take them as directed until all the pills are gone.  If you develop a rash, itching, hives, difficulty breathing, and/or feel that you may be having a reaction to the pills for any other reason, do not take any more and contact Dr. Kapadia immediately. You should not be alone for the first 24 hours after having anesthesia.

You may shower and wash your hair the day after surgery.  The sutures may get wet but avoid direct impact of water to the surgical site.  When drying the eye area, blot dry rather than rubbing.

Do not exert yourself for the first 5 days following surgery.  This includes bending over, lifting heavy objects, exercising, working out and other activities requiring exertion.  You may read, watch television, work on the computer, run errands, and perform other routine activities that do not require exertion. It is normal for one eye to heal more quickly than the other.  It is also normal for the incisions to look pink, lumpy and bumpy.  You can start exercising 7 days after surgery. Start slow and stop if you feel pressure around your eyes.

If you have pain, take Tylenol.  If this does not relieve the pain, call Dr. Kapadia.  Do not take aspirin, motrin, ibuprofen or another over-the-counter pain killers (besides Tylenol) for 3 days after surgery as these medicines can cause additional bruising and swelling. If you are blood thinners such as aspirin or coumadin for medical reasons, you may resume them the day after surgery. If there are any questions, please contact Dr. Kapadia.

You may resume all aspirin products, Vitamin E and multivitamins three days after surgery.  You may wear contact lenses as soon as you feel comfortable inserting them.  Do not wear dark makeup (e.g. mascara or eyeliner) for 14 days after surgery.  This may pigment the incision.  You may wear cover-up makeup the following day, if needed.

If you have severe pain, if your wound site becomes increasingly red and painful, begins heavily bleeding or develops a greenish discharge, or if you develop fever or any other concern about your condition, call Dr. Kapadia immediately.  He may be reached 24 hours per day Daytime:  978-393-5437,  Outside of business hours, call 617-636-5114 and ask to have Dr. Kapadia’s on call doctor paged.  There is an on-call doctor 24/7.  PLEASE DO NOT HESITATE TO CALL IF YOU ARE HAVING A PROBLEM!!!  If you have a non-urgent issue or question, feel free to email Dr. Kapadia directly at doctorkapadia@gmail.com.

The post Postoperative Instructions appeared first on Boston Eyelid Surgery.

Before treatment

Indications & Contraindications

The erbium and CO2 lasers are used for skin resurfacing. The laser works by delivering energy to vaporize small columns of tissue. As new skin grows back in the vaporized areas, patients often note an improvement in skin texture, wrinkles and/or dyschromia (brown or red spots). Two-three laser treatments may be needed to optimize the results.

Please let Dr. Kapadia know if you any of the following apply to you:

1. Conditions which may predispose to poor wound healing including diabetes mellitus, connective tissue disease, circulatory disorders or radiation/ chemotherapy.
2. Pregnant patients should not receive treatment.
3. Patients who have tanned within the last 30 days.
4. Use of Isotretinoin (Accutane) within the past 12-18 months.
5. History of hypertrophic scarring or keloid formations.
6. Epilepsy, heart disease or having a pacemaker.
7. Use of glycolic acid products, retinols or treinoin (Retin A) – these should be discontinued at least one week prior to the procedure
8. Use of medications which thin your blood including aspirin (even baby aspirin), Motrin, ibuprofen, naproxen, Aleve, Vitamin E or herbal medicines such as Gingko Baloba. Tylenol is okay to use.
9. Use of doxycycline or minocycline as these can increase skin sensitivity

Pre-Treatment Considerations & Preparations

At the time of your consultation, Dr. Kapadia will examine the areas intended for treatment and explain to the patient the treatment procedure, expected results, and the possibility of potential side effects. It is important to avoid direct sun exposure and wear daily sunscreen containing zinc oxide or titanium oxide for four weeks prior to the procedure. All patients will have “raw” skin after the procedure, often with pinpoint areas of bleeding. This is from disruption of the epidermis layer of the skin and may take up to 7-10 days to resolve. Strict adherence to the wound care regimen described below is essential to the healing process. The skin is often red for 4-6 weeks after the procedure but mineral based makeup can be worn after the skin has fully epithelialized (usually 5-7 days for a typical fractional CO2 laser treatment or 3-4 days for an erbium laser treatment). Most patients will feel comfortable returning to work and/or social engagements about 10 days after a CO2 laser treatment or 5-7 days after an erbium laser treatment. Everyone is different and the time it takes you to heal may be faster or slower than another patient. Dr. Kapadia encourages patients to watch YouTube videos on “fractional CO2 laser” so you are prepared for what you will look like after the procedure. The most common side effects of the laser are prolonged redness or dark patches on the skin (most common in darker skin patients). Less common or rare side effects include hypopigmentation (whitening) of the skin, scarring or infections.

