ADAS Dermatology

By David T. Harvey, MD, FAAD, FACP

Eyelid Surgery is a standard therapeutic and cosmetic surgery procedure that is performed in the fields of plastic surgery and dermasurgery. We approach this procedure in a unique fashion…combining the best of cold steel surgery with “state of the art” CO2 laser instrumentation.

Traditionally, eyelid surgery involves the removal of the delicate fat pads by 1. identification of the fat pedicle with gentle skin dissection. 2. lifting of the fat pedicle 3. clamping with a forcep or “kelly” clamp 4. cutting the fat with tenotomy scissors and 5. intense coagulation (heating of the delicate eyelid tissue).

In our practice, with CO2 laser, we are able to eliminate steps 3 through 5. Once the fat is teased out, it can be genly ablated (evaporated) without the need for clamping or excessive heating. Fat which is still noted can be gently sculpted away  and the overlying skin muscle interface (septum) can be contracted without cutting using the CO2 laser in a defocused laser beam pattern.

I believe the technique minimizes the risk of the most serious side effect -retro orbital hematoma (bleeding behind the eye). It also lends itself to a much more precise type of surgery, one where the surgeon is more of an artist and less of a forger and pillager.

Check out the technique by clicking here… ah yes, the eyes ….they are indeed a beautiful sight to behold once again.

Before

  

 

 

 

 

After -7 weeks postop

By David T. Harvey, MD, FAAD, FACP

Fig 1. Evolence

I wanted to blog about a new state of the art filler that I was recently introduced to and one of the first to use in the Jacksonville, Florida  area… Evolence™. This product is the latest filler to be used by dermatologists and plastic surgeons and has quite a few advantages over others (as I pleasantly found out). First of all,  the material is very, very smooth and easy to place. I was pretty amazed when I treated a patient’s cutaneous upper lip on a smoker I was sure needed a CO2 laser procedure (Fig 2).

The material is derived from porcine (pig based) collagen. It is processed in a very unique way, which eliminates the need for pretesting. The process of ribosylation, evidently reduces some of the secondary post-op swelling that is seen with some of the other products that we commonly use (Restylane™ and Juvederm™).

Anecdotal reports have the material lasting from 15 to 24 months but I am not commenting until I see it for myself. To date, I am very impressed with how the material seems to finds the small lines and virtually erases them. Bruising is minimal. Cost is similar to the other products mentioned and varies from $600 to $800 dollars per vial.

Fig 2a. Before upper lip line treatment

Fig 2b. After treatment

A new filler, Evolence Breeze™, is set to hit the US market next year and this can be used in the lip region.

I will keep you posted of my personal experiences with this material but so far …so good.