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Women Crush Wednesday

Woman Crush Wednesday

Over the next several Wednesday’s, we’d like to honor the beautiful, strong, intelligent women who comprise the #ellevated network. We’ll post about them on social media, and provide a short blog on who they are, what they do, and how they stay both beautiful and ellevated. So today as the inaugural #womancrushwednesday, we’re highlighting our founder, Dr. Ann Jayaram.

  • Who: Ann Jayaram, MD
  • What does she do: Eyelid plastic surgeon and founder of ellevateMD, the concierge beauty practice for empowered women
  • Empowerment advice: Surround yourself with women who inspire you and the rest will follow.
  • Favorite beauty services: Quarterly preventative Botox, a subtle lip enhancement, and yearly Fraxel laser to keep glowing 
  • Favorite beauty products: Skinceuticals Phloretin Vitamin C Serum and SkinMedica HA5 hydrator 
  • Skincare Routine: AM: Lancome Creme Radiance cleanser, Skinceuticals Phloretin, SkinMedica HA5, Skinceuticals Physical Fusion Tinted SPF. PM Routine: Lancome Creme Radiance cleanser, Skinceuticals reservatrol, SkinMedica 0.5 retinol on most of my face, SkinMedica 0,25 retinol around my eyelids, and Skinceuticals Triple Lipid Moisturizer
  • General overview of a typical day: Snooze for 15 minutes, 45 minutes treadmill speed walk while watching mindless TV, snob-approved pour over drip coffee, train to work while answering client inquiries, consultations/surgeries/procedures all day, train home while listening to business podcasts, make dinner with my hunky fiancé, grab a drink with a badass girlfriend
  • Favorite fashion of the moment: the double breasted, gold buttoned, chic woman’s blazer (Balmain for the splurge, Veronica Beard for a slight lesser splurge)
  • Favorite hotspot to chat with other #ellevated women: The Neiman Marcus Rotunda in SF for champagne and popovers

Transformation Tuesday

This GORGOEOUS ellevate gal had Dr. J’s signature ellevate Lid Lift and Bag Removal. So what is that you ask?

    • The ellevate Lid Lift is Dr. J’s most known procedure: 30 minutes, in office, local anesthesia only, and only about 5-7 days of bruising/swelling.
    • This involves the removal of excess, heavy skin on the upper eyelids, creating the look of rejuvenation
    • If done correctly, this procedure can give you a natural lift as well as correct any underlying asymmetry.
    • If done INCORRECTLY, this procedure can leave you with uncontrolled dry eye, scarring, or vision changes (….so let’s try to keep it all correct)
    • If you feel like your upper lids look heavy, feel tired, make you look asymmetric or older, get your ellevate Lid Lift consultation today!
    • The ellevate Bag removal treatment is a 90 minutes surgery performed in a surgery center under mild sedation
    • In this procedure, there is no external cut or stitches, ensuring no scarring at all
    • The procedure actually involves the removal of fat from the lower lids, ensuring that this is a permanent fix for your bags, and will not need to be repeated
    • While this procedure has about 10 days of bruising, these results are amazing!
    • If upper lid lift and lower lid bag removals are done together, both can be done in a surgery center under mild sedation with a total recovery of about 10 days
    • If heavy upper lids or bags under your eyes are bothering you, call today!

Introducing, EllevateMD

The Fresh New Face of ellevateMD

What do you need to know?

    • EllevateMD was created by Dr. Ann Jayaram, a board certified eyelid plastic surgeon
    • EllevateMD’s goal is to provide customized natural beauty for today’s busy woman
    • We start every visit with a thorough analysis from forehead to neck on beauty options, pros and cons, the science behind treatments, and expectation of results
    • We create a customized plan for you based on your areas of concern
    • We are passionate about connecting a network of strong and beautiful women
    • We believe in education, convenience and flexibility, accessibility for questions and follow up, painless procedures, and perfect natural results.
    • Dr. J has special expertise on upper and lower eyelid procedures, and has done over 5,000 in her career

An Eyelid Surgeon’s top 7 tips to get the most out of Latisse

If you are going to invest in your lashes, how do you get the most out of Latisse (Bimatoprost Ophthalmic Solution)?

 

  1. Make it a routine.

Because I prefer that my Latisse application does not interact with other creams and makeup products, it is the last thing I sweep across my lids before bed. Every night 😉

  1. Use the brushes in the pack.

Seems a little crazy that this product comes with about a million small brushes for such a small product, but it’s a good idea to use a clean, new applicator each night.

  1. Don’t waste it!

One drop onto the brush per eyelid. More product does not mean longer lashes—it only means Latisse dripping down your face.

  1. Upper eyelids only.

It’s not intended for lower lid application, so don’t waste it here. The bigger bang for your buck is lengthening your upper lid lashes–there are over three times more of them 🙂

  1. Stick with it.

Don’t get discouraged if you don’t get overnight results.  After one month of applying every day, most people see a difference in length of lashes.