What you will need to buy before the procedure

• Gauze pads – 4×4 size, preferably non-woven, available at any pharmacy
• White vinegar (for vinegar soaks after the procedure)
• Plastic container to store vinegar-soaked gauze
• Prescriptions provided by Dr. Kapadia
• Large tub of Aquafor ointment
• Ice packs – wet towels in ziploc bags or frozen peas work fine
• Spray bottle with distilled water – helpful to mist your face for comfort
• Hydrocortisone 1% – to have in case there is severe itching
• Benadryl – helpful if there is severe itching
• Tylenol – for pain
• Genteal gel (or other lubricant eye drops) – for use as needed for dry eyes
• Cetaphil cleanser
• Cetaphil moisturizer
• Mineral makeup (for healing phase, best to obtain this prior to the procedure)
• Suncreen (zinc oxide or titanium oxide, SPF 30+)

The Treatment Procedure

Make sure to eat breakfast and/or lunch on the day of the procedure. Arrive at the office one hour before your procedure as directed. You should not wear any makeup that day. After the paperwork is completed, a numbing cream will be placed on your skin to help reduce discomfort. The actual procedure will take approximately 30-60 mins to complete. You will need someone to drive you home after the procedure.

After Treatment

General Instructions:

• Stay hydrated, eat healthy foods and avoid alcohol
• Always wash hands before touching treated skin
• Avoid exercise for at least seven days after the procedure
• A sunburn-type sensation normally lasts from several hours to one day – use ice packs, vinegar soaks and mist of distilled water from a spray bottle to help with this sensation
• Sleep as upright as possible in a chair or with at least with several pillows for the first two nights to decrease swelling. Line your pillow with paper towels as you will have some bleeding during this time.
• Avoid harsh skin products for at least six weeks after the procedure as your skin will be extra sensitive during this time
• Tylenol can be used as needed for pain. Ibuprofen or motrin can increase bleeding but can also be used if needed.
• Use dry eye drops (e.g. Genteal gel) as needed for eye dryness
• Always wash hands before touching treated skin

Vinegar Soaks

• Make a vinegar solution of 1 teaspoon white vinegar in two cups of water. Soak gauze pads in this solution and store in a plastic container. Many patients prefer to keep this in the refrigerator as it is more soothing when cold.
• The vinegar soaks help clean the skin and reduce bacterial and fungal elements

Open wound phase – day of treatment until epithelialization is complete (4-7 days):

• When you leave the office, your skin will be an open wound. An occlusive ointment (such as Aquafor) will be applied before you leave the office and will need to be reapplied frequently. This helps protect your skin while the surface heals. Your face should always be covered with ointment until epithelialization is complete.
• Apply cold compresses (ice pack, frozen peas or wet paper towels frozen in A Ziploc bag) for comfort. Do not apply ice directly to skin and beware of detergents used to wash your towels, as these may irritate the skin. The cold compress should feel good – if it hurts then it is too cold. Paper towels are okay to use.
• Clean your skin only with the vinegar soaks. Apply the vinegar soaked gauze dripping wet for 10-15 minutes over the treated area. Avoid excessive rubbing. Reapply Aquafor ointment after the gauze is removed. Vinegar soaks should be done at least 6x/day.
• Itching can be treated with oral Benadryl. If severe, 1% hydrocortisone can be used up to 2x/day. Itching often starts the day after the procedure (day 1) and is much better by day 4. Do not scratch your skin as this can lead to scarring! Vinegar soaks will help.
• You can shower and wash your hair starting the day after the procedure taking care to keep shampoo away from your face.

After Epithelialization

• The skin will re-epithelialize within 3-4 days after an erbium laser treatment and 5-7 days after a CO2 laser treatment.. You will know this process is complete when there are no more “raw” areas of skin and the heavy peeling is complete. There will likely be some persistent redness.
• Discontinue the vinegar soaks and Aquafor ointment.
• Wash the skin twice a day with a gentle cleanser such as Cetaphil followed by a gentle moisturizer.
• Apply a sunscreen containing zinc oxide or titanium oxide daily for at least 4 weeks (after the moisturizer has absorbed). Your skin will be very sensitive to sun for several months after the procedure. Wear a hat if you go outside and avoid prolonged sun exposure.
• Use of mineral based makeup is now okay. Avoid liquid foundation as this may clog pores.

Call the office if you notice:

• Blistering or scabbing of the skin.
• Acne outbreak or outbreak of tiny cysts.
• Significant pain on day 2 or later, or severe pain at any time.

