Thursday, February 17, 2011

Cosmetic Eye Services

A quiet revolution is taking place in the world of facial cosmetic surgery.  The old view reported that over time, the structures of the face sag, there is too much skin, and we have to operate to remove and tighten.  While surgery still plays a role, the new approach looks at the whole picture and attempts to prevent aging changes by using non surgical techniques to enhance the appearance and only to use surgery carefully to complement the face.  
There are now so many options to help you retain a youthful appearance, and I am excited about bringing the latest technology and techniques to my patients.  Here is a brief overview of some common treatments.
Your skin ultimately is the foundation to all facial beauty and the number one problem faced by women is aging due to sun exposure.  By now, everyone knows that tanning and UV light damages the skin and causes premature aging.  In fact, being in Chicago where we have four full seasons actually makes many of our faces look younger and better than Americans tanning all year round!
My first recommendation is a daily moisturizer with SPF protection.  Be careful not to overdue tanning of the face and use hats and liberally apply sunblock when appropriate.  I tell my patients to use their favorite spas and salons to keep their facial skin in tip-top shape.
Ophthalmologists have been using the parent medication in Latisse for over a decade and are very familiar with it.  I love what Latisse does for lashes and every single woman will have bigger thicker and darker lashes.  We check all of our patients for potential issues and discuss problems.  The best part is that there is no long term effects and you can stop at any time.  If you don't want to do this all the time, then pick a special event or holiday and start Latisse a few months before.  It's worth a try.
For women who are curious but have never had any cosmetic procedures, I recommend Botox.  Botox treatments make everyone happy.  They decrease the frown lines between the brows, relax the laugh lines arounds the eyes, and smooth out the forehead.  It is important to remember that they don’t remove wrinkles, but only help to prevent skin from folding when our facial muscles work.  People who have never had Botox often worry that their face will have no expression.  A proper Botox treatment would never do this.  In fact, one of my clients was a dancer who felt that it was critical to have nuanced facial expressions as she danced.  I carefully adjusted the dose and location of Botox so that she was overwhelmed with the final result.  It is a very safe treatment that universally improves your appearance.
We now know that aging changes involve a loss of facial volume.  Look at how round and pudgy a baby’s face looks.  As we get older, the soft spongy material in our skin gets depleted.  As the skin loses volume, the tissues start to sag.  To combat this, aesthetic surgeons are now using dermal fillers to help retain the youthful face.  The safest fillers are made of hyaluronic acid.  Hyaluronic acid is a naturally occurring substance found in all mammals that helps to hydrate and add volume to your skin. In addition to its use as an aesthetic treatment, hyaluronic acid has also been used for more than 20 years for injection into arthritic joints to aid movement as well as for eye surgeries and wound repair. All of us have hyaluronic acid in our skin. By using only natural substances, there is a very low chance of an allergic reaction.
The treatments are fairly painless with minimal downtime and provide instant improvement in many areas of the face. Furthermore, since there is no permanent alteration, there is almost no risk of lasting problems. It is an excellent alternative to facial cosmetic surgery.
While many spas’s offer fillers by trained technicians, I have found that more advanced techniques that involve injecting around the eye are generally performed by surgeons.  The trend by eye surgeons is to help all areas around the eyes by using these materials.  
Blepharoplasty, or commonly known as an “eyelid lift,” is a surgical procedure to remove excess skin and fat of the eyelids. With age, the facial skin will ultimately droop. Excess skin on the upper eyelid can form a ’hood’, which hangs from the upper eyelid to the point of resting on the lashes. Excess skin and fat on the lower eyelid can lead to a ’baggy’ appearance.  When Botox and fillers are not enough, then surgery is the next step.  Surgery is an excellent way to reverse these changes. It is the third most common cosmetic procedure for both men and women. Surgery is outpatient, takes about one hour, performed under mild sedation, and is successful over 90% of the time.

Friday, February 11, 2011

Lazy Eye

I recently saw a baby who had crossed eyes and only used his right eye to see.  With some devoted patching by the mother, the baby began to see out of his left eye within one week.  This miracle still captures my imagination.  While my children are long grown now, here is another one of my old newspaper articles about a medical condition known as amblyopia.

My two year old is on a mission:  search and destroy Daddy’s glasses.  Whenever I lay them down, he stops whatever he is doing and runs over.  His eyes scan my face to make sure I don’t see his intentions.  Then he slowly stalks my glasses.  Usually, my military training takes over and a command and control voice saying, “NO!” is enough to deter him.  Sometimes, however, I do not see his approach.  As soon as my fragile wire and plastic spectacles are in his tiny hands, his feet start stomping in a victory dance and he scampers away to hide the loot.