  1. Tell your doctor if you are experiencing irritation.

You’ll read many articles about the possible darkening of your eye color but the much

more common side effect is eyelid irritation. This may be minor, but definitely worth letting your doctor know.

  1. Use the real thing!

There are many imitators coming out on the market these days, but none of them work the way Latisse does—and none of them have the FDA and scientific research behind them.

 

A note on side effects and safety information:

Do not use Latisse if you are allergic to Latisse or it’s ingredients, have glaucoma, or are currently treating it with medicated eye drops. Do not use Latisse if you are pregnant, possibly pregnant, or breastfeeding. Latisse may cause brown darkening of the colored part of the eye which is likely permanent or may cause eyelid skin darkening which may be reversible. If discontinued, lashes gradually return to previous appearance. For more information on contraindications, interactions, and potential side effects, please read the risks and benefits in important safety information.

Do I need lower lid surgery?

Many people have issues with the appearance of their lower lids.  However, because each problem is unique, there must be a personalized approach to addressing lower lids, and this is usually best done through an in person consultation with your eyelid surgeon.

First, let’s take a look at the most common lower lid problem in younger patients—the dark circle.

Most commonly in patients under 40, the true problem with the under eye area is dark circles. The unfortunate truth about dark circles is that there is no surgical cure all.  Why do we get them? The most common reason is lack of sleep, however other etiologies include heredity, thinning of skin as we age, allergies causing the dilation of blood vessels, excessive eye rubbing or inflammation, eczema or other skin disorders, iron deficiency leading to insufficiently oxygenized blood, crying, and excessive smoking, drinking, caffeine, or drug abuse.

The best and most effective way to combat under-eye pigmentation is an effective concealing regimen.  When dark circles are severe enough, a simple coat of concealer isn’t enough.  The perfect under-eye regimen consists of an eye moisturizing cream, a color corrector to offset the undesired pigment, a concealer, and a skin brightener to top it all off. Yep, it’s a commitment, but this regimen is sure to make a difference.  Here are the products I have come to love for myself.

  1. Eye cream:Clinique All About Eyes Rich, $32
  2. Color corrector: Becca Backlight Targeted Color Corrector ,$30
  3. ConcealerMaybelline Instant Age Rewind Eraser, $7.99
  4. Eye brightener:Becca Undereye Brightening Corrector, $30

If dark circles plague you, you will likely always need a lid regimen like the one detailed above, coupled with getting enough sleep, drinking enough water, and making sure you address any underlying skin problems.

Half the battle with dark circles is combating the shadowing that contour abnormalities can cause.  Sometimes, a small amount of strategically placed filler (ex: Restylane or Juvederm) in the tear troughs may also help. Evening out the peaks and troughs of the lower lid with filler and remove these contour abnormalities and get rid of those shadows, producing a brighter, more luminous effect.

Maybe your lower lids aren’t dark, but rather puffy…or something like that.

Well this is not as easy to assess as you may think. Are they puffy? Is there a true lower lid bag? Or is that part of your lower lid normal and the surrounding area is actually just hollow?  These are questions that an in person physical evaluation is usually necessary to answer.

How does your doctor tell?  You aren’t really able to examine your lower lids during upgaze, but luckily your surgeon can.  Oftentimes, when you look up, the movement of the eyeball muscles will cause a true fat bag to protrude, indicating that someone is a good candidate for a lower lid blepharoplasty.

A true “lower lid bag” is simply lower eyelid fat that has prolapsed through the orbital septum, which is the thin, film-like structure that is intended to hold the contents of the orbit—including orbital fat—back in place. As we age this structure gets weaker and thinner, and fat is more likely to prolapse through.  This is an extremely common problem in women in their 50’s and above, however can happen at a younger age when hereditary factors are at play.

Lower lid blepharoplasty (lower eye lift) is a surgery in which the surgeon makes either an external incision just below the lower eyelid margin or chooses to flip the lower eyelid and make the incision on the inside moist surface of the lower eyelid called the conjunctiva to avoid scar formation. In either case, the septum is opened, the fat is identified and trimmed/cut/sculpted till desired. Often times, surgeons will also talk about fat repositioning or fat transfer.  This refers to an attempt to remove the fat from behind the septum and place it in another location, most often draped over the inferior orbital rim in order to fill out some of the lower lid hollow areas.  To address hollow areas post surgery, some surgeons choose to add a bit of filler to the lower lid tear trough area, to achieve the perfect result of sculpted fat bag and filled trough hollowing.

Maybe you don’t have true lower lid fat bags. What else can cause lower lid fullness?