Do not hesitate to call the office at any time if you are concerned or have a question.

Dr. Kapadia is reachable by phone at his office during regular business hours.  978-393-5437 After hours, call the Tufts Medical Center page operator and ask to have Dr. Kapadia or the covering doctor paged 617-636-5114. Routine, non-urgent questions can be sent by email to doctorkapadia@gmail.com.

The post Fractional CO2 Laser resurfacing – Instructions for Before and After Treatment appeared first on Boston Eyelid Surgery.

Botox FAQ

Is Botox safe?

Yes. Botox has an excellent safety profile. More than 6 million Botox procedures were performed in the United States in 2012, with several million additional procedures performed in other countries. If Botox were not safe, it would have been taken off the market many years ago. Botox has been used for cosmetic treatments since the early 1990s and received official FDA approval for cosmetic use more than 10 years ago. Millions of people have been safely treated over more than 20 years with a very low rate of serious adverse events. In all likelihood, many people you know regularly receive Botox treatments even if they choose to keep this information private. Feel free to discuss the safety of Botox with your doctors (who may be Botox patients themselves!).

How does Botox work?

Botox helps relax overactive muscles. As we age, overactive facial expressions can lead to prominent lines and wrinkles. By relaxing these muscles, Botox can help lesson lines and wrinkles and help create a more youthful appearance.

Is Botox a poison?

Botox is a medicine which helps relax overactive muscles. In high doses, many medicines (including Botox) can be poisonous. The dose of Botox used for cosmetic purposes is relatively low, and there are very few long-term complications associated with this amount of Botox.

What are the main side effects associated with Botox treatments?

Bruising and redness at the injections sites are probably the most common side effects. The most common complication arising from Botox treatment is a drooping eyelid. In trained hands, this occurs in less than one in several hundred patients. This type of side effect is temporary and goes away as the Botox wears off.

Do I need to take time off of work to have Botox injections?

Most patients go right to work or other activities after a Botox treatment. Bruising can sometimes occur, but is usually mild and can often be covered with makeup.

Click Here To See Before and After Botox Videos and Photos.

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Excess Eyelid Fat

The space behind the eye, known as the orbit, contains a significant amount of fatty tissue. Orbital fat probably evolved to help cushion the eye from impact. However, as we get older, the support structures which keep the fat behind the eye weaken, and the fat moves forward into the eyelids. This results in a fullness to the lower eyelids which most people find aesthetically unpleasing. This fullness, commonly referred to as bags under the eyes, makes people look older and tired. The best treatment for this type of problem is usually removal of excess fat with a lower eyelid blepharoplasty procedure. Excess skin can be trimmed and tightened at the same time.

Tear trough deformity or hollowness at orbital rim

Dark circles under the eyes can be caused by a depression or hollowness in the lower eyelids. Patients who have this problem can usually feel the underlying bone when the area of hollowness is touched. Patients who have had an overly aggressive lower lid blepharoplasty in the past may have a similar problem.

The modern way to treat this hollowness is with injectable fillers such as Restylane or Juvederm. These treatments are less invasive than traditional surgery and typically last 9-12 months. Some surgeons advocate grafting or repositioning of fat to reduce hollows under the eyes, but Dr. Kapadia finds that this treatment is much less reliable than injection of fillers. In some patients, a lid tightening procedure known as canthoplasty can be performed to improve the lower eyelid contour.

Hyperpigmentation of eyelid skin

Dark circles under the eyes can sometimes be caused by excess pigmentation of the eyelid skin. Of the three causes of dark circles listed on this page, hyperpigmentation is actually the least common. Many patients feel that they have excess pigmentation, but this is often an illusion caused by shadows from excess eyelid fat or hollowness at the orbital rim.

A simple test to check for excess pigmentation can be performed while looking in a bedroom mirror with and without a flashlight. If the dark circles look bad in a mirror with overhead room lighting and then look better when a flashlight is used to illuminate the lower eyelids from below, the dark circles are caused by shadows and not by excess eyelid pigmentation. Bathroom mirrors usually have their own lighting (from the front) and won’t work well for this test. The same principle applies with flash photography. If the dark circles disappear when a photo is taken with a camera flash, there is no excess eyelid pigmentation.

Excess eyelid pigmentation, when present, can be treated with bleaching creams such as hydroquinone. However, the results of this type of treatment are almost always suboptimal. Eyelid pigmentation is an unfortunate problem which is very difficult to treat. Sometimes patients who have excess pigmentation may also have excess fat or hollowness in their lower eyelids and treating these conditions may help improve their overall appearance.

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