Ask A Doctor
Question: What could be the best way to remove this xathelasma in my eye without leaving mark in my skin. What it could be the specialist who can treat or remove this?
Answer: Xanthelasma of the eyelids are not uncommon and the only way of treating them permanently is to perform excision of the lesion(s) under local anesthesia. Typically the incisional "marks" required to remove them fades beautifully and one would be hard-pressed to see these incisions after a few weeks or months. Unfortunately there is no simple "magic" to remove xanthelasma non-surgically.   Most general ophthalmologists are skilled in removing xanthelasma but certainly those who are oculo-plastic surgeons (ophthalmologists who specialize in performing plastic surgery procedures around the eyes) are quite used to performing such minor surgeries.
Question: What is the difference between laser thermokeratoplasty and microwave thermokeratoplasty? Which one is more effective in the treatment of keratoconus? Is LTK dangerous since keratoconus makes the cornea paper thin? Side note: I've already had cross-linking done
Answer: Dear Wyatt...........thank you for your excellent question. However, this type of question is a very advanced, detailed question that is best served by a corneal sub-specialist who treats keratoconus patients (which I do not). Therefore, I will defer to the expert opinions of others.   Good luck!
Question: How long does it take the cornea to regenerate and/or repair itself once the stem cells are put in the cornea? Is it more or less effective then a regular corneal transplant? Is corneal stem cell transplantation experimental or is it FDA approved?
Answer: Thank you for your excellent question, but I must defer to a corneal specialist who does stem cell transplants and corneal transplants to answer these technical questions.
Question: I had LASIK vision correction in 2003, and over the last couple of years since starting estrogen therapy developed new astigmatism . I read that a side effect of estrogen is corneal steepening, changes in the curve of the cornea, and a concern for LASIK patients since their corneas are already weakend which the estrogen may cause a bulging cornea. Does anyone know if the cornea changes are progressive or will they stop. I am very worried about this. I want to be on estrogen for many more years, I am 31 yrs. old.
Answer: Thank you for your excellent question. Although I am not a corneal specialist and I do not perform Lasik, my understanding is that the possible estrogen changes to your cornea will not be progressive indefinitely so I do not think you need to worry needlessly. At some point you should be evaluated formally by an ophthalmologist to have corneal topography scan performed to quantify exactly the amount of corneal astigmatism you currently have. This way you have a current baseline to compare to in the future. Having simply a refraction to measure astigmatism is not sufficient and somewhat subjective, so corneal topography is very important in my opinion.
Question: I am 49 yrs old, have a sagging eye lid. what is the operation procedure , how long it will heal and how much it cost roughly.
Answer: Dear Devon:   Thank you for your e-mail inquiry. I will attempt to answer your question in very general terms as it is impossible to be specific without fully evaluating your specific situation. First of all, you mention that you have "a sagging lid" which implies to me that it may be only one eyelid and not both. The reason this may be important is that typically most patients that have excess sagging or drooping of the upper eyelids have it in both upper lids and if it is mainly excess skin and fat, then performing upper eyelid blepharoplasty is indicated.   On the other hand, however, perhaps your "sagging eyelid" may be due to muscle weakness causing one eyelid to be positioned lower than the other eyelid. If this is the case,  then a muscle tightening eyelid surgery may be indicated to physically elevate the eyelid. This muscle weakness may occur in both upper eyelids or simply in one eyelid.   Costs may vary tremendously based upon the specific procedure, as well as including the costs of the actual surgery (professional fee), the facility fee (operating room) and the anesthesia fee. In general, these costs may range from $1,500 up to approximately $3,000. Also, in certain circumstances depending upon the severity of the eyelid sagginess, sometimes the eyelid procedure may be authorized by your medical insurance.   In order to give you more specific information than the above, a personalized consultation would be necessary. Good luck, and let us know if we may answer any additional questions!  
Question: I have horrible dark circles under my eyes, I eat very well and get a decent amount of sleep. I exercise 6 times a week. I'm a 36 yr old male in great shape. Iv'e tried several different creams, cucumber treatment and such, nothing seems to work. Ive read about laser treatments and pigmentation injections? Any help would be great! Thanks Joe
Answer: Dear Joe..................thanks so very much for submitting your question regarding dark circles under the eyes. This can be a very challenging issue as dark circles may represent different things in different individuals..........for example, sometimes it is simply a shadow effect from fat pockets in the lower eyelids, whereas other times it may be true pigmentation.   The first recommendation is to see an eyelid surgery specialist who can assess your specific situation. Ultimately, whatever recommendation, if any, may only be of partial help as it has been my experience in the last 25 years that this type of issue is a difficult one to fully resolve.   Thank you again...............good luck!
Question: what can I do about lines in the side of the mouth and neck. estimated prices?
Answer: Hector....................thank you for your e-mail inquiry. Most commonly lines around the mouth are treated with dermal tissue fillers such as Restylane, Juvederm and others. In certain situations one may consider laser resurfacing as well. Lines around the neck are more difficult to treat in my experience as tissue fillers and laser resurfacing are not quite as effective. Sometimes after a personal consultation we may actually recommend the most conservative treatment which may be an at-home medical skin care regimen.   In order to make specific recommendations for you, one would need to perform a personalized evaluation so as to personally evaluate your skin and make specific recommendations.   Thank you again...............happy holidays!  
Question: Can liquid nitrogen treatment help treating my melasma, please advice.
Answer: Dear Anna................I would definitely NOT recommend liquid nitrogen to treat melasma as this approach would very likely result in possible hypo-pigmentation or white blotches on the skin. Melasma is better taken care of with either medical grade skin care or light/medium chemical certain unique cases one may consider either certain non-ablative lasers or intensed pulsed light.
Question: Hello I Have Congenital Ptosis Now I am 24 Years Old I have some questions regarding Frontalis Sling Surgery 1. Is Sling Reversible? I have mild to moderate Ptosis 2. Will my eyes droop even more after reversing? 3. Is the option of muscle resection still available after reversing frontalis sling?
Answer: Dear Pang................thank you for your question regarding congenital ptosis, which as you may know is completely different from acquired ptosis. Although I personally do not treat or operate on congenital ptosis patients, the best method for helping alleviate the symptoms is a frontalis sling, which is intended such that the patient uses their forehead frontalis muscle to help elevate the eyelid. The aesthetic results are far from perfect because in congenital ptosis the levator muscle has not developed properly. Typically in true congenital ptosis performing a levator muscle resection has little, if any, effect as the muscle has not developed from birth and therefore will not work by simply shortening or tightening it.   Best wishes in your search for improvement of your eyelids!
Question: My daughter is seeing an unusual vortex with her vision, and sometimes flashing lights. What type of doctor should I contact for this?
Answer: Dear John...............thank you for your question. It is most important to start by seeing a qualified medical eye care provider such as an ophthalmologist or medically trained optometrist to perform a thorough dilated eye examination to rule out any disease or disorder inside the eye. Assuming everything looks normal, there is a good likelihood that your daughter may be experiencing an ophthalmic migraine which most often is NOT accompanied by headaches. Such types of migraines may recur intermittently and most often each episode may last 15 to 30 minutes.   Please seek medical attention through your eye care provider at this point..................good luck!

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