Oculoplasty is the speciality of working with eyes, and Dr Benjamin Burt from Cosmetic Surgery for Women is one of the best. Working with Cosmetic Surgery for Women in Victoria, Dr Burt gives us some great information about eye surgery, or blepharoplasty, and why it’s important to see a specialist to get the best results.Trish: Oh well, I’m here today with Dr. Benjamin Burt and Dr. Benjamin Burt is something a bit different for us today. We’re going to have a chat to him. He’s an oculoplastic surgeon and he works with Cosmetic Surgery for Women and also Aesthetic Surgery for Men in Hawthorn and Berwick. So welcome!
Dr Benjamin Burt: Thanks Trish. Thanks for having me on the programme.
Trish: Yeah, I’m really looking forward to having a chat to you. First of all, oculoplastic surgeon, what is that?
Dr Benjamin Burt: Well, it’s a great question. It’s a kind of hybrid Trish. Oculoplastic surgeons have done ophthalmic surgery training and they’ve done a lot of training, at least two years but often a lot more, training in plastic surgery just around the eyes, the eye socket, lacrimal system, but particularly the upper and lower lids, forehead, and mid-face, as they pertain to the eye.
Trish: Okay. Say for example, if I’ve got really heaving eyelids, why would I choose to go to an oculoplastic surgeon as opposed to going to the doctor down the street that gets rid of the excess skin?
Dr Benjamin Burt: Sure, well, that’s a great question. There’s a lot of people that do cosmetic work around the eyes, but generally, if someone had a problem or if someone has a complex issue in that area that oculoplastic surgeons will take care of some areas that are often difficult for other specialties to deal with, such as ptosis, which is spelt P-T-O-S-I-S but it’s pronounced ptosis. Anything to do with the ocular surface we’re very comfortable with because we have that background in eye surgery.
I guess it’s a question of specialisation. A lot of the doctors that I work with in my group practise will just do one area. One doctor might just do breasts or another tummies, and that makes you quite adept at that area because you’re just operating that area all the time. All I do is upper lid, lower lid, brow surgery, and ptosis surgery, so you become very familiar with that area, with that anatomy and some of the complex problems that can occur there.
The cosmetic surgery, you want to be getting results that are fantastic every time, because we’re dealing with patients that are well. They don’t have disease most of the time and we want to make them look fantastic. The risk in that sort of surgery is a lot higher so we want to be getting great outcomes for our patients in cosmetic surgery in the eyelids.
Trish: It’s interesting what you say because I love that about Cosmetic Surgery for Women, is the fact that you’ve got Dr. Rubinstein, who just does boobs and tummies, and you’ve this Dr. McManamny who just does faces and noses, and obviously, Richard … I can’t even think of his surname …
Dr Benjamin Burt: Maxwell.
Trish: Maxwell, that’s right, who just does the massive weight loss surgery. It’s true, because repetition is the mother of skill. So if you just do that one thing you’re going to get really good at it, so I love that.
Dr Benjamin Burt: That’s right Trish. Yeah, I think just doing one area … Craig and I met years ago and he was focused on his area he knew about Gill Plastics because he’d been to the United States for a long time. He knew that I’d worked there for six years and I’d been a professor in Texas at Texas Tech University just in oculoplastics, just in that area. So we could see a connection with each other and we’ve worked with each other ever since.
Trish: Oh great. Yeah, I love Dr. Craig. I went and had surgery with him. He’s just amazing, but anyway, back to you. I hear you won an award for your work. Can you tell us a little bit about that?
Dr Benjamin Burt: Yeah, so this is a long time ago now, but when I was training, doing my surgical training, there was an award offered called the International Council of Ophthalmology Award. It was offered to 70 countries or so and I was lucky enough to win the first prize amongst 600 plus candidates from around the world. Yeah, I think it just shows our programmes in Australia are really first rate because we’re competing against everyone in the English speaking world and further beyond. That was back in 2001 I think, but yeah, it was a long time ago now. It was a fantastic thing to win and I was very lucky to receive that in Perth at the Royal College Ceremony many years later.
Trish: Oh, awesome. Tell me what’s the most popular procedure that you perform or the most common eye issues that people actually come to you for?
Dr Benjamin Burt: The number one reason people come to see me is they’re unhappy with the appearance of their upper or lower lid and they may be finding it’s a visual issue as well, so certainly a combination. In a cosmetic practise it’s very much related to the way they look and it tends to be women any age between the 20s up to 50s, 60s and beyond that are just unhappy with the way that their skin is hanging down over their lashes. They can’t put their mascara on anymore. They can’t put eyeshadow on and it may be affecting their vision as well.
