Dr Jayson Oates: Hi Trish, nice to be here.
Trish Hammond: Lovely. Now, I know that you do lots of blephs and I know an article of yours has been published in the Journal of Facial Plastic Surgery recently. I just want to talk to you about all the benefits, like why having a bleph can actually help. My partner actually does have the really heavy eyelids but it’s not just an aesthetic thing is it?
Dr Jayson Oates: Yeah. Well, eyelid surgery is one of the most popular facial plastic surgeries. The eyelids are an area that we see ageing changes the earliest. Especially in the upper eyelid with the hanging skin. It’s not a big procedure, it has a quick recovery, and it makes a really big difference because your eyes are where people look at you. Taking the hooding away from the upper lids makes a big difference to how people feel about themselves and how people view you. We’ve known that and understood the aesthetic benefits and the confidence that people get from blepharoplasty for a long time, but we’ve always had this feeling people come back and say, I feel less tired, I get less headaches.
We’ve mentioned it, but in March, as you said in the Journal of Facial Plastic Surgery they actually published a study on 108 people where they were looking specifically for headaches and the benefits that they got.
Trish Hammond: Right, so basically people could probably be suffering from headaches and not even realise that it’s a result of having the heavy eyes.
Dr Jayson Oates: Yeah, that’s certainly the case. Eyes and eyelid problems are sometimes missed a bit as a cause of headaches. I even had a sinus surgery patient years ago who we did the sinus surgery and got this great result and thought, “Great, now your headaches will be gone.” It wasn’t until she got a new set of glasses the headaches went away and that really made me focus in more on eyes, eyelids, and vision as a cause of headaches. In this study they were looking at two issues: one was just the droopy skin on the upper eyelid which is the most common thing that people complain about. Also, a condition called ptosis. Ptosis is slightly different and it’s where the eyes don’t open quite as much. The eyelash line sits a little bit lower and in fact can even be covering the top of the pupil.
There is a surgery that is often combined with blepharoplasty where we shorten the tendon that lifts the eyelid up itself or opening of the eye and that can correct ptosis.
Trish Hammond: Right. Okay so, because on that … I know a lot of people have blephs done by people who aren’t specialists. In that sort of situation, that’s not going to be picked up is it? Someone who’s not a specialist in that is not going to know about …
Dr Jayson Oates: That’s exactly right, and that’s one of the concerns those of us who have had specialised training in this area are concerned about. Because, technically it’s not hugely difficult to take a little bit of skin out of the upper eyelids, and general practitioners are doing it in their office under local anaesthetic and you can get some improvement like that. For people who have really heavy lids and they don’t have access to a specialist trained surgeon, then that’s an option. The ptosis surgery is much more technical surgery. Even just the recognition of having a ptosis needs more experience and training. That’s why we do encourage people to seek out a specialist surgeon to do this kind of surgery so 1. they can have the full assessment and they can have the full range of surgical options offered to them for their particular issues.
Trish Hammond: Okay. How would someone know that they’ve got a ptosis?
Dr Jayson Oates: It’s an interesting thing, a lot of people don’t recognise it. It’s one of those things that I do point out to people when they don’t recognise things. In cosmetic surgery you need to be a little bit careful about that because people often come in with their one complaint. It’s tempting to say, “Well, what about this or what about that?” Then they walk out with three or four complaints and more concerns than when they walked in, and that’s not really what we’re trying to achieve. With eyelid surgery if you don’t point out the ptosis before you operate and you do a great blepharoplasty, you’ve taken away the excess skin and they come back and say, “But my eyelids are still really droopy.” Then you say, “Ah, well that’s because you’ve got a ptosis and I didn’t point that out before.” It’s sort of too late and you don’t really want to have to go back and operate a second time.
Trish Hammond: Yeah. I’m lucky I don’t have those heavy eyelids, I’ve got lots of other things but not that.
Dr Jayson Oates: Flippy eyes.
Trish Hammond: I do, I do, I have known quite a few people that have had a bleph. A lot of them have actually said that they didn’t realise that they couldn’t see as well before. Once they had the bleph it just totally opened up their eyes. I sometimes sit here and kind of lift up my forehead and nothing changes for me. One of my girlfriends said oh how she could tell was she could actually just lift up her forehead. She said, “Oh my God, I can actually see a whole lot more.” That’s when she realised that she had a problem that could be fixed.
Dr Jayson Oates: That’s actually one of the things that we look for in assessing ptosis. One of the ways that your body naturally holds the eyelids open if you have this, is to raise your eyebrows up and to pull the skin up. Sometimes we’ll see somebody who’s got one eyebrow that’s hitched up, you see that a lot. To me, that’s an immediate indicator that I need to be looking for a ptosis. Sometimes it’s what we call a compensated or hidden ptosis. If you get them to just relax their eyebrows down a little bit then you see the eyelid come down.
