Mark J. Lucarelli, MD

Although it initially sounds paradoxical,  Botox can be used to weaken certain muscles to allow a subtle, but pleasing, elevation of the eyebrows.

The frown muscles (corrugators) and some related muscles are the target.

By treating these muscles, a gentle, natural-looking lift can be achieved.

For most patients Botox works 3-4 months.

Malar festoons are often asymmetric.  Their treatment is difficult.  In fact, this is an area of facial surgery in need of much better solutions.

Unfortunately,  the fluid can not be simply aspirated from festoons.

Hyaluronic acid products like Restylane and Juvederm can be dissolved with an enzyme called hyaluronidase.

That said,  one would not expect any of the filler injected 7 years ago to still be present.

Laser resurfacing and IPL are generally oriented toward different goals.

Erbium and CO2 resurfacing lasers can have their best effect on improving skin texture.

Different wavelengths of IPL can be emphasized to address skin pigmentary changes such as dark spots  (lentigos),  redness from rosacea,  and very fine vessels (telangiectasia).

Patients with fair skin tend to have fewer problems with laser skin resurfacing than do those with darker skin types.

There are several simple and inexpensive things that can be done to help keep skin healthy and beautiful:

1.  Minimize sun exposure

2.  Hat, sunglasses, protective activewear, and sunscreen when out in the sun

3.  Use a moisturizer with SPF 25 or 30 -- every day

4.  Avoid smoking

5.  Choose a healthy diet with plenty of anti-oxidants

There has been a very strong trend in eyelid surgery (and in facial surgery in general) toward fat preservation and away from fat removal.

That said,  every case must be individualized.  Sometimes fat removal is still a valuable option.

In many cases, I will sparingly remove fat from certain areas and reposition most of the fat over the bony rim.

Experts in eyelid surgery will customize their surgery to a patient's individual anatomy rather than always sticking with one set technique.

Mark J. Lucarelli, MD, FACS

Madison, WI

There are usually 4 main things that are necessary for insurance to help cover upper blepharoplasty:

1. Patient's symptoms of blocked visual field from the upper lids
2. Physical findings noted on the surgeon's examination (upper lid skin crowding the lashes or overhanging the margin
3. Visual field testing showing the blockage of peripheral vision
4. Photos of the excess skin

That said,  different insurance companies vary in their coverage policies. Also, these cases get close review during preauthorization, since blepharoplasty is often chosen for cosmetic reasons.

A general answer, but I hope it helps,

Mark J. Lucarelli, MD, FACS

Madison, WI

The first line of treatment of chalazia is often warm compresses several x daily for a couple weeks.  Many specialists also recommend an eyedrop or ointment with a steroid to be used for 2 or 3 weeks.  When such conservative measures fail,  lancing the chalzion is usually the next step.

In general recovery from blepharoplasty usually goes smoothly and quickly.

Patients commonly have significant swelling,  but it is most often nearly resolved by 10 days- 2 weeks. The swelling can be limited with lots of cold compresses for the first 48 hours and head-of-bed elevation.  Bruising can be quite variable.  When NSAIDs, aspirin and other blood thinning agents are avoided for the week prior to surgery,  bruising can be minimized.  Activity during the first week of recovery needs to be quite limited.  After that,  I instruct patients to gradually get back to their activities, exercise, and work.  Most patients are pleased with how quickly they recover after blepharoplasty.

There are no good creams or lotions to resolve bags under the eyes.

For textural changes of the skin,  Erbium or CO2 laser resurfacing treatments can help rejuvenate the skin.

For someone with mild volume loss below the eyes (tear trough),  hyaluronic acid fillers such as Restylane or Juvederm are excellent.

In the occasional patient with excessive lower lid fat pads, partial debulking of the fat with transconj. blepharoplasty with incision behind the lid may be a great option to reduce the bags. 

For excessive skin laxity and hollows below the eyes,  redraping the existing fat, supporting the muscle, and trimming the skin conservatively (blepharoplasty with fat transposition) is often the way to go. 

The good news is that there are many state-of-the-art options ranging from non-surgical to more involved surgical procedures.

Mark J. Lucarelli, MD FACS

Madison,  WI