Austin Facial Plastic Surgeons

Droopy Eyelid After Strabismus Surgery, Do I Need Surgery?

I had strabismus surgery on only my left eye 4 weeks ago. The alignment is fine now, but what I didn't expect is that now my eyelid droops. My eyelid feels like there is a weight on it that prevents me from lifting the lid all the way up. I did not have this problem before. Is this likely permanent? Would a blepharoplasty fix this? I had a previous strabismus surgery 25 years ago, and DID NOT have droopy eyelids afterwards.

I would agree with Dr. Schuster, however, I would tell you that after 4 weeks this problem may yet correct itself.  Their may be swelling or some temporary injury to the muscle.  If it fails to correct after several months, ptosis repair is a relatively straight forward surgery without a great deal of recovery and a high success rate.

Louis W. Apostolakis, MD

Austin Facial Plastic Surgeon

Is the Orbicularis Oculi Muscle Ever Frozen with Botox Injections?

I read the paragraph below on an Oprah.com article, and was wondering if this muscle is commonly or ever frozen by botox injections? "When someone smiles out of genuine delight, a facial muscle called the orbicularis oculi involuntarily contracts, crinkling the skin around the eyes. Most of us are incapable of deliberately moving this muscle, which means that when a person fakes a smile, her orbicularis oculi likely won't budge."

I have not looked at Oprah's explanation, but it is not true that the orbicularis muscle is inactive during a fake smile.  It is very easy to voluntarily activate that muscle and a fake smile would most certainly include the orbicularis.  In fact, it would require a great deal of concentration to fake a smile and not use the orbicularis muscle to any appreciable degree.  It is true that a faked smile is different than a real smile, but it has to do with the fine details of the activation and includes all of your smile muscles, not just the orbicularis.

Botox could be used to fully disable the orbicularis muscle.  But this is never done.  You only treat the portion in the Crow's foot area.  If you were to disable the entire muscle, you would not be able to close your eyes except by passive "spring" of the tissues and gravity.  This is seen in people after nerve injuries or strokes and it can be very dangerous to the health of your eye.

Louis W. Apostolakis, MD

Austin Facial Plastic Surgeon

Blepharoplasty on Women of Color Without Cutting to Prevent Scarring- Who Can Do It?

Chicao has a surgeon who can do blepharoplasty without cutting on women of color (Dr. Julius Few). He goes in thru the lower eye lid. Is there an east coast plastic surgeon who does the procedure this way?

It sounds is if you are referring to a lower eyelid blepharoplasty.  The lower eyelids often times are treated by a surgical approach that is through the inside of the eyelid (no skin incision).  In fact, I do the majority of lower blepharoplasty surgery this way regardless of skin color.  You should be able to find many surgeons who do it this way.  I would caution you to avoid fat removal, but rather ask for fat repositioning and/or surgical implants and fillers.

The upper eyelid surgery will need a skin incision in just about 100% of patients.  While there are some surgeons who will do fat injections into the upper eyelid, I do not believe that this is a satisfactory method except for perhaps the very rare patient who only needs volume.  Despite dark skin color, the incision is unlikely to be an issue for you as upper eyelids heal very well in most all people.  I do not treat the upper eyelid incision any different on Blacks, Hispanics, or other dark skin types and have excellent results.  This is particularly true in patients who are in their late 50's or older.

Non-surgical approaches for lower eyelids include Restylane injections.  This can work very well in many people but is not permanent.  Other treatments with various non-invasive "gadgets/lasers" will almost certainly be a waste of you money.

Louis W. Apostolakis, MD

Austin Facial Plastic Surgeon