FAQS AND RELATED LINKS
FAQS AND RELATED LINKS
Whenever new potential patients are interested in learning about the facial reconstructive and cosmetic surgery options offered by Dr. Taban, we aim to provide them with the best level of customer service possible. Oftentimes, we see people for their initial consultation who have the following questions and concerns, which may be similar to your own.
Common Questions & Concerns
Q: What should I bring to my Initial Consultation?
A: If you did not receive a New Patient Packet in advance by email, we ask that you arrive 15 minutes early to fill out your paperwork. You’ll also be asked to bring the following with you: health insurance card (if applicable), close-up portraits or pictures of yourself from various periods of your life taken before surgeries or before the current problems began, and any related laboratory or imaging such as CT or MRI scans.
Q: If I decide to have surgery, when can it be scheduled?
A. Surgery may be scheduled as soon as one week after your initial consultation providing there is availability and that you are cleared for surgery by your primary care physician, internist or cardiologist. Our office routinely keeps surgery time available for those who desire to schedule right away. Our surgery coordinator will walk you through scheduling and preoperative requirements.
Q: Can I finance my surgery?
A. We accept cash, checks, and credit cards (Visa, Mastercard, American Express, Discover). Alternatively, our office offers financing through Care Credit, available to anyone who qualifies. You may qualify in advance at their website or by calling them directly.
Q: Where will my surgery be performed?
A. Dr. Taban is affiliated with multiple outpatient Ambulatory Surgery Centers in the area (including Specialty Surgery Center, LaPeer Surgery Center, Lasky Surgery Center, Santa Barbara Surgery Center), along with Hospitals (UCLA, Cedars-Sinai, Cottage). The location will be determined based on availability, patient preference, type of surgery, and patient health status. Procedures under local anesthesia can be performed in our office procedure room, with a certified nurse.
Q: What type of anesthesia will be used for my procedure?
A. There are three types of anesthesia: local, local with IV sedation (MAC), and general anesthesia. The choice of anesthesia depends on the type of surgery, patient’s preference, and patient’s health status.
Most surgeries are performed under local anesthesia, with or without IV sedation (MAC). MAC anesthesia is light “twilight sleep”, similar to what happens during colonoscopy. The main advantages of this anesthesia are: (1) it does not require putting a breathing tube, (2) the recovery is much faster, (3) there is less nausea after surgery, and (4) safer. Furthermore, this is ideal in operations where patient’s cooperation is necessary during the surgery (such as asking the patient to open and close the eyes for proper positioning). MAC anesthesia is performed by an anesthesiologist. Local anesthesia alone is performed without an anesthesiologist, which can be done in the office procedure room.
Q: What Types of anesthesia are available for eye surgery?
Here are three basic types of anesthesia that can be used during oculoplastic or eyelid surgery. From least invasive to most invasive are: local anesthesia, MAC anesthesia, and general anesthesia.
Local anesthesia involves injecting local numbing injection to numb the eyelid and surrounding structures and the surgery is performed is performed while the patient is fully awake, much like a dental work. MAC anesthesia combines local anesthesia with intravenous sedation, whereby the patient is relaxed and in “twilight sleep” during the surgery, much like how it is done during colonoscopy. Most oculoplastic surgeries can safely be performed using either local anesthesia or MAC anesthesia. The advantages are patient cooperation during the surgery which produces better results along with quicker postoperative recovery.
General anesthesia is usually reserved for more invasive operations (orbital surgery) and kids. The patient is totally put to sleep with an endo-tracheal (breathing) tube.
The decision of what type of anesthesia to use is made by discussion between the patient, surgeon, and anesthesiologist. The type of surgery, the age of the patient, health of the patient, patient wishes, and surgeon preferences are determining factors.
Q: Is there anything I should do to prepare for my surgery beforehand?
A. Yes! It’s important to see your primary care physician or internist at least one week prior to your surgery for standard preoperative clearance. You will have blood drawn and an EKG (if applicable). You will need to take our History and Physical Exam Form with you to the appointment which explains to your physician what blood tests to order. If you live out of the area you may have this done near your home. History and Physical Forms can be emailed, faxed or mailed to you and/or to your physician.
Avoid medications which thin the blood for two weeks prior to surgery. These include aspirin, ibuprofen, Aleve, Motrin, Excedrin and Coumadin. Also avoid vitamins E & C and herbal supplements such as Gingko Biloba and St. John’s Wart. Patients who are taking daily doses of aspirin and Coumadin may need to see their cardiologist, in addition to seeing their internist or regular primary doctor, to be cleared for surgery.
