Dr. Jeffrey Spiegel, M.D. FACS is a world-renowned facial plastic surgeon specializing in advanced facial plastic surgery. Headquartered in Boston, Dr. Spiegel sees patients from around the world who come for the most safe, effective, and beautiful facial plastic surgery available anywhere.
Dr. Jeffry Spiegel, Chief of the Division of Facial Plastic and Reconstructive Surgery at Boston University Medical Center, offers a full spectrum of cosmetic and reconstructive treatments including facelift, eyelift, nose surgery, facial surgery, and more.
Dr. Spiegel is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology – Head and Neck Surgery. He is the director of an academy accredited facial plastic surgery fellowship and professor at Boston University School of Medicine.
FutureDerm (FD): I’ve heard that people feel uncomfortable getting peels done around their eyes, can you tell me a little about doing them in the eye area?
Dr. Jeffrey Spiegel (JS): Acid peels can be done around the eyes and eyelids as long, as it’s done by someone who’s experienced at it like a doctor. You wouldn’t want to go to someone who’s not a physician, plastic surgeon, or a facial plastic surgeon. And you wouldn’t want to take chances because it’s a very delicate area, and you need to take great precautions to protect the eyes while you’re doing. If you have kind of crepe-like skin on your eyelids, sometimes the chemical peel can delay the need for an eyelid lift.
FD: What are some of the precautions you take as a surgeon?
JS: You have to have certain materials available. You want to have eye washes, eye fountains, an antidote solution to the acid to dilute it should anything happen. We like to use ointments and eye protectors and certain types of wet gauze to keep things away from the eye itself. And then we make sure that none of our sponges are dripping, so that they’re all minimally wet.
FD: Who’s a good candidate for chemical peels on the eye area?
JS: So if you look at your eyelid skin and it’s not that you have wrinkles that are caused by the muscle movement, it’s not that you really need Botox™. You look at your eyelid skin, and it’s very much like crepe paper, thin skin with fine lines and wrinkles. That kind of person is really good for this because the skin is going to tighten a bit and the collagen is going to thicken. That kind of person is going to be good for this or a more ablative laser.
FD: What are the differences between an ablative laser and a chemical peel?
JS: The ablative laser is going to give you a bigger result, a better result, but it does have more downtime. The chemical peel can be done with very minimal downtime — just some redness. So, a lot of this depends on what you’re looking for. If you’re willing to accept more moderate results, but less downtime, then that’s an excellent option. But if you’re really the kind of person who needs or wants as near to perfection as can be achieved, then you’re going to want either an ablative laser or surgery.
FD: Can you elaborate on the differences between the results of a chemical peel and ablative laser?
JS: It depends on the kinds of chemical peels you use. The types like trichloroacetic and lactic acid will be considered mild or moderate strength chemical peels. So, you’re not going to be destroying all the skin. There are stronger chemical peels, which will actually almost burn off some of the skin and then allow new skin to heal. So those are much stronger and the results are more dramatic, but the downtime is longer.
The ablative lasers are removing the outer skin and allowing new skin to form, and after that new skin forms you get a beautiful appearance. But while it’s forming, you can have scabs. So, the more tissue that’s removed, the great the result will be, but the longer it’s going to take before the new skin is mature.
FD: What’s the downtime for an ablative laser? A chemical peel?
JS: Well, it depends. What’s going to happen is that when you get the laser done, it really removes the outer layers of skin. Once the outer layers of skin are gone, your body heals itself — it takes time for that to happen, and for all the colors to match. So you’re probably looking at two weeks of pretty weepy skin, and it could be up to six weeks of redness. As for the chemical peel, the downtime maybe 48 hours, maybe a little longer.
FD: What are the precautions someone should take before getting a chemical peel or ablative laser treatment done around their eyes?
JS: First, you need to see a facial plastic surgeon so that they can talk to you and see if it’s right for you. One thing you should do is make sure that your surgeon is going to give you an antiviral and usually an antibiotic to take for a couple of days before. So these kinds of procedures can activate viruses in your skin that can come out and cause blistering and pain and scarring that you would otherwise not get.
FD: What should you do immediately after one of these procedures?
JS: Well, you want to keep it cool and protected. Some people will recommend that you use an ointment to cover the area. Other people will say just to use cooling packs for comfort. I think keeping your skin moisturized is important. I will sometimes have people use simple Vaseline for real maximal moisture to the area. In moist environments, your skin is going to heal better.
FD: What should you do once the skin is healed for maintenance?
JS: You want to think about what causes fine lines in the beginning. If it was sun exposure, make sure you’re using a good sunscreen. If it was muscle activity, make sure you’re getting Botox™ or Dysport™ to relax that area. And, of course, good skin care products are always going to help.
FD: How long should you go in between getting these procedures done again?
JS: The ablative laser you may not need to do ever again, or you may need to do it many years later. For the chemical peel, it depends on the depth of them. If we use a very strong chemical peel, you may never have to do it again. And other chemical peels, you’ll planning on doing every month or so for, let’s say, six months to get the best results. It depends on which you pick.
FD: Tell me a little bit about what you do when you perform an eyelift?
JS: With an eyelift what we’re doing is re-draping the skin, just like if you have a wrinkled bedspread on your bed and you re-drape it to get rid of all those wrinkles. It’s the same thing with the eyelid skin. So, your surgeon is going to remove the extra skin, so that there’s just enough skin to fit in your eyelid to keep it looking smooth and perfect.
The downtime for that might be very short, because, for example, when I do it, I just use dissolving stitches that fall out within five to seven days. After only two days, you’re able to wear makeup. And then after a few more you can put makeup right across that line. It’s a very short process, maybe five to six days.
FD: So how long are you able to see a scar?
JS: Well, there will be a fine line there if you look carefully for a while. With a little bit of makeup it disappears in about a week or so. And it eventually becomes hard enough to see that sometimes I can’t find where it was.
FD: What are the benefits of the eyelift over other procedures?
JS: So, the eyelift will allow you a number of things, not just the skin, such as if you have fatty areas, little things like that. You can address all of that at the same time. And the chemical peel is good for people who really aren’t quite ready for surgery — either things aren’t bad enough yet or they aren’t emotionally comfortable with surgery yet — and so the chemical peel is a nice way to go. And the laser can be somewhat in between. If you have a lot of discolored skin, or you have lots of fine wrinkles that maybe surgery isn’t going to address as well, then it’s a good choice.
FD: Are there any downsides to these procedures?
JS: Yes, when you have a darker skin color, you need to be very careful about lasers, because a laser can result in the skin color being uneven. So, lasers are best for people with light skin tones.
And then, the other comment that I’d make is that a really skilled and contemporary plastic surgeon might look at you and say you don’t need any of those things, you need fillers or Botox™. We can do amazing things with fillers now. Where in the old days you had to have surgery, people have discovered that sometimes putting filler into the eyelids is really what you need to look more youthful and attractive.
So, we’ll have people all the time who come in for an eyelift surgery, and I’ll say, “What you really need is for me to put some filler in here.” And I’ll show them where and they’ll try it, and they’ll go, “Oh my gosh, that got rid of the need for surgery.” The downtime for that is about an hour.