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Bulletin Board for
Patient's Questions and Answers
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Reconstructive 
Hand
Cosmetic
Congenital Breast
Head & Neck
Skin
Cancer
Microsurgery
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Ptosis (drooping of upper eyelid) Facelift / Neck lift (rhytidectomy)
Facelift surgery (rhytidectomy)
Ptosis of the eyelid (drooping of the upper eyelid)
Ectropion (Drooping of the lower eyelid) Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts. Eyelid Reconstruction
The Aging Face
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Cosmetic Eyelid Surgery (Blepharoplasty)Subj: Re: Surgey soon Dear Dr Bermant; I am about to have Blepharoplasty to my lower eye bags. I am 26 years of age. My doctor had recomended to operate on the mucosa, on the inside of hte lower lids. my concern is when the fat is removed, won't there be to much skin after the supporting fat is removed, or is there a possibilty that he will remove some skin although he is operating on the inside. Thanking your attention Dr. Bermant responds: Too much skin can be a problem. It depends on the patients eyelids. Sometimes we care for this with the laser, sometimes there is too much skin and the external skin incision is better. You need to discuss this with the doctor who is about to operate on you. I cannot comment on your case without examining you. If you do not feel comfortable with your doctor's answers, hold off on the surgery until you get the questions answered. I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures. Michael Bermant, MD Subj: Re: Black Eyes Dear Dr. Bermant, I am a 28 year old male. I have dark circles under my eyes. Can my yes be treated? Is Blepharoplasty an answer to my problem. Please respond! Thank You. This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. Dark circles can come from several problems. See my other responses on the above responses. You would need an evaluation before any recommendations could be made. Blepharoplasty is not the first choice for darkness under the eyes. I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures. Michael Bermant, MD Subj: Re: Blepharoplasty and Dry Eyes I am a 46-year-old female considering upper eyelid blepharoplasty. I had lower lid blepharoplasty ten years ago, and developed dry eye syndrome that affected my contact lens wearing time. I was also told I have GPC (giant papillary conjunctivitis) probably as a result of the dry eyes and contact lenses. Since having punctal occlusion the the lower puncta, I have been able to resume wearing contacts again. My question is, will having the upper lid blepharoplasty cause dry eye syndrome again and will I be able to heal properly with the GPC? Thanks you for your advice. C Dr. Bermant responds: This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. You are at risk with any eyelid surgery for more dry eyes. The eyelids and tear protection are directly related. Conservative eyelid surgery by a competent physician IS a possibility. However even with initial minimal swelling, the tear protection balance will be upset. Using artificial tears should get you over the first challenge. If the lid movement is impaired permanently, your dry eye problem may still be an issue for a long time. With conservative eyelid surgery problems usually are only transitory. So it depends on how bad your eyes are. A minimal deformity or problem should probably be left alone. A major deformity with conservative treatment may be reasonable to try. Be careful with your selection of surgeon. I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures. Michael Bermant, MD Subj: Re: Re: Blepharoplasty and Dry Eyes Dear Dr. Bermant, Well I had my upper blepharoplasty in Northern California, where I reside, about 10 days ago. There was a minor (I think minor) problem in that the plastic surgeon hit a blood vessel or capillary in the left eye when applying the anesthesia. The right eye started healing immediately , but the left eye remained quite purple and ugly a lot longer. Even after 10 days, there was still some bruising in both the upper and lower lid of the left eye. Yesterday, I applied a new makeup I purchased called Coverup from Germany (and quite expensive) to try to hide some of the left eye bruising. I also applied a little bit on the right lower lid because it also covers dark circles. I applied the rest of my makeup (a little foundation, which I applied over the Coverup -- I do not normally bring the foundation up under my eyes but the makeup specialist who sold me the Coverup makeup told me to do so. The next thing that happened was quite startling and scary. My left eye started to swell, first in the inner corner on the lower lid, which rapidly progressed around the entire left eye to the point I could not open my eye. I was able to see the plastic surgeon shortly thereafter. He said in his 8 years he has never seen such a reaction! He prescribed a steroid and antibiotic (methylprednisolone dospak and Augmentin 250 mg t .i.d.). I am now able to open my eye half-way and thankfully it did not seem to affect my vision. What concerns me is how purple the left eye is again. I must tell you the plastic surgeon does not know I know about the broken capillary. I had the surgery on the Friday before Labor Day. He went away for the weekend and was supposed to have a doctor on call for him. When I saw how purple the left eye was compared to the right I decided to call him Saturday morning. The answering service paged him and did not seem to know anything about a covering doctor. A couple of hours passed and still no call from anyone. I called the answering service again and he said someone would definitely get back to me. I decided to call the Surgery Center where I had the surgery performed. I talked to my nurse there who assisted the plastic surgeon with the sedation. She is the person who told me about the blood vessel problem. Well, the entire weekend passed and I received no call from anyone. I was quite disappointed. My appointment with the plastic