Make arrangements for someone to pick you up the day of your surgery and someone to stay with you for at least the first 8 hours. If you live out of the area and will be traveling alone to Los Angeles for your procedure, our office can arrange for a nurse to accompany you to your hotel immediately following surgery and to stay with you for 8 hours.
Q: How long is the recovery period and how much time should I plan to take off work following surgery?
A: Patients should rest the day of surgery, but they should be up and about in a day. Strenuous activity is to be avoided for about one week after surgery. That means any activity that has the potential to raise your blood pressure such as exercising, bending, lifting, brisk walking and sexual activity. You need to sleep on your back for 1-2 weeks after surgery unless you have this highly recommended pillow which will allow you to sleep on your sides without putting pressure on your eyes. Go to sleepandglow.com (Use TABANMD for a discount). Avoid alcoholic beverages (and smoking) and medications that thin the blood (unless otherwise noted by your doctor) during the recovery period. Avoid getting your eyes wet for one week. Keep the dressing on until your post-operative appointment. Normally most patients feel comfortable returning to work and resuming their social activities within 7-10 days. This may vary depending on your type of procedure and how quickly you heal.The majority of the bruising and swelling will resolve by one to two weeks. Minor swelling and bruising can be concealed with a special camouflage makeup.
Q: When will my first follow up appointment be scheduled?
A: Typically, 1 week following surgery. The surgeon will determine this on the day of your procedure. On that day you will be given an appointment for your first post-operative visit along with detailed instructions which you must follow carefully.
Q: When will my stitches be removed?
A. Normally in about one week, or when the wound is adequately healed.
Q: Can I do anything to minimize bruising and swelling?
A. Of course. Sleep in a reclining (not horizontal) position for 1 week following surgery to minimize the collection of fluids in the face and eyelids. Follow the instructions you will be given about making and administering your cold and warm compresses. Taking Arnica or Bromelin prior to surgery and during your recovery can help minimize bruising. These are natural and potent supplements.
Q: Who should perform eye plastic surgery? Who should perform blepharoplasty? Who should perform droopy eyelid surgery?
A. Eye or eyelid cosmetic plastic surgery is best performed by an experienced MD trained in oculoplastic surgery. An oculoplastic surgeon is an ophthalmologist who has completed additional 2 year fellowship on cosmetic and reconstructive eye plastic surgery (including eyelids, orbits, lacrimal system, and surrounding facial structures). They use minimally invasive techniques to provide the quickest and best natural results possible, avoiding unnecessary complications and the dreaded “surgical look”.
Q: Is it possible to change eye shape?
A. The answer depends on exact existing anatomy of the individual patient’s eyes and facial structures and what their desire is. In general, it is not a good idea to do such procedure, unless there is reasonable problem or asymmetry is present. No matter what, the goal is to provide improved eye appearance and function, without taking unnecessary risks, while keeping natural eye appearance and avoiding “surgical look” or need to look like somebody else.
Q: What causes eye or eyelid asymmetry? Why is one eye larger or smaller than the other eye?
A. Eye size asymmetry can be due to many causes. True eye size asymmetry (from one eyeball being bigger or smaller than the other) is rare but can happen. Most commonly the asymmetry is illusion due to other eyelid asymmetry and/or eyeball position asymmetry. One common cause of eye asymmetry is asymmetric upper eyelid ptosis (droopy upper eyelid), causing the eye with the droopier eyelid to appear smaller. Its treatment is droopy eyelid (ptosis) surgery. Another related cause of eye size asymmetry is upper eyelid retraction where the eye appears bigger than the other eye. Its treatment is eyelid retraction surgery. Another cause of eye size asymmetry is if one eyeball is more bulgy (protruding) than the other other eyeball, making the eye appear larger. Its cause needs to be determined and possibly treated via orbital decompression surgery to make the eyeball go back. Another related cause of eye asymmetry is if one eyeball is more sunken than the other eyeball (enophthalmos), making the eye appear smaller. Again, the cause of enophthalmos needs to be determined and then treatment could be considered.
Q: What is the best procedure for bulging/prominent eyes?