One of the most fascinating therapies in pediatrics happens everyday, but never gets much attention.  Thousands of children across the country have a condition known as amblyopia, or the more common description, lazy eye.  Why do they call it lazy eye?  It’s a vision problem that happens in children a perfectly normal eye doesn’t see 20/20 even with glasses.  The eye is okay and yet the child cannot see because of brain development.

Although there are many different reasons for such a situation, one major cause of lazy eye is when both eyes are not straight.  Eye movement is a complex dance that requires more choreography than any Broadway musical.  Each eye is controlled by six different muscles and three separate nerves that come directly from the brain.  This control is further complicated because we have two eyes that must dance in step.  They have to move together to give us stereo vision.  Some hefty computing power in the brain makes all this happen.  If this system is just a little off, if the “wiring” is hooked up the wrong way, the child may develop crossed eyes.
Now the child's brain is faced with a dilemma.  It receives two different images.  Anyone who has ever experienced double vision will understand how confusing and disturbing this can be.  Little children don’t understand, but their brains work overtime to help them cope.  If the brain is confused by what it sees out of both eyes, then it may just ignore all the information that comes from one of the eyes.  If this happens for any length of time, the parts of the brain devoted for vision doesn’t develop properly.

Whatever the cause, children with amblyopia have brains that don't pay attention to the signals from an otherwise normal eye.  Despite all the fancy lasers and surgical technology that has developed over the years, the treatment is still simple.  If the brain is ignoring one eye, let’s retrain it.  A simple eye patch, like a pirate from the high seas, can cover the good eye.  Now the small child’s brain has to make do with the situation.  Over a few weeks to months, the brain literally changes.  Nerve cells make new connections.  Other cells start receiving signals that they didn’t get before.  The child begins to see again with his lazy eye.

This is not easy to do.  I always tell the parents that they are about to go into battle.  We take a child that sees out of one eye, and with a patch, suddenly we make that child go “blind” until their second eye starts to see.  Miraculously, these children do recover vision.  Now if only I can find my glasses, I would be able to see again.

Tuesday, February 8, 2011

Cataract Surgery

When I was a major at Scott AFB in downstate Illinois, I was also a weekly science columnist with the Belleville News-Democrat.  I wrote several columns about medicine and especially about ophthalmology. In posting this column that was written over a decade ago, I was surprised to see that while the surgery has improved by leaps and bounds, the essential magic of cataract surgery was still present.

With the continual debate over national health policy, something seems to have been forgotten.  Miracles are taking place.  Every day, in every city, modern medicine is performing miracles.  Surgeries that would have been impossible a few years ago are performed in community hospitals.  These “miracles” have become so commonplace that we forget what has been accomplished.
Cataract surgery is the most commonly performed operation in the United States.    The days of the Coke bottle lenses are gone.  Fear of blindness from this condition is virtually eliminated.  These days, everybody has a relative or friend who has had this operation.  Yet, most people are not exactly sure what is done.
The eye is truly like a camera.  A cataract is a dirty lens.  It can distort the vision, cause glare, blur words, and turn white into dull gray.  The surgery removes the dirty lens and replaces it with a man made implant (a bionic eye as one of my patients puts it).
How does the lens come out?  There is no such thing as laser cataract surgery.  In some patients, a laser has to be used AFTER the surgery.  Instead of a laser, current techniques use the same energy that the obstetrician uses to find out the sex of unborn children--ultrasound power.
I like to use a grape model to explain how we operate on the lens.  First we take a tiny needle and tiny tweezers and tear a small circle of grape skin off.  Then we take a tiny ultrasound hose which shakes and sucks out the grape part.  A little bag of grape skin is left.  A small piece of plastic or silicon is then put inside this bag as a replacement lens.  The bag holds this lens in place just like the original lens.  Vision is restored.  I hope this explanation doesn’t spoil your taste of grapes.
The technical aspects are interesting but they don’t tell the whole story.  My excitement occurs in the following days when people begin to see again.  As one of my patients said, “You know, as I get older, everything gets worse.  From my arthritis to my hearing, I seem to be breaking down.  That’s why it’s so special to have something get better.  I see like I used to years ago.”
That sums it up better than I could have done it.  The miracle is the magical rejuvenation of sight.  Sadly, millions of healthy people in the rest of the world are totally blind from cataracts.  Many are forty to fifty years old, in the prime of their lives, and yet they cannot work, cannot see their children, or cannot even see a doorway.   The newspapers report on the aging of America, but in reality, the world is aging.  Let us hope that miracles will take place there as well.

Thursday, February 3, 2011


We met with Rolando Toyos to kick off our new IPL treatment for dry eyes.  All the staff physicians and technicians learned about how difficult life with dry eyes can be.  Some people have suffered for years and after seeing many doctors and trying everything available, they give up on the hope that their eyes will ever be normal.

We performed IPL on four patients and the amount of secretions we were able to express from the eyelids was impressive.  I really believe this will change a lot of lives and make a huge improvement in my ability to take care of my dry eye patients.