More importantly than that, it makes them feel as if they look tired and perhaps they’re getting comments like, “You look tired,” or “Have you been getting enough sleep? Are you unwell?” That really affects them because they may feel perfectly fine but they’re giving this perception to people that they’re unwell or that they’re lacking sleep.
Trish: Yeah, totally, and I know that it can affect their eyesight, so I get it. I’m one of those lucky people that don’t think I’m going to need it but you never know. Well, I wonder how many people don’t realise that a blepharoplasty can actually probably improve people’s vision. Am I right in saying that because half of the people say that?
Dr Benjamin Burt: Yeah, it’s absolutely true. When I was working in the United States for six years, we had to do visual field tests on people to show an improvement when we repositioned their lid skin to suggest that that was the case. In Australia it’s quite simple. The rule is that if the skin of the upper lid is resting on the lashes then it would be visually significant to that patient. So that said, most people come in because they feel like they’re prematurely ageing in that area or those makeup issues we mentioned before. But certainly, that’s important, especially from a family where maybe one of your parents has had that surgery at a young age, or you look at your mum or your dad and think they’re so heavy in the upper lid. That sort of surgery can occur at an earlier age and help someone avoid that situation where it really is a big, big problem up and to the side.
Trish: Yeah, of course. Tell me are the results of a bleph permanent?
Dr Benjamin Burt: Yeah, they are. I mean the change that occurs is permanent. Dr Bryan Mendelson gives a fantastic talk on this on his YouTube clips that are really useful and I would agree. If you do the surgery properly and it forms a strong crease, then that will have a permanent effect on someone’s eyelid. I mean they continue to age, as we all do, but the change in the eyelid is permanent. A lot of my patients that have no crease, some of them are Asian, some of them are not Asian, that have not fold in the upper lid, will notice that for the rest for their lives that that crease will be there. Then that’s not to say they may not need something down the track, but the results are very long lasting if the surgery is performed properly and it forms a strong upper lid fold.
Trish: Do you see many patients for revisions? What could be the biggest cause or concern if this surgery goes wrong, especially with, say, a less experienced surgeon or whatever? Because I’ve seen … Well, I’ve had a couple of patients contact me and … There’s my phone … I’ve had a couple of patients contact me in the past and one sent photos. What had actually happened, she’d had too much skin taken from her upper eyelid so you could actually see the tops of the whites of her eyes. She was worried because she thought it made her look like she was crazy. What happened?
Dr Benjamin Burt: Well, yeah, that’s very scary. That’s really scary. I mean that’s the principle with this surgery. I know I’m a conservative oculoplastic surgeon, and the reason is I can always take more skin; that’s easy to do, but usually we get it right the first time. But if someone has taken too much skin or too much fat, it’s very difficult to remedy that problem. Unfortunately, I do see a lot of patients that have gone to Asia, and of course we all know there’s some great surgeons in different parts of Asia, but it’s hard to know when you come from Australia or other parts who they are, and may have had too much skin removed.
They come back to Australia and then they need work done to try and allow them to close their eye properly or, as you point out, to drop their lid to a normal position, or lift it. That’s a very difficult position to be in and I see a lot of those patients. That’s a part of my practise that is sad, but it’s very rewarding if we can get someone back on track and get them looking normal again. But certainly, surgeons that haven’t done a lot of that surgery do tend to take more fat than they should and may not be sure how much skin to remove to give someone a good result.
Trish: I find as well with blephs people think oh, it’s just a little bit of skin above the eyes. Anybody can do it, and it’s actually not the case at all. It’s the opposite.
Dr Benjamin Burt: Yeah, I agree totally. It seems like not much but the point of this surgery is it’s very detailed and one millimetre means a lot in the surgery that I do. That’s not the case with breasts and tummies. One millimetre doesn’t matter because of the size of the tissue that’s being removed and repaired. But in eyelids you notice if someone’s got an eyelid that’s one millimetre higher on one side than the other. You’ll notice that, and the same with folds. So, that detail is what’s essential in oculoplastics. Our instruments are even different that we perform surgery with, to breast surgery and tummy surgery, so it’s a sort of intermediate field between microsurgery and the bigger plastic surgeries.
