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Capstone writing services write for me wgu mba it capstone problem statement almoners report card our first topic is eyelid surgery many people develop puffiness and wrinkles around their eyes my guest is dr. Howard Kahn was a laser cosmetic surgeon Irvine he specializes in eyelid surgery thanks for coming Howard thank you you know what happens when we age what happens around the eyes here what is going on what's the process well when people get older 30s 40s 50s they tend develop loose skin around the lids and also there's sun damage which will cause wrinkles around the eyelids also there's a greater hereditary component where no matter how much exercise that a person does they'll look tired because somebody in the family had some bags under the eyes which is a fad that's come forward so the fats there all the time it's not that the fat is deposited as we get older but you have this fat here and it or and just comes to the surface it's deeper down yeah I think the fact will come to the surface and also the overlying tissue will tend to thin out which will cause the fat to to have the appearance of puffiness and and the darkness under the eyes what causes that well the darkness can be a combination of things it can be fat that's come forward it can be a pigment on the surface that we address with some of the lasers and it also can be actually loss of fat in the inner portion of the lower lid and with that we actually fill that with material so as an ocular surgeon this is your whole Valley wick you you specialize in this you've been specially trained in this unlike other cosmetic surgeons who may do just general cosmetic surgery this is what you really focus on yeah my special is eyelid surgery and I have trained in general surgery but also I'm board-certified in ophthalmology and have fellowship training in just the ocular plastic surgery so that's basically what it was with someone with my training does all day as eyelids and related you know things so what happens you explain to us what happens during the eyelid surgery would well I prefer to use the leis for these procedures I'll just show you an example of a patient who had surgery of the upper and the lower lids and we do these in the office with local anesthesia we cover the skin with some ointment to numb it up so when we give the local anesthesia the patient doesn't feel the local and we place protectors over the eyes and instead of using a scalpel we use a laser to make the incision and this is a diagram of the kind of procedures that we do where we remove skin and fat so we draw a line where I want the lid crease to be a second line to include the redundant skin and instead of using a scalpel we use a laser and this is a handpiece for a co2 continuous-wave laser and it makes a tiny little beam of light and this beam of light will seal the blood vessels as a cut so that's the advantage over a scalpel that there's not bleeding so the surgery is done faster and people have usually very little bruising now we recently went to your office and we're going to show some patients that you did the procedure on so would you like to come with me see this yeah okay now if I pull it get really bad okay so this is just starting but I let me take a look right here with the upper lid which were all lying right here okay and ii like to include some weird onion skin and then i use a laser with a point two millimeter spot size is a little beam of light the cuts and see also blood vessels as a cuts there's no bleeding and then we close that with sutures the sutures stand for about one week how much can you get rid of on this okay well let me just show you I came here with that I would not surgically take any skin but I would use this laser to tighten up the skin and I'll show you that laser just a second the other thing is you have this line right there and you see that little kind of it's like a it's like a little dent right yeah with that I fill that with some Restylane you can see how it's often set up you mention Photoshop and it looks like a photo sure does but if this was what I've done with her because she had a really deep line right there to show you how it works there's some areas that are not treated to this little cells will seal the tiny little holes okay and that's the whole key so that's the story no it looks like I mean you have with the laser that you have less bleeding so you have less bruising there yes and so you get back to work faster and the other laser that you demonstrated there was the the Fraxel right right and is that what you have on the table there right the this the other modality of lasers that are used in eyelid surgery have to do with tightening the skin and reducing the brown spots and there have been other lasers throughout the years that have done this but the present of modality is called the of the Fraxel laser and this is the handpiece that where the energy is applied the Machine is attached to this disposable handpiece and the laser we glide the laser over the area that we're treating it can be the eyelids the face hands neck chest and it puts tiny little spots of energy in and the adjacent skin will seal up those little holes so the healing takes about 48 hours and so there's less risk of infection with this procedure so you're saying to me that compares ago when they did with I guess they still do it that way with traditional cutting and stuff their downtime would be quite extensive wasn't it after well when I used a scalpel I used to tell people and I used a scalpel from about 82 until 92 and I've used the laser since about the early 90s and I used to tell people to expect to be bruised for several weeks and now I tell people three or four days use so so the there's there's certainly the downtime advantage then the other advantage is this technology of shrinking the skin with these fractional lasers because in the old days which was not that long ago you know 10 15 years all we could do was pull the skin so we can now address the sun damage element where the skin can be tightened at the same time and all these are done with local anesthesia this is a quantum leap and improve I mean compared to what you described before can you do the upper and lower at the same time everybody's different and sometimes people need just the upper just the lower sometimes just resurfacing so everybody's different but we'll often do the upper lid surgery lower lid where remove a little fat from the lower lid and the laser tightening all at the same time and that combination takes about an hour so you can get rid of the droopy eyelids up here get rid of the wrinkles on the side get rid of the puffiness underneath in an hour yes and get back to work in well 3 or 4 days usually wow the sutures in the upper lid stay in for about a week there are no sutures on the lower lid and of course with the lace or tightening there are no sutures there also that's amazing so this is really sounds like your business is only going to grow as we all get older and not that that is simple to do I would think that there's not too much room for error here and I would think that somebody wants to really work on their eyes they should see somebody who's trained in an ocular surgery like this but this is really fascinating that you can get back to work so quickly and working all these delicate tissues and get such a great response and now you've been a pioneer in this you've been doing this for many many well I start anew I started using lasers when I was at Johns Hopkins in 1978 I've worked with laser companies to help develop some of these so it's a lot of fun to have these new devices that actually work and are safe well well we're running out of time though that was very interesting and I appreciate you coming on and I think a lot of people are gonna seek out your expertise thanks for having do my the capstone cottages san marcos New York State College of Veterinary Medicine.