A common finding in the lower lid is a “hypertrophied orbicularis” or a particularly robust lower eyelid muscle. If this is the case, it is essential to differentiate this from a true fat bag, because lower lid blepharoplasty will not fix this!  A fat bag will usually be inferior to or below a hypertrophied orbicularis, which is one common way of telling these two conditions apart. Unfortunately there is no great fix to a hypertrophied orbicularis, because excising some of that muscle often leads to scarring between overlying skin and underlying structures. In this case, a small amount of lower lid filler can improve the contour and make patients happy. Of note, filler in this area usually lasts about 1-2 years, so can be a really good investment.

Are there any other conditions that can affect the lower lids?

One of the more common other problems in the lower eyelids is eyelid laxity or looseness.  With aging, we lose the elasticity of our skin, and the lids don’t appear as tight anymore.  This can also be secondary to constant tugging from contact lens placement, rubbing from irritation or allergies, or trauma.  There is a surgical correction for this—one can have a lower lid tightening procedure called a canthopexy.  In this procedure, the eyelid is disinherited from the orbital bone and reattached at a tighter position. It is usually a quick 30 minute procedure, however you should know that this procedure can cause a few months of swelling and inflammation at the surgical site. While this usually subsides and produces a nice cosmetic result, it is important to factor in a few months of healing for this procedure.

If you are unhappy with the look of your lids in any way, have a consultation with your eyelid plastic surgeon—chances are, there is a personalized and unique solution that can solve your problems!

If I have dry eye, am I not a candidate to get eyelid surgery?

The answer is yes. There are some additional things that you need to consider. But it does not necessarily preclude you from moving forward. Upper lid blepharoplasty is one of the most rewarding satisfaction producing surgeries that one can udergo—A relatively straight-forward, often times in-office procedure can take years off of the appearance of your face—so understandably, everyone, including those with dry eye are interested in learning more about it. What things should you be cautious about if you have dry eye?

Lifting your eyelids does just that. It lifts them.

Dry eye is a condition that can range from being asymptomatic to being absolutely downright debilitating. It is caused by one of two overarching problems: insufficient tear production or overexposure of the eye….or in some cases, both. Upper lid blepharoplasty removes redundant eyelid skin on the upper eyelid, giving a more youthful appearance, but also raising the place where the upper eyelid meets the eye—causing more of the cornea-the anterior clear structure of the eye—to be exposed all day long. As you can imagine, the more of the cornea exposed to the air, the more your existing tears can evaporate. Another factor to consider is what happens when we close our eyelids? If too much skin is removed from the upper eyelids, they may not be able to close all the way—causing major dry eye complications on the inferior portion of the eye. This becomes especially problematic when we sleep—often if one has too much skin removed from their upper eyelids, the will have about 1-2 mm of lower eye exposure during sleep. This is a dry eye nightmare!

Okay, so lift my lids…but just don’t lift them too much.

Well that is definitely the idea—but it doesn’t always happen. Plastic surgeons have many different ways of determining how much skin to remove during upper lid blepharoplasty. A general rule of thumb is that there should be about 20 mm of skin remaining from upper eyelid margin to lower eyebrow. While this is a nice rule, most of the time, surgeons use a pinch test to determine the appropriate amount of skin to excise. This involves setting the lower portion of the skin incision at the natural eyelid crease and using a set of forceps to pinch an acceptable amount of skin to excise while making sure the eyelid can still close and doesn’t lift too much. However, often times, surgeons just focus on how much skin should be removed to produce a tight, wrinkle-free upper eyelid—and this can often lead to overlifting.

Things to think about if you have dry eye and are considering eyelid surgery:

  • If you currently use artificial tears or lubricating ointment to keep your eyes comfortable, you will definitely need to continue this regimen after surgery, and possibly increase the frequency
  • You may want to indicate to your surgeon that staying conservative would be your preference
  • If you choose to have your surgery performed by an oculoplastic surgeon, this doctor is trained first and foremost as an ophthalmologist, and will likely perform a cornea/dry eye evaluation at the time of your plastic surgery consultation. However, if you choose to have your plastic surgery by a facial plastic surgeon or a general plastic surgeon (which are both well-trained, capable options), make sure to see an ophthalmologist for a general eye exam both before and after your surgery.
  • There are many ways to treat dry eye—if your plastic surgery made your dry eye more symptomatic, some of your options include artificial tears, lubricating ointments, eyedrops medications such as RESTASIS® or Xiidra® , or even the placement of punctal plugs. Make sure you asking your ophthalmologist about all of these options.

References

Naik, Milind N et al. “Blepharoplasty: An Overview.” Journal of Cutaneous and Aesthetic Surgery 2.1 (2009): 6–11. PMC. Web. 4 Jan. 2017.
Saadat D et al. “Safety of blepharoplasty in patients with preoperative dry eyes.” Arch Facial Plast Surg. 2004 Mar-Apr;6(2): 101-4.




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