Cosmetic Procedures and Services
"Cosmetic" eyelid surgery also known as an eyelid lift or blepharoplasty restores eyelid structure rather than changes the basic appearance of the eyelids and eyebrow. Dr. Mauriello attempts to reverse the gravitational and sagging effects of aging without producing a "plastic" surgical appearance.
COSMETIC BLEPHAROPLASTY
Dr. Mauriello performs cosmetic eyelid (blepharoplasty or eyelid lift) surgery on patients who wish to minimize baggy upper and lower eyelids with stretched out skin and inelastic skin. His 3-step technique for lower lid blepharoplasty elevates the cheek, removes the bags, and tightens the skin as part of his standard cosmetic lower lid surgery. All the surgery is performed through a small skin incision in the corner of the eye. The lower eyelid incision is not carried out across the lower lid and the skin scar has not been an issue with any of his patients after surgery.
Note enhanced elevation of upper cheek due to gradual tightening of eyelid skin. The upper cheek is slightly more elevated 6 months as compared to 3 months after surgery. Dr. Mauriello's unique techniques provide these subtle elevations of the upper cheek through a small incision. The laser causes tightening of the lower lid over 6 months.
In the case of upper eyelids, blepharoplasty helps relieve the gravitational downward traction on the forehead muscles. Many patients experience significant relief from the heaviness of the eyelid tissues and the fatigue of browache when reading after upper eyelid blepharoplasty. The lower eyelid bags that extend into the cheek are also improved by lower eyelid blepharoplasty. Dr. Mauriello has performed laser incisional blepharoplasty with the carbon dioxide since 1995. This technology reduces the operative time so that support of the delicate eyelid structures can be supported at the time of blepharoplasty.
LASER INCISION TECHNIQUES
Dr. Mauriello performs surgery with a carbon dioxide laser techniques to reduce swelling during surgery and maximize the result when tissues are redraped and elevated. The effect is tissue tightening with redraping of the sagging tissues.
MIDFACE CHEEK LIFT
Dr. Mauriello elevates the upper cheek when he performs his standard blepharoplasty. This technique is unique. The cheeks are lifted upward rather than towards the side of the upper face to provide a natural unoperated appearance without creating a pulled, mask-like appearance.
BOTOX INJECTION FOR FACIAL WRINKLES AND BROW ELEVATION
Dr. Mauriello performs Botox injections in the Summit office. Botox injections temporarily improve brow frown and scowl lines and elevate eyebrows. Botox selectively weakens the muscles around the eye that cause the brow to contract downward so the frontalis muscle in the forehead is able to elevate the eyebrow and aging and sagging upper eyelid tissues with less effort. The Botox induced brow lift may simulate surgical brow elevation without the inherent risks of surgery. The greatest advantage of Botox treatment over surgery is that the effects are temporary and generally last 3 to 6 months. A minimal dose is effective in producing a definite but subtle and cosmetic pleasing effect. The treatments are tolerated with temporary discomfort and patients may drive themselves home from the office. Patients are quite happy with the results.
In addition, crow's feet at the outer corner of the eyes may be softened and improved by this office treatment. These crow's feet are improved significantly by cosmetic eyelid surgery. Patients immediately return to work after Botox injections.
Restylane (hyaluronic acid), approved by the FDA in December, 2003, is distributed by Medicis. Restylane has basically replaced collagen injections. Restylane lasts longer than collagen and does not require any skin testing. It may be combined with Botox to prolong its effect even longer than 6 months with Restylane alone. Ask Dr. Mauriello. Restylane is ideal for the lower face including the mouth and lips. The jowls may be improved as well. Perlane , approved by the FDA in May 2007, has larger particles than Restylane and may essentially sculpt and fill in depressions in the lower face and jowl (FDA off-label use). Juvederm is another hyaluronic acid filler distributed by Allergan.
The combination of Botox for the upper face, Restylane for the lower face, and the eyelid surgery to open and refresh the eyes without changing or distorting their shape helps to rejuvenate the entire face. Both Botox and Restylane are performed in the office.
FRACTIONAL CARBON DIOXIDE LASER SKIN RESURFACING
Improved tone, texture, and tightening of skin as well as diminished pore size occur with fractional laser resurfacing. There is a 5-day down-time associated with dramatic technology that came into the forefront of laser resurfacing in 2007. Only one office treatment is necessary.
