Help Haiti with Surgical Friends Foundation

Because of the devastating earthquake that occurred in Haiti, thousands of people have lost their lives. The country is in desperate need of continuous help. Surgical Friends Foundation is planning its first trip to Haiti to see patients at Hope Hospital in June 2010. Here is how you can help:

Text SFF to 85944 to donate 10 dollars (charged to your cell phone)

* $10 donation will pay for 20 IV bags needed for dehydrated children

* $50 donation will pay for antibiotic treatment needed for 5 children

* $250 donation will pay for one child’s surgery

* $1000 sponsors one surgeon for a mission trip

For more information or to make a donation http://surgicalfriends.org/trips/haiti/

Thank you!

What our Patient's are Saying

Dear Dr. Parsa:
I have been trying to formulate the appropriate way to express my gratitude to you. It is difficult because it is mingled with all the emotions of Gabe’s ordeal that I have been experiencing. The process began with a tremendous amount of fear and anger which I had to disguise for Gabe’s sake. He kept saying that I needed to be positive. It was the only way that he would make it through all of this, and so we did that together, fortunately with some success. Interestingly, as he progressed in his recovery, my emotions welled to the surface and I had several trying weeks as I dealt with the challenge of ridding myself of the image of a brutal stranger beating my child’s face.

I know that time will heal both of us physically and emotionally. And in all of this was you, our wonderful surgeon, skilled in both your medical specialty as well as your ability to offer us your calming and reassuring presence. All that you are and have done for us means more than I can express to you on this page. Know that I will forever be grateful to you for your extraordinary skills and for steering us with care through our crisis.

P.S. If there is ever another family who would benefit from speaking to me or Gabe, please do not hesitate to have them contact me. I would be happy to offer support for anyone in a similar difficult situation.
Sincerely,
Jade

Patient Before and After

Lower eyelid blepharoplasty

Videos of Eyelid Surgery in High Speed

Your Cosmetic Surgery Questions Answered

Q: Surgery for right eyelid ptosis?

A: Dear Ray There are multiple techniques available to fix ptosis (droopy eyelid). If you have that much blockage of your visual field you will need revisional surgery. Make sure you look for someone who has experience doing this kind of surgery.

What our Patient's are Saying

Dear Dr. Parsa:
I was a patient of yours last year, and I want to thank you for your help and fine work. I wanted to wait a while to see how everything went before I wrote, and in appreciation, I want you to have the gift I send along, and to thank you and compliment your staff for such a professional and excellent job they all did. I also thought you might like an update now. Everything came out beautifully, I look wonderful, and I feel so much better. It is amazing how just a small thing can make such an improvement. I will feel much better about my appearance and my self-confidence in that area for years to come. Frankly, I think I will probably feel so much better for the rest of my life that I am extremely happy I decided to do this and cannot imagine now not having done it. I think this one thing was such an improvement. Thank you very much for everything and especially for doing such a concerned and careful job. I was very anxious about the procedure and doing anything like this. I am very glad I chose you. I will keep you posted on everything.
Sincerely,
Jackie

Dr. Kami Parsa's Credentials

Surgical Training
• University of Miami Bascom Palmer Eye Institute

Fellowship: Oculoplastic and Reconstructive Surgery

Ranked #1 fellowship by U.S. News & World Report

• University of Southern California Doheny Eye Institute

Residency: Ophthalmology

Internship

• University of California , Los Angeles UCLA
Internship

Education

• University of Southern California School of Medicine

Doctor of Medicine

• University of California , Los Angeles UCLA

Bachelor of Science in Biology, Cum Laude

Academic Appointments

• Assistant Clinical Professor: USC Keck School of Medicine, Department of Ophthalmology.

• Clinical Fellow: University of Miami School of Medicine

Patient Testimonial

Marie,
You are a real asset to Dr. Parsa’s practice, making each patient feel truly special. Your sweet and cheery personality reminds me of a beautiful rose.
Warmest regards,
Lisa

Patient Before and After

Lower eyelid blepharoplasty

Your Cosmetic Surgery Questions Answered

Q: How long does an upper Eyelid surgery usually take?



