Dr. Rostami is exquisitely knowledgeable about the eye area. As an ophthalmologist first, then as a specialist in oculo-facial plastics, she truly understands all the intricacies presented by the musculature and underlying eye area structures. Where most physicians are primarily interested in scheduling you for surgery, Dr. Rostami takes a different, more flexible approach. In your consultation with her she will asks a range of questions to get a complete picture of your situation — including your eye health, your family eyelid history, the supplements you take, and even the position of your eyebrows. She will then suggest the right solutions for you, taken from a wide variety of options — both surgical and non-invasive and non-surgical procedures.
At your consultation, you will be asked questions not typically asked by other surgeons. She wants a complete picture of you and your eyes, because where other physicians are mostly interested in scheduling you for surgery, Dr. Rostami has other tools available to her—some that are non-invasive and non-surgical—as well as surgery. She takes her time to evaluate your eye health, your family eyelid history, the supplements you take, and even where your eyebrows are positioned!
DO YOU NEED EYELID SURGERY?
We often hear from our patients that their eyelids feel heavy. Sometimes they tell us how their eyelids interfere with their peripheral vision. They mention how, at the end of the day, they use their fingers to prop up their eyelids and experience a sensation of relief. They also share how they are often plagued by headaches they feel are directly attributable to their heavy eyelids. In females, we hear how they no longer know how to put make up on their eyelids because no matter how they apply it, it doesn’t look “the way it used to look.”
OTHER SURGICAL EYELID PROCVEDURES
As we age, we may lose elasticity in our upper eyelids, causing a condition known as ptosis (pronounced toe-sis). Or we may have had this condition from birth. It occurs in one or both eyelids, causing the eyelids to appear “half mast,” or like a window shade is pulled half way down. With this condition, the complaint we hear most often is that they used to have “bigger eyes,” meaning that more of their iris and pupil were visible in the past before the eyelid “drooped.” These patients often use their forehead muscles to hold open their eyelids.
FOREHEADS AND EYEBROWS DROOP, TOO
Many patients come in asking for an upper blepharoplasty, when they do not realize their entire forehead has shifted down, creating a heaviness to their upper eyes, contributing to the excess skin on the eyelids, and even a thick fold of skin between their eyebrows! Sometimes, just the outside corners of their eyebrows have dropped, but this can add to the extra skin on the eyelids, too. In cases like these, a brow lift or forehead lift should definitely be considered because an upper blepharoplasty alone will not address the heaviness of the brow.
LOWER EYELID COMPLAINTS
Another common complaint we hear is that lower eyelids are puffy, wrinkled, hollow, have dark circles, and have very loose and sagging skin. Upon examination, we see the patient has experienced volume loss in their cheek area, an unfortunate but normal aging event, revealing the lower orbital rim of their bone structure, and tear trough deformities. This can accentuate the fat accumulation in that area, or even create an illusion of darkness because of the hollow left behind with the cheek fat moved down.
This is one of the most challenging areas to improve, although Dr. Rostami has found a combination of treatments that works. In younger patients she uses dermal fillers. Her favorite for this area is Restylane® or Belotero. If there is some atrophy of the cheekbone, she injects the cheek with Radiesse® for a lift to the cheek, which minimizes hollows.
With patients in their 40s and 50s, in addition to fillers in this area, she may add Botox® or Dysport® to decrease the crow’s feet around their eyes. To soften fine lines, she suggests either CO2, Fraxel® or TCA peels of their lower eyelids. For puffiness, she may recommend having the fatty pockets conservatively removed via an outpatient surgery called trans-conjunctival (inside the eyelid) lower eyelid blepharoplasty.
In older patients, to help with sagging skin and deeper wrinkles, she usually recommends a subcilliary (incision below the lower lashes) lower eyelid blepharoplasty, with or without fat removal, to lift and remove the loose skin. These patients also benefit from Radiesse® injections in the cheek area, since bone and fat have atrophied from the face as aging occurs.
Find the Right Injector
The use of dermal fillers around the eyes is currently an off-label use of the products. However, in the hands of competent oculoplastic specialist, it is a very effective tool in improving lower eyelid tear trough deformities. The eyelids are very unforgiving and any mistake in this area is very difficult or even impossible to correct. This is why Dr. Rostami is very selective in which hyaluronic acid filler she will use. Hyaluronic acid is a natural substance in our bodies that provides fullness and elasticity. If anything were to go wrong with this type of filler, it can be erased with hyaluronidase.
We have seen patients who received filler injections for tear trough deformities with undesired results. Dr. Rostami was able to repair some of these complications, but others were impossible to repair, especially in cases of the wrong filler choice and superficial injection technique. Only time will be able to remedy these complications (like heavy discoloration), as the product, if it is non-permanent and is absorbable, gradually wears off.
Despite the caveats, fillers are great tools for improving the appearance of aging eyes. However, dermal filler selection and injection technique are paramount to the success of the procedure. If you are considering filler injections of the lower eyelids, choose a surgeon who is properly trained in the anatomy and blood flow of the eyes.