photos of Dr. Binstock’s patients

Our eyes and eyelids are the central feature of our face and appearance. They express our emotional state and well being. Tired, droopy, puffy, wrinkled eyelids herald the onset of aging and these features often convey an incorrect sense of our well being to the world around us.

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How can Dr. Binstock help?

Dr. Binstock’s state-of-the-art procedures can help rejuvenate your eyes and eyelids in a natural, pleasing, and aesthetic manner. These advanced techniques include eyelid lifts to improve hanging, puffy upper eyelids, and the invisible incision lower eyelid technique. Fractional laser resurfacing or chemical peeling are used to improve crow’s feet and crinkled eyelid skin. Botox® Cosmetic and Dysport™ injections are also used to smooth out and minimize crow’s feet and to elevate the eyebrows.

When did Dr. Binstock learn these procedures?

Dr. Binstock learned to perform cosmetic eyelid surgery while serving as a Fellow in Dermatologic Surgery at the University of California San Francisco in 1979. He studied the transconjunctival invisible lower eyelid approach for lower eyelid surgery while visiting Dr. Pierre Fournier in Paris, France in 1986.

Eyelid rejuvenation can produce a great change in one’s appearance and sense of well-being. At the same time, it is moderate in scope when compared to more extensive cosmetic procedures, such as face or neck lifting.

What is an invisible lower eyelid incision?

Lower eyelid bags, i.e., fatty puffs, can be removed transconjunctivally, that is, by making an incision behind or through the inside surface or conjunctival of the lower eyelid. This incision is invisible on the outside surface of the eyelid and heals by itself without being sutured.

Wrinkles in the lower eyelid skin show minimal improvement following lower lid blepharoplasty. Attempts to smooth the skin by removing lower eyelid skin often result in a rounding of the shape of the eye and the unnatural appearance of white showing under the iris of the eye. These changes are very uncommon and are minimized by the transconjunctival approach as the skin surface and muscular support of the lower eyelid remain unaltered, helping the eye to maintain a pleasing, natural appearance.

Fractional laser resurfacing or chemical peeling can be combined with this procedure to help tighten and smooth out lower eyelid wrinkles, skin excess, and crow’s feet. Botox Cosmetic and Dysport can reduce crow’s feet and elevate the eyebrows.

What upper eyelid approach is utilized?

Upper eyelid rejuvenation includes removal of excess skin that may weigh down the eyelid and even rest on the eyelashes, and the fatty puffs or fullness that so often give the eyes a puffy, tired look. Reduction of excess skin and fatty tissues and the tightening of the upper eyelid opens the eyes again to reveal the eyelid margin, a deeper eyelid fold, and a crisper appearance.

Dr. Binstock follows the natural line and crease of the upper eyelid. He makes a very fine incision that extends just over the bony rim of the eye area to elevate the skin that often hangs over the outside corner of the eyelid as well as the eyelid itself. This entire incision is generally closed using one suture placed under the skin’s surface except at its entry and exit points, so that suture track marks are minimized. This suture is removed five days after the procedure.

Upper and lower eyelid lifts can be performed separately or together under local anesthesia, in the quiet of our office setting, in one to two hours.

How should I prepare for eyelid rejuvenation?

Good health, reasonable expectations, and careful preparation are essential to insuring a safe and speedy recovery. An eye exam by an ophthalmologist, appropriate laboratory test, and a physical exam will be requested.

Be sure and tell Dr. Binstock what concerns you have, what benefits you would like to see, and if you have or have had any eye or eyelid problems. Preparation for these procedures includes avoidance of aspirin and related substances to minimize the possibility of increased bleeding. These procedures are performed under local anesthesia in both the San Francisco and Mill Valley offices. You may be given light sedation prior to surgery, but will be awake at the end of surgery. A friend must accompany you home and spend the first night with you.

Cosmetic procedures are not covered by medical insurance health plans.

What should I expect following eyelid lifts?

Some bruising and swelling will occur and generally subside within seven to ten days. Contact lenses are to be avoided for two weeks, and make-up and exercise for one week. Sutures are used in the upper eyelid only (not the lower eyelid), and are removed in five days.

Are there potential complications related to eyelid rejuvenation?

There are potential complications associated with every type of surgery. Any time skin is incised it heals with a scar. Dr. Binstock is careful to place the incisions in locations that are not readily visible, i.e., the eyelid fold of the upper eyelid. The lower eyelid incision is invisible as it is placed on the inner surface of the lower eyelid. Complications relating to eyelid surgery are not common, but certainly can occur.

In the past, the most common complication of eyelid surgery was with the correction of the lower eyelid, with a pulling down or outward of the lower eyelid margin giving the eye an unnaturally rounded appearance. Now that lower eyelid rejuvenation is performed through the back surface of the eyelid, i.e., transconjunctivally, these distortions are most infrequent.

Upper eyelid complications also occur. On rare occasions, the upper eyelid can become droopy after surgery. This generally resolves over a period of several weeks to months, but can be repaired at a later date if necessary.

Other potential complications include: postoperative bleeding, infection, numbness, bruising, dryness of eyes, asymmetry of eyelids, or small puffy areas at the edges of the incisions. It is not possible to list every conceivable complication. Loss of vision, although extremely rare, has been reported (one in 40,000 cases has been reported). This information is not meant to frighten you, but rather to enable you to make a decision concerning the benefits of eyelid rejuvenation from an informed position.