Trish: Yeah. Tell me, is there an average age of a patient and do you see more women than men, or is there an average age, or not really? I think, as Australians, we tend to have that eye, that bleph issue, or a lot of Australians tend to … I think is it one in four people that have it done? Is that right of have I just-?
Dr Benjamin Burt: It’s such a common surgery. I think it’s one of the top four surgeries, behind breast surgery and tummy surgery that’s performed, different types of breast surgery, the mastopexies and the augmentations, but it’s right up there. It’s almost the third most common surgery in cosmetic surgery so it’s a very common surgery. Now I get two groups. It’s really bimodal so that I get a younger group that they really have been born with lids they’re not happy with. As they get older, in their teens, they’re just not happy that their lid’s so low they can do the things they want to with their lid, or they feel that it’s just not the way they want it to look. A lot of those patients might be Asian, but a lot of them aren’t as well in that they’re just unhappy with the very low fold that they have. That’s a very gratifying group to work with. I’ve done a lot of young people, continue to do a lot of young people in that area, and they’re a very exciting group of patients to work with.
Dr Benjamin Burt: Then there’s the older group that … Sorry to interrupt Trish, but the older group that were really happy with their lid but it’s changed as they’ve got a bit older, and maybe they’re in their 30, 40s, 50s and they want to have a lid similar to the way it was when they were younger. So they’re the two big groups.
Trish: Yeah, because young men are always relative to how old I am to me.
Dr Benjamin Burt: Well, yeah, I guess they’re all young in a way, but it can be at any age, but in the cosmetic practise it really is in those two big groups. So really young people that are unhappy with their appearance and never were, maybe never had a lit to put their makeup on, that sort of thing, and then that older group that were really happy with their appearance but it’s just changed as they’ve got a little bit older.
Trish: Yeah. So what’s the most rewarding part of your job?
Dr Benjamin Burt: It’s definitely seeing the improvement in confidence and appearance in people that have had surgery. I mean you can’t know what a surgery is going to be like until you’ve had it done, but just seeing their face and their excitement for two reasons. First of all, they feel they look like themselves because I’m not changing their face in a dramatic way, but that they can see better, that their eyelid feels lighter, that they look more alert, more awake, more refreshed and younger. But it’s their face. It’s the same shape. The eye is the same shape as it was before. It’s very gratifying to see how happy people are after that surgery.
Trish: Yeah, and I’m going to ask you one more question. What is the most unique or interesting case that you’ve ever had?
Dr Benjamin Burt: That’s a great question Trish. I’m certainly not prepared for that one. Look, there’s so many interesting cases in oculoplastics. There’s people that have had big problems with surgery before, or injuries before, or childhood problems, tumours et cetera. Repairing those sort of people is very different to a normal straightforward cosmetic case but it can be challenging and a lot of fun. In terms of one particular case … See I think it’s people that have always had a problem. They might have even been born with that issue and they didn’t really realise it could be corrected, so they’re very gratifying cases.
Yeah, nothing stands out to me as the best case I’ve ever had because they’re all exciting. Everyone has their story and it’s just fun to be a part of someone improving their appearance and feeling better about themselves.
Trish: Totally. Oh, that’s been so, so interesting talking to you because I have had the unfortunate situation of speaking to people who’ve actually had their eyes done and things have gone wrong. It’s right there. It’s like what do you do? For anyone who is out there having-
Dr Benjamin Burt: You can’t hide it, Trish. You can’t hide the face.
Trish: No, exactly. Well look, thank you so much for taking the time to talk to us today. I really, really appreciate it.
Dr Benjamin Burt: It’s great talking to you Trish. I wish I was up in Byron to talk to you face-to-face.
Trish: Well, anytime. So if you’re out there and you’re looking for someone to do a bleph for you, Dr. Benjamin Burt is based in Melbourne, but he has people travel from everywhere so do consider that as well. If you’re interested just drop us an email to firstname.lastname@example.org. I’m also going to put a little link to that YouTube video for Dr. Bryan Mendelson that you talked about.
Dr Benjamin Burt: Yeah, it’s very useful and, yeah, he’s a great surgeon and a wonderful example of what a great surgery can do to the eyelids. Yeah, it’s a fun area and I’d be happy to see any of your listeners Trish.
Trish: Fantastic. Thank you so much! Have a great day. ‘Bye.
Dr Benjamin Burt: ‘Bye.
If you’d like to arrange a consult with Dr Benjamin Burt give Cosmetic Surgery for Women a call on (03) 9429 8363.