A: Typically, an upper eyelid blepharoplasty takes about an hour. You need to make sure you are comfortable with the surgeon operating on you and if you are having eyelid surgery the surgeon should be an oculoplastic surgeon. Hope this helps.

Glossary of Oculoplastic Terms - B

B cell lymphoma: Types of non-Hodgkin’s lymphoma affecting B cells. It develops more frequently in immune compromised individuals.

Basal cell carcinoma: Most common type of skin cancer. A slow-growing, malignant, but usually non-metastasizing epithelial neoplasm of the epidermis or hair follicles, most commonly arising in sun damaged skin of the elderly and fair skinned.

Basal cell nevus syndrome: A syndrome of myriad basal cell nevi with the development of multiple basal cell carcinomas in adult life. These patients need to be followed closely for the development of basal cell carcinoma.

Benign mixed tumor: Neoplasm of epithelial and myoepithelial differentiation, varied architectural and cytologic features and mucoid, myxoid or chondroid stroma.

Blepharochalasis: A congenital or acquired condition characterized by undue looseness or pendulousness of the eyelid skin due to an abnormality or deficiency of elastic fibers. This is an idiopathic condition.

Blepharoplasty: Blepharo = eyelid + Plasty = to change. An operation performed to remove excess skin, muscle or fat from the eyelids to create a more youthful appearance. This procedure needs to be customized and individualized for the patient. The art of blepharoplasty has changed significantly in the past 10 years. Today the goal of the operation is to create a more natural look based on each patient's individual needs.

Blepharoptosis: Drooping of the upper eyelid.

Blepharospasm: Involuntary spasmodic contraction of the orbicularis oculi muscle.

Blowout fractures: Bone fractures caused by direct trauma to the globe, which leads to an increase in intraorbital pressure and decompression via fracture of the orbital floor.

Blue nevus: A dark blue or blue-black nevus covered by smooth skin and formed by heavily pigmented spindle-shaped or dendritic melanocytes in the reticular dermis.

Botox: A neurotoxin protein produced by the bacterium Clostridium botulinum. It is used in minute doses both to treat painful muscle spasms, and as a cosmetic treatment. In cosmetic facial rejuvenation it allows paralysis of the affected muscle to temporarily eliminate static wrinkles. The effects of Botox typically last about 90 days. 

Bowen disease: A form of intraepidermal carcinoma characterized by the development of slowly enlarging pinkish or brownish papules or eroded plaques covered with a thickened horny layer. Microscopically, there is dyskeratosis with large round epidermal cells that contain large nuclei and pale-staining cytoplasm and are scattered through all levels of the epidermis.

Brow lift: Operation to elevate the eyebrows.

Brow ptosis: Droopy eyebrow caused by heavy tissue above the eye; it can obstruct vision and result in fatigue caused by the effort required to raise this tissue out of the way.

Buccal mucus membrane graft:  A type of mucosal graft from the lips; commonly used to reconstruct the fornices in situations that the patient lacks normal tissue from previous trauma, injury or birth defect.

Bulbar conjunctiva: The thin, clear tissue over the sclera, which is the white part of the eyeball.

Periocular aging and the changes associated with it

Smoking, sun damage, genetics, stretching from swelling, and the wear and tear from chronic rubbing and blinking all contribute to changes around the eyelids as we age.

Skin changes: Around our mid-30s the skin around the eyelid starts to thin and lose its elasticity. Slowly this can result in excess skin in the upper eyelids which will cover the crease. The term dermatochalasia, which means excessive loose skin, is used to describe this condition.

Orbicularis oculi: As mentioned previously, this circumferential muscle is responsible for eyelid closure. Stretching of this muscle with time also contributes to the overhanging skin. It is the chronic use of this muscle, combined with squinting and sun damage which result in the static wrinkles we see around the eyes termed “crows feet.” There are two types of wrinkles, static and dynamic. Dynamic wrinkles only appear when we are using that specific muscle. For example, if you were to stand in front of a mirror and actively raise your brows you will see dynamic wrinkles in your forehead from activity of the frontalis muscle. Static wrinkles, on the other hand, are present at all times, even when the muscle is at rest. Botox is a neurotoxin and a paralytic agent that acts by inhibiting the action of those specific muscles and thus temporarily (three to five months) decreases static wrinkles. Facial fat and volume: As we age, the facial