surgeon was Tuesday afternoon. I did mention the incident about not returning my calls, and he said he was sorry and that he did not know why my calls were not returned. I asked him why the eye was so purple and he said everyone heals differently. He certainly did not lie and possibly did not want to frighten me with the news of the broken capillary. Being I have an extensive medical background (almost 20 years as a medical transcriptionist), I would have preferred to know all the details and discuss it. But I let it go. Most likely, I will not be giving this plastic surgeon anymore of my business. My question to you then is concerning the capillary. Is it possible the capillary ruptured again. My left eye after the makeup reaction incident is again very purple. In your opinion, does this sound like a makeup allergy or something else. It is odd that the right eye had the makeup applied and it did not swell! I am very confused at this point. I have another appointment with the plastic surgeon tomorrow and very gently may bring up the broken blood vessel issue. I just wanted to get your opinion on this, if you wish to comment on it. Thank you in advance for any help you can shed. Hopefully, my eye will recovery fully. I know all surgery is risky and something things do go wrong! Sincerely, CR P.S. Do you think it would be a good idea to have a dermatologist look at my eye for a second opinion? Thanks again. Dr. Bermant responds This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. Allergy problems are rarely focal. Generally if one eyelid had a reaction to the makeup, the other one should have also reacted. Putting on makeup too early can cause a weakly healed vessel to reopen. 9 days after surgery should have given the vessel plenty of time to heal. Anesthesia of the eye can result in a hematoma (collection of blood) in the best of hands. This can lead to some extended bruising as you have described. During surgery good plastic surgeons go out of their way to seal any bleeding vessels as there IS less bruising that way. Bleeding again after surgery does happen but usually shortly after the operation not 9 days later. But I guess anything can happen. Hope all goes well in your recovery. Why don't you ask your doctor if he/she feels the second opinion would be helpful? Michael Bermant, MD Subj: Re: my eyes I am 17 years old and have hereditary "baggy eyes". If i had transconjunctival blehpharoplasty would I have to have skin resurfacing along with it or should I have enough skin elasticity to just have the fat removed. Dr. Bermant responds: This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. Blepharoplasty surgery can be done through incisions just below the eyelashes or as you mention transconjunctival (from the inside of the lower lids). When surgery is done externally the redundant skin can be tailored to fit the defect. Extra skin from a transconjunctival skin needs to be managed in another fashion, this is usually by laser resurfacing. Baggy lids can be a combination of extra skin, loose muscles, and fat sticking out from around the eyes. As extra fat is removed to restore a more normal contour, the redundant skin / muscles become much less redundant than what would seem to be the case before surgery. Some cases of redundant skin are obvious what needs to be done. Others need an examination and the fine judgment call of an experienced surgeon. Trying to do such a determination from the information provided is foolhardy. You need to ask this question of the doctor examining you and discussing your surgical options. I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures. Michael Bermant, MD Subj: Bell's palsy Does anyone have info about Bell's Palsy? Dr. Bermant responds: This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. Bell's palsy is a paralysis of the facial nerve which controls the muscles of your face. Involvement can be of a small part or the entire nerve. When involving the branches controlling eyelid function, you will need to protect the eyes from drying out since the lids no longer do their job. When involving the lip muscles, speech is impaired. There are several causes of Bell's palsy, infection is one of the most common. This is a condition that needs evaluation by a competent physician and education tailored to that particular patient. I hope this information proves of value. Michael Bermant, MD Thanks for your response. Question: what would an mri show that a cat scan wouldn't? How about a spinal tap? I have lung cancer with lesions on brain, one in area of pons. Thanks--J Dr. Bermant responds: This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. These questions are for the doctors working with you. It depends on what they are looking for and the versions of the machines available in your region. Swelling or compression of the facial nerve can occur during cancer or cancer treatment. Tumor growth or swelling of tissues during such cancer treatments as radiation therapy or chemotherapy can press on the facial nerve in several regions. You need to talk to your own physicians about these problems. Subj: blepharitis I was just diagnosed with dry eye syndrome and blepharitis. My eyelids are killing me. I understand both conditions are chronic. Any info on blepharitis would be appreciated. Dr. didn't take much time in explaining. He gave me blephamide eye oint. help!!!!!!!!! this is something that has been going on for a long long time. I just couldn't stand it any longer and this bout has been bad for several months this time. Dr. Bermant responds: This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. Dry eye syndrome and irritation of the eye can be serious conditions and be the result of other medical problems. A complete evaluation and education are important parts of treatment. Go back and talk to your treating doctor and find out more about your condition. If patient education is not part of that doctors package, then try another. I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures. Michael Bermant, MD |
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