A. First, the cause of the bulgy/prominent/protruding eye(s) needs to be determined. The two most common causes of bulgy eyes (aka proptosis) is thyroid eye disease (Graves disease) and inherited bulging or large eyes. The treatment of true bulgy eye is orbital decompression surgery. Another cause of prominent eye could be eyelid retraction where the upper eyelid is too high or the lower eyelid is too low, giving appearance (illusion) of prominent eye. The treatment for eyelid retraction is eyelid retraction surgery. Individual consultation is necessary to determine the cause and treatment of large/big eyes.
Q: Which filler is best to treat under eye hollowness or dark circles? What filler is best to treat sunken eyes?
A. The important properties for the ideal eye filler include safety, effectiveness, ease, longevity, and reversibility. Currently on the market, the best two eyelid filler materials are Belotero and Restylane. Both are made of hyaluronic acid gel, safe, effective, and reversible (using hyaluronidaze). These filler types last 1 to 2 years around the eyes, but can last even longer. These fillers are be injected around the eyes to treat under eye hollowness, dark circles, tear trough deformity, sunken eye appearance, and upper eyelid hollowness, thereby giving more youthFUL eye and facial appearance.
Q: What is the best treatment for under eye dark circles?
A. Under eye dark circles are usually caused to shadow effect that occurs when eye bags cast on hollow under eye area. The best treatment for under eye dark circles depends on the specific individual and their anatomy. In general, if there is excess eye bags (fat prolapse) present, then lower blepharoplasty may be the best long term option. If there is more hollowness than bags present, then the best treatment might be to fill the hollow area with either eyelid filler injection or eyelid fat grafting/transfer. In person consultation will determine the best treatment for eye dark circles.
Q: What are the causes of Tearing?
A: Tearing or otherwise known as epiphora is a condition in which the tear duct overflows. According to
Medicalnewstoday – “An overflow of tears on the cheek, due to imperfect drainage by the tear-conducting passages.”
- Over-Production of Tears – possibly caused by an irritant in the eye.
- Blocked Ducts. – causes the eye to overproduce tears.
- Ectropion (outwardly turned eyelid) and Entropion (inwardly turned eyelid)
- Possibly eye- injury
- Dry Eyes – may cause again over-production tears spill out and not on your dry eye. Once the cause is determined then the correct treatment can be implemented.
Q: Do You Have a Chalazion?
A: If you have something that looks like a sty but has not gone away, then the answer is probably yes. A chalazion is caused by a blocked tear gland in the eyelid. It often occurs due to a common condition called blepharitis, which cause the many tiny tear glands in the eyelids to produce thick oily secretions.
Q: How is a sty different from a chalazion?
A: They differ in that a sty is caused by an active bacterial infection while a chalazion is caused by inflammation only. A chalazion is sometimes the after effect of a sty. It is less tender but lasts longer.
Q: What are symptoms of a chalazion?
A: You may have some or all of the following symptoms:
● Appearance of a painless bump or lump in the upper eyelid, or in the lower eyelid
● Blurred vision, if the chalazion is large enough to press against the eyeball How do you treat a chalazion?
Many chalazia go away on their own in a few weeks or a month. If it does not go away, it may be worth going to your doctor. Treatment options depend on the size and exact location of the chalazion. Treatment options for chalazia include aggressive eyelid hygiene, injection of a medicine into the chalazion, and surgical drainage in the office.
Q: What is Eyelid Ptosis?
A: Eyelid ptosis refers to a drooping upper eyelid. The eyelid droop can range from very mild and hardly noticeable to severe enough to cause vision problems. Ptosis can be present at birth or develop over time.
What Causes Eyelid Ptosis?
● Congentinal (present at birth)
● Trauma to the eyelid
● Neurologic disorders
● Age-related loosening of the muscle responsible for lifting the eyelid
Some conditions can cause an appearance of ptosis. Causes of “pseudo-ptosis” include an excess of upper eyelid skin/fat and droopy eyebrows. Therefore, treatment may have to include treatment for ptosis and “pseudo-ptosis”.
Read more about treating eyelid ptosis.
Q: What is the Difference Between Enucleation and Evisceration?
A: Enucleation is the surgical procedure in which is eyeball is removed. Evisceration is a procedure similar to enucleation, with the difference that the sclera (eye shell) is not removed.
Which option is better? If the option is available, evisceration is preferred as it provides better
ocular motility and reduces the chances of implant extrusion in the future.
Why are these procedures necessary?