Facial fat and volume: As we age, the facial fat begins to absorb resulting in volume loss in the face. Around the eyes, the loss of midface fat can contribute significantly to the lower eyelid “bags,” and this may be the primary reason they are formed. In the past 10 years most of the modern techniques in periocular rejuvenation take into account this concept of volume loss. Modern techniques in volume replacement include injection of synthetic materials such as Restylane and Juvederm, which are hyaluronic acid products lasting nine to 12 months. An alternative is injection of the patient’s own fat after a small amount of liposuction; this fat injection lasts a lifetime. It should also be mentioned that soft tissue around the eyes descends with time due to gravity.

Septum: This structure can weaken over time, resulting in herniation of orbital fat and also contributing to the lower eyelid “bags.”

Orbital fat: Not only the orbital fat pockets can herniate through a weakened septum but they too can be partially absorbed and with time give rise to a gaunt and “hollowed” look. Older surgical techniques would remove the excess herniated fat, resulting in a worsening of the “hollowed look.” (Pictured below is a patient who had aggressive fat removal 20 years ago which resulted in the hollowed appearance.) Unfortunately many “old school” surgeons are unwittingly contributing to an epidemic of post-blepharoplasty hollowness.



Figure 1 — A 67 year old female who underwent aggressive
blepharoplasty with fat removal 18 years ago. As you can see there
is significant post-operative hollowness around the eyes which
makes the patient look older and “emaciated.”

Patient Before and After

Upper and lower eyelid blepharoplasty

My Experience Having Ptosis Surgery

Ptosis, pronounced toe-sis, is the medical term for drooping of the upper eyelids. The droopy eyelid can be mild to severe. People who have ptosis may complain that people tell them they look “tired or lazy.” Because of a constant effort to raise the eyelids it is not uncommon to also complain of fatigue and tension headaches.

Patient Testimonial

Dear Dr. Parsa:
Words cannot express how thankful and appreciative I am to have found you. I am deeply grateful for you, for your generosity and caring nature as pertaining to my medical condition. As you know, I was apprehensive about having further surgery, but you are and have been reassuring and confident in the type of procedure you would perform in order to fix my eyelid from the beginning. The fact that you are not pushy and gave me the time and space to make the decision on my own allowed me to prepare myself mentally and emotionally, that really made a difference. Besides from that, your continuous generosity made me confident that you were the right doctor for the task at hand. You will never know how appreciative I am of that. I would also like to let you know how pleased I am with the results of the surgery. I have not felt this comfortable in years. My parents are also very grateful since this was my 14th surgery. You have a true gift. Thank you again for your patience, time, concern, and overall care. I pray that God continues to give you strength to help people who truly need life-changing medical procedures.
With much appreciation always,
Sophia

Patient Before and After

Upper eyelid blepharoplasty & Trans bleph endotine browlift

Glossary of Oculoplastic Terms - A

Abscess: A circumscribed collection of purulent exudate appearing in an acute or chronic, localized infection, caused by tissue destruction and frequently associated with swelling and other signs of inflammation and pain.

Abducens nerve: Cranial nerve # 6. Innervates the lateral rectus, which abducts the eye (moves the eye out); located in the superior orbital fissure.

Accessory nerve: Cranial nerve # 11. Controls the muscles of the neck and overlaps with functions of the vagus nerve; located in the jugular foramen.

Acrochordons: A polypoidal outgrowth of both epidermis and dermal fibrovascular tissue; also known as a skin tag.

Acropachy: subperiosteal new bone formation.

Actinic keratosis: A pre-malignant warty lesion occurring on the sun exposed skin of the face or hands in older fair skinned people.

Adenocarcinoma: A malignant neoplasm of epithelial cells in a glandular or gland-like pattern.

Adenoid cystic carcinoma: A histologically defined type of carcinoma characterized by round, gland-like spaces or cysts bordered by layers of epithelial cells without intervening stroma.

Adenoma: An ordinarily benign neoplasm of epithelial tissue in which the tumor cells form glands or gland-like structures in the stroma; usually well circumscribed, tending to compress rather than infiltrate or invade adjacent tissue.

