Blindness After Blepharoplasty (Eyelid Surgery)

Can Blindness Occur After Blepharoplasty? 
Losing one's eye sight would be the most devastating complication after a blepharoplasty procedure for both the patient and the surgeon. Fortunately, blindness after an eyelid procedure rarely occurs (1 in 10,000 cases.)  Before one undergoes an eyelid procedure, one should be cognizant of its potential complications, such as blindness.  It is also very important to recognize the symptoms of an impending visual loss after a blepharoplasty procedure so that your plastic surgeon will be able to address this problem in a timely manner.


Fast Facts about Blindness after Blepharoplasty

• Permanent visual loss after blepharoplasty was estimated to occur in 1 in 30,000 in a new study.
• Temporary visual loss after blepharoplasty was estimated to occur in 1 in 50,000.
• Majority of patients developed symptoms within 24 hrs of the procedure.
• History of hypertension is the most common risk factor associated with blindness after a blepharoplasty procedure.
• Postoperative vomiting and a history of vascular disease occured more frequently in patients who developed permanent visual loss.
• Most common cause of blindness after blepharoplasty is retrobulbar hemorrhage (bleeding behind the eyeball).

The Blind Beggar by Jules Bastien-Lepage (File courtesy of Wikimedia Commons)

Symptoms to Look for an Impending Visual Loss after a Blepharoplasty 

• Severe pain (41% of patients)
• Pressure sensation (36% of patients)
• Blurred vision (not common)

Preventive Measures to Reduce the Risk of Vision Loss after Eyelid Surgery

• Good control of high blood pressure before surgery
• Minimize postoperative nausea and vomiting
• Minimize physical activity after surgery
• Any medication that can increase bleeding, such as aspirin, ibuprofen, or certain supplements like garlic pills, gingko biloba, vitamin E, omega-3 fatty acids, should be suspended two weeks before surgery and should not be taken for at least one week after surgery.

It behooves the astute plastic surgeon, as well as the educated patient, to be aware of this potential complication.  It is imperative  for one to recognize the symptoms of an impending visual loss after an eyelid procedure so that vision can be preserved.   I recommend to always ask your plastic surgeon information about blepharoplasty prior to undergoing this procedure.

Emmanuel De La Cruz M.D.

Houston Plastic Surgeon

Reference:
Hass AN,  Penne RB, Stefanyszyn MA, Flanagan JC. 
Incidence of postblepharoplasty orbital hemorrhage 
and associated visual loss.  Ophthal Plast Reconstr Surg
2004;20:426-432
Lelli GJ, Lisman RD. Blepharoplasty complications. Plast 
Reconstr Surg 2010;125:1007
Mejia, Ergo and Foad Nahai. Visual Loss After Blepharoplasty: Incidence, Management, and Preventive Measures.  Aesthetic Surgery Journal.  January 2011;31(1): 21-29
Wolfort  F, Vaughan T, Wolfort S, Nevarre D. Retrobulbar hematoma and blepharoplasty.  Plast Reconstr Surg
1999;104:2154

BOTOX for Migraine Headaches

BOTOX for Migraine Headaches:  Is it Effective?

Migraine headache is a disabling medical condition that affects 11 out of 100 people in the United States.  Majority of these patients are women (3 out of 4 people with migraine headaches.)  With the serendipitous discovery of BOTOX reducing the frequency of migraine headaches in women who underwent BOTOX treatment for their forehead wrinkles, the idea of using BOTOX to treat migraine headaches seem promising.  Does BOTOX really treat migraine headaches?  

Migraine Headache Symptoms

• Throbbing pain on one or both sides of the head
• Stiff neck
• Visual hallucinations such as zigzag lines and flashing lights
• Nausea and vomiting
• Irritability 
• Mood swings
• An episode of migraine can last from 3 to 72 hours

Photograph courtesy of Targetwoman.com

Fast Facts about BOTOX for Chronic Migraine Headaches

• BOTOX was approved by the FDA on October 2010 for the prevention of chronic migraine headaches for adults.
• Chronic migraines are defined as migraine headaches that occur more than 15 days a month for more than four hours per day.
• A study involving 1,384 adult patients revealed that patients who received BOTOX injections for migraine headaches experienced 7.8 and 9.2 fewer days of migraine than they had before the studies started. Those who received  placebo injections (sugar pill) experienced 6.4 and 6.9 fewer headache days.
• Patients who received BOTOX for chronic migraine headaches experienced 107 and 134 fewer hours of headache, versus a reduction of 70 and 95 hours for those on placebo.
• Patients were also found to have reduced consumption of migraine headache medications, such as sumatriptan, after BOTOX injection for chronic migraine headaches.
• About 1% of patients who received BOTOX injection for chronic migraine headaches found that their migraine headaches worsened after treatment.
• Most common side effect was transient cervical pain (neck pain) according to one study.