Often you’ll also see a deeper upper eyelid crease on the side that they have the raised eyebrow. That’s because the muscle that’s going above the eyeball itself is pulling really hard to lift that eyelid up so that they can see out of it. They’re using every muscle that’s above the eye on that side to hold the eye open. Interestingly, that’s also why people sometimes will get a ptosis after they have Anti-Wrinkle Injections into the forehead. It’s not actually that the Anti-Wrinkle Injections has leaked into the eyelid muscle itself, it’s that they’re using their eyebrow muscle to hold the eyelid open.
They come in and say, “I’ve got this crease above this one eye, one eyebrow, can you fix that with Anti-Wrinkle Injections?” If somebody hasn’t got that experience and training says, “Oh yeah, we can just soften that muscle a little bit and that’ll bring your eyebrows back to being level,” and then they get a droopy eyelid. That’s one of the tricks for people who are new in doing Anti-Wrinkle Injections as well. The other thing regarding seeing better is I always tell patients that the world is going to be brighter after you’ve had your upper blepharoplasty surgery. You’ve got these little visors that are built right over your eyes at the moment and we’re going to take that excess skin away and open that up. Sometimes you have people say, “Look, I have to wear sunglasses more now because I see the world a whole lot more than what I did before.”
Trish Hammond: Yeah, of course. Tell me, is there any help in, is there any support with Medicare? What does someone do? The first step is they think, “Oh my God, this could be something that could actually help me to see better, fix up my headaches or whatever. You’ve got to go to your GP and you get a referral to see a specialist like yourself.
Dr Jayson Oates: Yes.
Trish Hammond: Of course when you’re doing your research you want to see someone who does lots of blephs and proper qualified specialist surgeon.
Dr Jayson Oates: Experience certainly can help here and somebody who has had a lot of training and a lot of experience in eyelid surgery.
Trish Hammond: Get a referral from your GP, come and have a consultation. Are there any, what’s the Medicare, are there rebates or entitlements that people can get assistance with?
Dr Jayson Oates: Yes, Trish. There is a small Medicare rebate for blepharoplasty surgery, if the eyelid is getting to the point that it is starting to get into the field of vision. Sometimes we will do a visual fields test. If the upper outer corner of the visual field, or sometimes the excess skin of the eyelid itself will be getting in the way. Ptosis surgery also has a Medicare item number as well.
Trish Hammond: Oh good, so they’re eligible for some sort of rebate.
Dr Jayson Oates: Yeah, so long as there’s a real issue there. A lot of people who just want their eyes to look a little bit better and the skin isn’t hanging down low enough to be getting into their visual field then unfortunately no they don’t qualify.
Trish Hammond: Yep, okay. How long does the procedure take? Is it … Say if you’re just doing the upper eyelid.
Dr Jayson Oates: Upper eyelid surgery by itself I normally do it under twilight sedation. My practice in Subiaco, Western Australia has its own accredited twilight sedation hospital.
Trish Hammond: Actually I noticed that. You’ve got the first Government licenced one, haven’t you?
Dr Jayson Oates: Yeah, it was quite a process going through the Health Department the first time and they’ve never done it either and didn’t know exactly what they wanted to achieve. Yes, we’ve had the first accredited twilight sedation hospital for over 10 years now, maybe 12 years and getting on. The surgery itself takes about 40 minutes. Obviously, there’s a bit of time heading off to sleep and having a local anaesthetic and waking up again so maybe an hour or so. Then people recover here for an hour or so afterwards. They can’t drive home and need somebody to pick them up and take them home. If we’re adding in ptosis surgery that adds about another 30 or 40 minutes to the operating time as well.
Trish Hammond: Okay, and that can all be done under the sedation.
Dr Jayson Oates: Oh yeah. We do all of this under sedation. In fact, it’s been a long time since I’ve done one under general anaesthetic.
Trish Hammond: Would there be a case where you would do it under general or …?
Dr Jayson Oates: If a person had a particular medical issue that they couldn’t have twilight and we wanted to have the extra care of general anaesthetic in another hospital but that’s incredibly rare. I guess the other is if a patient just had a particular fear. I think when most people understand twilight sedation they understand that you will drift off to sleep. We’re not going to expect you to be brave while we’re poking around near your eyelids. Which is why the whole concept having of done just under local anaesthetic and then you have to be brave while somebody is operating around your eyes really doesn’t thrill me. My patients, even though it’s a very light sedation, they go off completely to sleep, they don’t have to be brave. At the end of the procedure I always tell them, I’ll just give them a little bit of a poke and say, “Time to wake up,” and then they just wake up instantly.
Trish Hammond: Wow, that’s fantastic. All right, so it doesn’t sound difficult at all. I did want to ask you another question. You can’t drive yourself home which makes a whole lot of sense. Say for example, if you take the day off and you’re having your procedure done, how long do you think before someone can go back to work? What do you look like when you’re done? Can you go back to work the next day or …?