Adipose tissue: Fatty tissue.

Adnexa: Appendages of the eyeball, including the soft tissue, muscles and eyelids.

Afferent pupillary defect: A condition of the eye where the pupil does not constrict appropriately to the level of light reaching it. It is very important in the evaluation of optic nerve function.

Albright syndrome: Polyostotic fibrous dysplasia with irregular brown patches of cutaneous (skin) pigmentation and endocrine dysfunction, especially precocious puberty in girls.

Angiotensin converting enzyme: An enzyme that catalyses the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.

Ankyloblepharon: Fusion of the eyelids to each other along the lid margins.

Annulus of Zinn: A ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit. It is the origin for five of the six extraocular muscles.

Anophthalmic socket: An eye socket that lacks an eyeball.

Anophthalmos: Congenital absence of all tissues of the eyes.

Apert syndrome: Disorder characterized by craniosynostosis and syndactyly; associated with hearing loss; mental retardation is a variable feature.

Arcus marginalis: Collection of fibrous tissue where the orbital septum meets the orbital rim.

Arteriovenous fistulas: An abnormal communication between an artery and vein, usually resulting in the formation of an arteriovenous aneurysm.

Arthritis giant cell: Giant cell arteritis (GCA) is a type of vasculitis or arteritis, a group of diseases whose typical feature is inflammation of blood vessels.

Aspergillosis: A type of fungal infection. Usually affects immune compromised hosts.

Asian Blepharoplasty: Cosmetic eyelid surgery for Asians. This procedure is usually done to decrease upper eyelid fullness and reduce the epicanthal fold that is common in Asians.

What you Need to Know about Revisional Eyelid Surgery

Revisional surgery is surgical correction of previous poorly performed surgery. Some of the most dreaded complications of facial plastic surgery are those associated with the eyelids. This usually happens when the surgeon is not experienced or familiar with the delicate anatomy around the eyelids. The field of oculoplastic surgery focuses on cosmetic, reconstructive,and revisional surgery around the eyes. It is important to consider this when referring a patient for cosmetic surgery. Depending on the specific problem, the necessary correction may involve a simple procedure or a complex eyelid reconstruction. The goal of revisional surgery is to regain normal function while maintaining aesthetic outcome.

The most common complaint that is referred for revisional surgery is the inability to close the eyes completely after previous cosmetic surgery. This problem usually happens when excess tissue and skin were removed during the previous surgery. Depending on the severity of the case, there are several procedures which can be done or combined to achieve the desired functional and cosmetic outcome. For example, skin from behind the ear, which very closely matches the texture of eyelid skin can be harvested and used to raise the eyelid. The mid-face can also be elevated by suspension sutures to raise the lower eyelid. The conjunctiva can be elevated by borrowing mucosal tissue from the mouth.

Although subtle, the natural youthful eyelid is V-shaped at the corners. The rounded corners of the eyelids after some cosmetic eyelid surgery is an artificial “operated appearance.” The rounded corners are not only a cosmetic problem for the patient, but they also can interfere with normal blink dynamics. The patient usually complains of tearing or dry eyes. This problem can be reversed by a special surgical technique on an outpatient basis. Postoperative hollowness can be revised by placement or injection of fat into the eyelid or orbit.

Eyelid Ptosis Correction Surgery

Ptosis, pronounced toe-sis, is the medical term for drooping of the upper eyelids. The droopy eyelid can be mild to severe. People who have ptosis may complain that people tell them they look “tired or lazy.” Because of a constant effort to raise the eyelids it is not uncommon to also complain of fatigue and tension headaches.

The most common reason for ptosis is acquired ptosis , which develops as we age. This is due to disinsertion of the tendon that holds the eyelid up in a normal anatomic position. Another cause is congenital ptosis , which happens when a child is born with droopy eyelids. This is rather an urgent medical condition for the child and surgery may be needed to prevent permanent loss of vision in the affected eye. Other rare causes of ptosis include myogenic ptosis from conditions such as Myasthenia gravis, neurogenic ptosis , due to third nerve palsy and mechanical ptosis from tumors or trauma.