Unfortunately, BOTOX is not the panacea for migraine headaches.  It can reduce the frequency of migraine headaches in patients who have chronic migraine, but does not completely cure it.  I recommend seeing your physician (especially a Neurologist) to determine if you have chronic migraine headaches, and to evaluate if you are a good candidate for BOTOX to treat this disabling medical condition.

Emmanuel De La Cruz M.D.

The Woodlands Plastic Surgeon

References:
US FDA: FDA approves Botox to treat chronic migraine. October 15, 2010    www.fda.gov
Cady et al.  A multi-center double-blind pilot comparison of onabotulinumtoxinA and topiramate for the prophylactic treatment of chronic migraine. Headache. 2011 Jan;51(1):21-32. pp1526-4610
Diener et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial.  Cephalalgia. 2010 Jul;30(7):804-14
Dodick, et al.   OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program.   Headache. 2010 Jun;50(6):921-36  
Oterino, et al.  Experience with onabotulinumtoxinA (BOTOX) in chronic refractory migraine: focus on severe attacks. Journal of Headache Pain.  February 2011.(Epub Ahead of Print)  

Dermal Filler Injections for Breast Augmentation?

Dermal Filler Injection for Breast Augmentation:  Is it Safe?
Research has shown that many women have shown significant interest in having a breast augmentation.  However, only a small percentage of women who contemplated about breast enhancement opted to undergo surgical intervention.  The advent of minimally invasive procedures for breast enhancement, such as fat transfer and hyaluronic acid injections, has garnered increasing attention from the media, and significant interests from women who are seeking a minimally invasive procedure for breast augmentation.  Hyaluronic acid dermal fillers being used for facial rejuvenation is now being extensively promoted for breast augmentation in 17 countries throughout Europe and Asia. The hyaluronic acid filler, Macrolane, was developed by Swedish scientists to be used for breast augmentation, as well as for buttock augmentation.  Because of the increasing popularity of this new procedure for breast enhancement, safety issues are now being raised, especially in the United States.

Sunlight By Julius Leblanc Stewart (Photo courtesy of Wikimedia Commons)

Fast Facts About Breast Augmentation Using Macrolane (Hyaluronic Acid Dermal Filler) Injections

• Macrolane is a hyaluronic acid gel that is both biocompatible and biodegradable in nature.
• Macrolane used for breast enhancement are injected either subglandular (above the pectoralis muscle) or submuscular (below the pectoralis muscle.)
• Larger volumes are required for breast enhancement as compared to facial rejuvenation.  A maximum volume of 100 ml of Macrolane per breast was used in a study conducted in Sweden.
• Macrolane injections are temporary and lasts for 1-2 years.
• The study conducted in Sweden showed that in women who underwent Macrolane injections, 78% of the hyaluronic acid filler remained at 3-months; 57% remained at 6-months; and 34% remained at 12-months based on the breast MRI evaluation performed after the procedure.
• Capsular contracture (85% with Baker Scale III) was the most common complication after Macrolane injection for breast augmentation (25% of patients.)
• No serious adverse events or inflammatory reactions were found after 1 year of injection.
• Macrolane injections for breast augmentation is NOT FDA-approved, and is not available in the United States.

The minimally invasive nature of Macrolane injections for breast augmentation seems to be promising for those who seek an alternative solution for breast enhancement.  However, due to the limited clinical studies available regarding its safety, as well as the unknown effects for mammographic detection of breast cancer, one should proceed with caution regarding having this procedure done, especially in the United States.  I recommend asking your  plastic surgeon regarding the different alternatives for breast augmentation if one is interested to have their breast enhanced.

Emmanuel De La Cruz M.D.

References:
Hedén, et al.  Macrolane for Breast Enhancement: 12-month Follow-Up.  Plastic Reconstructive Surgery.  2011. February; 127(2): 850-60.
Hedén, et al.  Aesthetic breast surgery: Consulting for the future—Proposals for improving doctor-patient interactions. Aesthetic Plastic Surgery. 2009;33:388–394
McCleave.  Is Breast Augmentation Using Hyaluronic Acid Safe?  

Aesthetic Plast Surg. 2010 Feb;34(1):65-8; discussion 69-70. Epub 2009 Dec 5.

Nahabedian, Maurice.  Discussion: Macrolane for Breast Enhancement:12-Month Follow-Up. Plastic Reconstructive Surgery.  2011. February; 127(2): 861-862.