Many people are understandably jumping on the cosmetic bandwagon to look great for their age. To meet the demands of their patients, physicians from various specialties are incorporating aesthetic rejuvenation treatments into their practices. Unfortunately, without advanced knowledge of surgical anatomy or extensive training and experience, some high-level procedures may not go as planned. Fixing undesirable results by other surgeons (revisional surgery) is extremely challenging as it may necessitate removal of thickened scar tissue or improperly injected fat or filler; removal of excess skin left behind (dog-ear deformity); replacement of tissue lost by overzealous excision using grafts or flaps; and/or restoration of normal eyelid shape or function. Over the past 20 years, Dr. Gupta’s mastery of surgical techniques and laser technologies has enabled her to successfully and safely perform revisions on numerous patients and restore their quality of life.
Xanthelasma are yellow cholesterol plaques that are deposited through the circulation in the inner two-thirds of the upper and lower eyelids. Only one-third of these individuals actually have high serum cholesterol. In some patients, the xanthelasma are so extensive that they cover most of the eyelids and yield an unsightly appearance difficult to conceal with makeup. Laser resurfacing and chemical peels simply do not work. Consequently, these patients hide behind glasses and have low self-esteem with some experiencing depression and social isolation. A highly skilled oculofacial surgeon can give these patients their eyes and lives back by performing complete excision of these plaques followed by placement of skin grafts.
The gallery below depicts representative examples of revisional and complex oculofacial procedures performed by Dr. Gupta.
PLEASE NOTE: THIS GALLERY CONTAINS SOME GRAPHIC PHOTOS
BEFORE/AFTER GALLERY: COMPLEX CASES: REVISIONS/XANTHELASMA
History: This 66 year old initially presented to Dr. Gupta with low self-esteem and a several year history of chronic eye pain, redness, and tearing as a result of unsuccessful upper and lower blepharoplasty performed elsewhere. She went on to have 4 revisional surgeries elsewhere to correct the ectropion (lower lid droop) but her symptoms, condition, and appearance did not improve. Moreover, the facelift she underwent was also complicated by “dog ear” skin folds under her jawline.
Solution: This patient underwent a complex but successful revisional eyelid surgery with Dr. Gupta, which consisted of filler in the hollowed areas in the upper and lower lids; excision of scar tissue bands pulling down the lower lids; ectropion repair for both lower lids (tarsal strip fixation); contouring the upper lids; browpexy; and punctal plugs (for dry eye). Dr. Gupta also performed a revisional neck lift to correct the dog ears (excess skin/fat folds along jawline) left behind from the previous lift. All of these procedures were performed with a laser in the office under local anesthesia.
This patient’s life has changed dramatically in that she feels great about the way she now looks and has a lot more positive energy and self-confidence.
History: For many years, this 52 year old with extensive xanthelasma was so adversely affected by the cosmetic appearance of her eyelids that she stopped participating in family gatherings and alienated herself from others. She would hide behind glasses and refused to ever have her photo taken.
Solution: Dr. Gupta artfully combined laser upper and lower blepharoplasty with complete excision of each xanthelasma plaque on all 4 eyelids. A primary closure would have resulted in severe eyelid malpositioning and full thickness skin grafts were therefore performed to preserve normal eyelid shape. The grafts were harvested from the “non-xanthelasma” skin that was excised during upper and lower blepharoplasty and carefully shaped and sutured to fill the skin defect areas after plaque removal. Fortunately, all of the grafts survived and healed virtually invisibly for an aesthetically pleasing outcome.
This patient not only has her eyes back but she has a robust social life with improved self-esteem. Now, photos are more than welcome!
History: This 57 year old presented to Dr. Gupta 1 year after unsuccessful Radiesse injections in her lower lids elsewhere. The eyelids became chronically inflamed, irritated, and hardened where the filler was injected. Massaging and warm compresses did not help. The appearance of her eyelids led to wearing sunglasses full time and social isolation.
Solution: Dr. Gupta performed revisional surgery in the lower eyelids in conjunction with an upper and lower laser blepharoplasty. Extensive vascularized scar tissue was found around the filler which was causing chronic inflammation. The scar and filler were meticulously removed without violating the integrity of the overlying skin in each lower lid. She has healed beautifully and now has her life back!
History: This 53 year old presented to Dr. Gupta with a 2 1/2 year history of hiding behind glasses and depression as a result of unsightly red, painful lumps across most of her lower eyelids. She had undergone “Restylane” injections elsewhere but she went back as they did not look right. The injector reassured her all was well and proceeded to inject more.
On Dr. Gupta’s examination, the lower lid “mounds” were tender to touch and gentle pressure resulted in drainage of a copious amount of foul-smelling mucopurulent discharge (see photo below). These were large abscesses (pus pockets) in both lower lids from contaminated filler material.
Solution: After initial drainage of the abscesses, Dr. Gupta put the patient on a 2 week antibiotic course. The swelling and tenderness improved but the lumps persisted. A lower lid revisional blepharoplasty was then performed, which revealed infected silicone at various depths with extensive scarring and inflammation across the eyelids. After a grueling 2 hours, the contaminated filler and scar tissue were removed and irrigation with antibiotic solution performed before closure. The patient healed quite nicely and as early as a few months after the revisional surgery, got her eyes and life back.
More before/after photos coming… please stay tuned!