There are many reasons why a patient may need his or her eyeball removed:
• Cosmetic reasons due to disfigurement
• Severe infection in eye
• Control pain in a blind eye
• Remove a tumor
• Severe injury
Who should perform these procedures?
When in need of enucleation or evisceration, it is best to use an experienced and board certified oculoplastic surgeon. He or she will determine which option is best for you.
Q: What do you need for a successful Prosthetic Eye?
A: When replacing an eye that has been lost, there are two critical team members.
The first is an experienced and board certified ocular plastic surgeon. If the eye has to be removed, the surgeon will perform an enucleation or evisceration.
After the eye has been removed, there are a number of surgical procedures that can be done to restore proper function to the remaining and surrounding structures (eye socket, eyelids) to provide the best possible setting for a prosthetic eye.
Now that the socket is ready, you must have an artificial eye designed. This is done by an ocularist.
Q: What is an ocularist and how do you find one?
A: According to the American Society of Ocularists, an ocularist is “a carefully trained technician skilled in the arts of fitting, shaping, and painting ocular prostheses.” In other words, this is the person who will make an artificial eye for a patient.
Getting a custom eye that matches the remaining eye is crucial for a patient who has experienced eye loss, an emotional event.
Resources for evaluating and locating a skilled ocularist can be found on the Society’s website: www.ocularist.org
Q: What is the Best Method to Fix Asymmetrical Cheeks?
A: There are various options to fill the midface/cheek area and make the cheek more symmetric and full.
These include temporary fillers (Restylane, Juvederm, Perlane, Radiesse), nonpermanent fillers (Sculptra), fat transfer, and implants. They each have advantages and disadvantages and need to considered on an individual basis, during consultation.
Q: How to Reduce Pain During Neurotoxin or Filler Injections?
A: They are various techniques and products that can be used to reduce the pain during neurotoxin (Botox, Dysport, Xeomin) and filler (Restylane, Juvederm, Radiesse) injections. Dr. M. Ray Taban discusses the various options available.
- Using the smallest needle possible. That would be a 32g needle for neurotoxin injections and slightly larger for the fillers.
- Applying numbing cream prior to the injections.
- Applying ice prior to and during the injections.
- Performing various distraction techniques, such as tapping somewhere else on the face with a finger.
- Mixing botulinum toxins (Botox, Dysport, Xeomin) with bacteriostatic (preservative) saline, rather than preservative-free saline.
- Minimizing the number of injection points.
Q: Is Restylane a Good Option for Under Eye Bags?
A: Filler (Restylane) under your eyes to fill in the dark hollow circle is a very good nonsurgical option for you. I am sure they are people in London who do it (seek an oculoplastic surgeon).
Q: Is it possible to surgically remove filler (Juvaderm) injected 4 years ago under the eyes? “Ive had multiple hyaluronidase (at least 6 or 7) and 1 steroid injection which failed to reduce the lumpiness (they just degraded my tissue), nor has time resolved the problem (despite doctors’ claims that this filler is “temporary” and “reversible”!). If the Juvaderm has indeed been absorbed/dissolved, why is the lumpiness still there and can whatever is there be removed, akin to a bleph?”
A: Another alternative option to removing any lump present in your case is to actually fill in the hollow areas surrounding it (upper cheek, lower eyelid, etc) with fat transfer, or possibly other fillers. Consult an oculoplastic or facial plastic surgeon.
Q: What is Anophthalmia?
A: Anophthalmia or anophthalmic socket results when an eye is removed (enucleation or evisceration). Losing an eye is an emotional event to any patient and can cause insecurities about his/her appearance. An oculoplastic surgeon is responsible for restoring proper function of the remaining and surrounding structures (eye socket, eyelids) to provide the best possible opportunity before a prosthetic eye (fake eye) can be made by an ocularist. Prosthetic eye is placed over the eye socket when the eye is removed (enucleation or evisceration) for various reasons. The prosthetic eye should like the other normal eye and should not be obvious to the observer.
There are various techniques involved including orbital volume augmentation by implant or fat grafts, upper eyelid ptosis surgery and lower eyelid tightening (ectropion surgery) with canthoplasty.
Who Should Perform The Surgery?
When choosing a surgeon to perform socket surgery, look for an oculoplastic surgeon, with membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), which indicates he or she is not only a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, but also has had extensive training in ophthalmic plastic reconstructive and cosmetic surgery.