SKIN CARE and FACIAL PEELS
As final enhancement of the face, Dr. Mauriello performs facial chemical peels in his office in order to maintain the results after surgery or for simple skin maintenance. Presently, he recommends that patients use a sun block and moisturizer as well. He has not found enough scientific data to strongly recommend the use of multiple cosmaceuticals to eliminate wrinkles. Facial peels provide improvement as well but at this time, Dr. Mauriello prefers fractional laser resurfacing.
Depigmenting agents may reduce the pigment that creates dark circles under the eyes in some patients. More importantly, cosmetic eyelid surgery as performed by Dr. Mauriello using his special techniques reduces the shadows created by the hollows under the eyes to significantly improve "dark circles" in most patients.
BROW LIFT
The brow may be lifted through the upper eyelid (blepharoplasty) incision and alternatively through small incisions in the scalp and sometimes in the forehead. Direct brow lifting may be achieved by incisions above the brow. In general, brow surgery is reserved for patients with asymmetric brows. Since the eyebrows frame the face, any change in their shape and position impacts greatly on the individual's appearance. The brow lift may accentuate the hollow or space between the eyebrows and the upper eyelid. Upper lid surgery alone may often "open the eyes" without changing the brow position. Furthermore, Botox may be used to elevate the brow and even appropriate grooming of the brows may change their appearance without surgery. All these alternatives should be discussed with your surgeon.
Latisse® (bimatoprost ophthalmic solution 0.03%)
LATISSE® (bimatoprost ophthalmic solution, 0.03%) is presently the only prescription treatment with FDA-approval that is designed to generate longer, thicker, and darker eyelashes.
Mechanism of Action
The precise mechanism of action is not known. Research suggests that the drug increases the percent of hairs in the anagen or growth phase. It also appears to increase the duration that eyelashes remain in this growth phase.
Method of Application to the Base of the Upper eyelashes only
Latisse® is applied thinly (topically) to the base of your upper eyelashes only. It is important to use the single-use applicator brush supplied by the manufacturer. The drug should not get in the eye and should not be applied to other areas. In the clinical trials necessary for FDA-approval, patients experienced results in as few as 8 weeks with most patients showing maximum response in 20 weeks. Not all patients respond.
Possible side-effects
Permanent iris pigmentation rare but may occur and that is why photographs are necessary and are taken by Dr. Mauriello prior to treatment for during treatment over time. There is an increased risk if the drug is applied to the eye. Furthermore, patients that are pregnant should not use the drug. If the eyelid or eye tissues are red or inflamed or if eye or eyelid surgery is planned, the drug should be discontinued are restarted after consulting personally with your physician. The drug’s effect will no longer be evident once the medication is stopped. It is important to recognized that dark pigmentation of the skin may occur if the drug is applied anywhere on the skin. This pigmentation is generally reversible but it is possible that the resulting dark circles may not improve once the drug is stopped. Therefore, patients must use the applicator provided by Allergan and be instructed and monitored by a physician when using this prescription drug. All possible side-effects should be explained to you in detail by the prescribing physician before you start using this medication.
Possible side effects and complications include but are not limited to:
• Pruritis (itching)
• Hyperemia (redness of eyelid skin or eye tissues)
• Skin hyperpigmentation
• Irritation
• Permanent iris darkening and pigmentation
• Dry eye
• Increased risks if the drug is applied to the eye
Furthermore, it is unsafe for you to take this medication without careful periodic office examinations at the discretion of the prescribing physician and as recommended by your physician.
Latisse®: A Great Treatment
There is no question that the drug is a wonderful modality for patients who wish to have longer, thicker, and darker eyelashes. The medication has been promoted by Brooke Shields on the www.Latisse.com website. You may wish to view the website for further information. Also, call Dr. Mauriello’s office for an in-office consultation to learn more about Latisse®.
Disclaimer: Please note that the information provided on this website is educational, does not in any way constitute a second medical opinion, and it does not create a physician-patient realtionship. Finally, the website is tended to provide information only and is not designed to advertise any specific product or its use. Dr. Mauriello has no disclosures.