Dr Jayson Oates: Good question, and it really depends on how comfortable you are if somebody sees you and you’ve got some bruising, swelling, stitches and wants to know what’s happened to you. I can remember a few years ago coming in on Monday morning and walking past my secretary and saying hi and walking into my room saying, “Hmm, she looked like she might have been crying. Oh I did her eyelids last week.”
Trish Hammond: Yeah, right.
Dr Jayson Oates: It was three days after her surgery and I walked right past her and totally forgot that I’d done it. I thought she looked like she had a little bit of swelling there but I didn’t even notice that she’d had surgery. Some people bruise more easily than other though. If you’re an easy bruiser I tell them, “Look, expect that you’re going to have some bruising for a week. If that’s going to concern you then plan to hide away a little bit, don’t have any big public functions.” In fact I say, “Look, try and give yourself a couple of weeks before you’re really fully out and about.” We tend to take the stitch, and I run the stitch mostly underneath the skin and there’s just a little tail out at the outer corner of the eyelid.
At the end of the first week we slide that stitch out. For some people they could walk out to the front desk and people in the waiting room wouldn’t know that they’ve had anything done. Other people are going to have a little bit of bruising and that may just be a little bit of yellowness or sometimes somebody who knows and they’ll often tell you, “Look, I’m going to bruise so badly.” They’ll walk out at a week and they’ll still have a bit of purple around the corners of their eyes. It’s best to allow a couple of weeks.
Trish Hammond: Yeah. I asked that question because I actually worked with a girl who had it done. I think she had it done on a Friday, went back to work on a Monday and I actually just thought she had makeup on for the first time because it looked like she had black mascara.
Dr Jayson Oates: Purplish marks….
Trish Hammond: Yeah, I had no idea that she’d had any surgery, just yeah, it was just amazing. I suppose you’re right, everyone is different.
Dr Jayson Oates: Yeah, and a lot of people will be able to pick that themselves. It’s also whether they care or not. I’ve had some patients that say, “I don’t care, this is what I’m having done, I’m not about to hide what I’m doing.”
Trish Hammond: Yep, that would be me.
Dr Jayson Oates: Other will be exact opposite and say, “No way, I don’t want anybody to know.”
Trish Hammond: No, I’ve had nothing done, ever.
Dr Jayson Oates: I just look like this naturally.
Trish Hammond: Yeah, yep, yep. Oh, that must have been in Byron. Oh no, that’s great. Alright, so I did have one other question to ask you. Recovery is not that long, you’ve got Medicare entitlements. Is it beneficial to have private health insurance or it doesn’t matter?
Dr Jayson Oates: For my situation it doesn’t make any difference. The rebates from private health funds were so small that they weren’t worth it so we don’t use private health fund rebates at all.
Trish Hammond: Is that, what about the hospital portion of it? That doesn’t …
Dr Jayson Oates: Yes. If you’re going to have general anaesthetic say at a hospital then you can get, if you qualify for the item number then you can get private health fund rebate for the hospital. If it’s a cosmetic procedure and you’re not getting a Medicare rebate then you won’t qualify for the private health fund. In that case the cost of the hospital is significant. That was one of the main reasons why we set up our own twilight sedation procedure because external hospitals charge a lot for cosmetic procedures and it adds a huge amount to the total cost of the procedure.
Trish Hammond: Yep, fantastic, that’s great. Alright, awesome. One last question I was going to ask you before you finish up because that’s been really, really helpful, is the costing roughly. Can you give us a rough estimate of what it would cost?
Dr Jayson Oates: Yeah, it’s around about $5,000 all up with us to have your upper eyelids done. That includes the operation cost, theatre cost, sedation, post-op reviews, and any creams and ointments that we use and give you.
Trish Hammond: Great. If somebody wanted to, you can do the upper and lower eyelids at the same time if they need that done as well?
Dr Jayson Oates: Absolutely.
Trish Hammond: Great.
Dr Jayson Oates: It’s important to keep the balance. We also use the CO2 laser resurfacing for the lower eyelids because we can get some really nice tightening there. I actually find I do less lower eyelids today than what I did a decade ago when I didn’t have the CO2 laser. It’s still a balance there and it depends on what the issue is and how much of a fatty bag they have sticking out. Sometimes it’s surgery and sometimes it’s laser.
Trish Hammond: Fantastic. Thank you so much for that, that’s been really, really helpful today.
Dr Jayson Oates: Look, great talking to you, Trish, thank you.
Trish Hammond: If you’re looking for a bleph and you’re in either WA or in Sydney and would like to speak to Dr Jayson Oates you can contact them via their website which is academyfaceandbody.com.au or you can drop us an email to email@example.com or just come up on our Facebook group. Thank you so much for joining us today, Dr Oates.
Dr Jayson Oates: Thanks a lot, Trish.
Trish Hammond: Thank you, bye.
Dr Jayson Oates: Bye.