Q: How Do I Know When it’s Time for an Eyelid Surgery?
A: The upper eyelids become “heavy” and “droopy” over time, due to the aging process. There are three basic factors that each, separately, contribute to these changes. The first is that the muscle or tendon (levator) that lifts the upper eyelids loosens and that causes the upper eyelids to lower.
This is called Ptosis. The process can be asymmetric. If this is mild, then it is only an aesthetic issue. If severe enough, it can block the vision and cause fatigue/headache from constant compensation by the brow/forehead being lifted. The treatment for this is EYELID PTOSIS SURGERY.
The second process is that the skin on top of the eyelids looses elasticity and stretches. This is called upper eyelid DERMATOCHALASIS. This has nothing to do with the position of the upper eyelids relative to the eyes, which is related to factor one discussed above. The treatment for this is UPPER BLEPHAROPLASTY.
The third factor that contributes to upper eyelid “heaviness” or “droopiness” is descent of the brows/forehead (BROW PTOSIS). If severe enough, the brow can encroach on the upper eyelid space and contribute to increased skin in the upper eyelids. The treatment for this is BROW LIFT.
A patient may have one, two, or all three of these factors and each would require its own specific surgery. However, they can all be combined in one surgery, usually under local anesthesia with or without sedation. The recovery for each or all of them combined is also the same, namely about 7-10 days of having a “black eye”.
The term blepharospasm can be applied to any abnormal blinking or eyelid tic/twitch, and the name of the disorder makes sense once you break down the term. Blepharo means “eyelid”, and spasm means “uncontrollable muscle contraction”. So blepharospasm basically means that a patient has uncontrollable muscle contraction of the eyelid.
There are many causes of eyelid spasms, including dry eyes, Tourette’s syndrome, and Tardive Dyskinesia. Benign essential blepharospasm is a chronic benign condition, which essentially means that it is not life threatening. Blepharospasm involves abnormal, uncontrolled eyelid and facial spasms or contractions on both sides. The visual disturbance is solely due to the forced closure of the eyelids, and should not be confused with true eyelid droopiness (ptosis) or hemifacial spasms, which is one-sided eyelid or facial spasms.
Q: What is a blepharospasm?
A: There are, thankfully, treatment options available for blepharospasm, with the most common one being botulinum toxin. This is a toxin produced by the Clostridium Botulinum bacteria, and periodic injections of the toxin will weaken the muscles by blocking nerve impulses transmitted from the nerve endings of the muscles. Minute doses of the toxin are usually injected intramuscularly into several sites above and below the eyes, but the exact site of the injection will vary slightly from patient to patient, and depend on the preference of Dr. Taban.
The botulinum toxin works by temporarily weakening or paralyzing the affected spasmodic muscles. Benefits begin in 1-14 days after the treatment, and last for an average of three to four months. Long-term follow-up studies have shown it to be a very safe and effective treatment, with up to 90% of patients obtaining almost complete relief of their blepharospasm.
Q: What is an Orbital Blowout or Fracture?
A: Trauma to the orbit and eye area most often results in bruising (black eye). It can also result in fractures of the orbital bone, most commonly the orbital floor (known as orbital blowout fracture) and/or orbital medial wall. The orbital bones “blow out” into adjacent sinuses.
Q: Is it Normal for One Eyelid to be Drooping 3 Weeks After Blepharoplasty?
A: Using ointment at this point is not needed. The droopy upper eyelid could be from residual swelling of the upper eyelid or it could have been present prior to the blepharoplasty. Blepharoplasty only removes excess skin from the upper eyelids. It does NOT actually lift the eyelids. If there is true droopy upper eyelids (ptosis), then that requires ptosis surgery by tightening the muscle responsible for lifting the eyelids. You should wait at least 3 months from your surgery to allow any residual swelling to subside. If at that time there is still droopy eyelid, then you might need ptosis surgery. See an oculoplastic surgeon.
CONTACT THE LOS ANGELES OCULOPLASTIC EXPERT
Dr. Taban is one of the leading oculoplastic eye surgery doctors in the LA region. Contact us via online support form, or via telephone at: (310) 278-1836Dr Taban’s answers to real patient questions on RealSelf.com in purple like the other headers
RealSelf Q&A with Mehryar (Ray) Taban, MD, FACS
Dr. Taban’s answers to real patient questions on RealSelf.com.
Next, view our Patient Forms.