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Q: My upper lids droop over my eyelashes and I would like to have them fixed. I have seen two plastic surgeons, one who agreed that he could help me with my upper lids, another who told me I’d have to have a brow lift as well. My brows are fine with me and I do not understand why a brow lift would be necessary? Why would a surgeon recommend a procedure I did not ask for?

A: You really should go and have another talk with your plastic surgeons – if one recommended a brow lift, he should have explained why he did so. Rarely would we suggest a procedure about a body part not brought to our attention by a complaint originated by a patient. For example, we would never comment about very large or small breasts if a patient came in to discuss an abdominoplasty (i.e. “tummy tuck”).

The two exceptions I can think of relate to chin implants and brow lifts, but in such a situation, I sure would hope that the patient left the consultation with an understanding of why we are recommending the brow lift or chin implant procedures! Patients with weak chins who come in complaining of a large nose or a droopy neck cannot get a great profile without addressing the weak chin because the chin, nose and neck all contribute to the profile. Likewise, if a patient complains of heavy upper eye lids, we have to analyze the balance between the eyelid and brow position.

As a plastic surgeon, our duty is to lay out the options for a patient and each person has to choose the procedure(s) that will give them their desired results. In a pure upper eye lid blepharoplasty, the thin skin excess of the lids is removed but the distance from the lashes to the brows is not changed. In patients with low brows, removing the thin, excess upper lid skin may not be appreciated unless the thicker tissues just below the brows are raised as well. This is not to say that every low brow must be raised when doing an upper lid procedure, but the patient has to understand that only the thin, upper lid skin excess will be removed, that the thicker brow hooding will be unchanged, and that the distance between the brows and lashes does not change with an isolated blepharoplasty.

If a patient desires a more open – eyed look, this will only be accomplished if a brow lift is added to the eye lid procedure. Not only will the eye area look more open following a brow lift, but during a brow lift, the frown lines between the brows will be minimized because we can remove some of the muscles that cause these frown lines, called the corrugator and procerus muscles. And finally, occasionally I’ll see a patient with hooding caused by low brows who thinks they would like an upper eyelid blepharoplasty, but when I gently elevate the brows, I can see that this patient does not have an excess of thin, upper lid skin, just low malpositioning of the brows and I will recommend to this patient that a brow lift be performed without a lid procedure per say.

A brow lift is a minimally invasive procedure. In the endoscopic brow lift, a few half inch incisions are made behind the hair line, allowing the instruments to be inserted. The tissues are freed from the bone, the muscles sculpted, and the brows raised a few millimeters. The brows are fixed in their new position with a variety of devices. The incisions are rarely perceptible after healing has taken place. Occasionally, a brow lift will be performed as an isolated procedure, but more commonly it will be combined with a minimally invasive midface or thread lift, an eyelid procedure or a standard face lift.

If you have any specific questions about cosmetic procedures, you should see a qualified, board certified plastic surgeon to review your options and have additional questions answered!

About the author of this article:

Dr. Bunkis,MD, FACS of Orange County Plastic Surgery is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call OCPS at 949-888-9700, email your questions to info@ocps.com or visit our website for more information.

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Clinical depression is a common disease these days because of the tense lifestyle of man. Continuous stress is one of the major causes of depression. Family problems, shock, unpleasant atmosphere, social un-acceptance are some reasons behind depression. Here are some facts about the disease.

Clinical depression is a mental disease. Generally, everyone gets depressed once in a while, but if this situation continues for a long span, it is considered as major mental depression. Such people lose their self esteem, and do not enjoy any activity.

How to discover such patients:

In all other physical diseases, patients can go to the doctor for they realize their problems personally. Most serious complication about this disease is that patients rarely accept that they need psychiatric treatment. Even people around such patients neglect some basic symptoms of depression. So, the possibility of treating such patients in the initial stage of the disease becomes rare.

Everyone gets tired and mentally frustrated often. Even we do experience unwillingness to live frequently. Doctors also believe that this is the defense mechanism of our mental system. Low mood is always not depression. However, prolonged sadness and a low mood can be depression. It is curable if taken proper care of.

First of all, sad mood is not the only symptom of depression. There are many other symptoms too which will help you to trap the disease in an earlier stage. Those are:

1) Mood:

Bad mood is the first symptom of depression. These patients are always unhappy. They don’t need any particular cause to become sad; sadness becomes their natural mindset in this period.

2) Unwillingness:

In this disorder patients loose hope. They do not take part in any social activity neither do they enjoy participating in interesting things.

3) Ill-tempered nature:

Such patients loose their humor instantly. They have the tendency to be rude, impatient and so on; automatically they get harsh replies which make their condition worse.

4) Lonely:

These people develop the attitude that no one likes them, so, they start distancing themselves from their folks. You can observe that these people choose sitting at home alone instead of going out with friends.

5) Sleeplessness:

Sleeplessness is the major problem faced by depressed people. They cannot sleep peacefully thorough out the night. Either they get horrible dreams or illusions. Medication for this problem can make them sleep and some depression pills also work against this problem. However, if these patients do not get proper treatment, they try various addictions to overcome the problem.

5) Addiction:

Extreme addiction to alcohol and drugs is also common in depression patients. As it seems the only way to kill stress and sadness, these patients get easily attracted towards addiction.

6) Indifference:

Patients of depression are always unconcerned about what is happening around them.

Although they seem indulging in activities, mentally they are in a void. This is the reason, one gets blunt replies from them frequently.

7) Denial:

As they lack confidence, they deny any suggestions given to them. Depression and low mood do not allow them to accept things and enjoy moments. So, they just deny every offer you put forth to them. Even persuading them to take medication is a big challenge for you.

These are some symptoms you can find in patients of depression. If you are concerned about such a person then take immediate steps to cure him/her. There are antidepressants and depression pills available to treat them. So, go to the psychiatrist, consult him and bring the patient back to life. Have some patience while dealing with them; be patient to get your buddy back to normality.

About the author of this article:

Jim Karter has co-ordinated with the sites:- Depression and Suicide Depression and Anxiety Cortisol and depression Depression Symptoms

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