What is oculofacial plastic surgery?
Oculofacial plastic surgery is a sub-specialty of Ophthalmology, in which the surgeon has two additional years of training in plastic surgery of the eyelid, orbit and facefollowing residency. Oculoplastic surgeons have in-depth knowledge of the eyelid and extensive experience in eyelid surgery. They specialize in eyelid surgery and do not perform ENT or general plastic procedures. Dr. Phan is an oculofacial plastic surgeon.

What is ASOPRS?
ASOPRS is the acronym for the American Society of Ophthalmic Plastic and Reconstructive Surgery. The society comprises of oculofacial plastic surgeons, who have had stringent training or extensive experience in order to become members, and maintains high standards of the sub-specialty. Dr. Phan is a member of the ASOPRS.

What is an ASOPRS fellowship?
The American Society of Ophthalmic Plastic and Reconstructive Surgery offers a two-year fellowship to highly selective ophthalmologists. Each year, only about 20 positions are available among the tens of thousand of other training programs offered in the United States. Dr. Phan completed her ASOPRS fellowship at Johns Hopkins University.

Where does Dr. Phan operate?
Some eyelid procedures, such as upper lid blepharoplasty, can be performed under local anesthesia (injection with numbing medicine) and in the minor procedure room in the office. Majority of the cases will be performed at the surgery center under sedation that is given through an IV with an anesthesiologist present. Few surgeries are performed under general anesthesia. Dr. Phan typically operates at the Los Gatos Surgery Center.

Are the surgeries outpatient?
Yes. Patients are typically observed in the recovery area for 30-60 minutes after surgery and then discharged home.

May I drive myself home after surgery?
No. You need a responsible adult driver to bring you in and take you home after surgery. You should not be driving the rest of the day after sedation or general anesthesia. It is also a good idea to have a driver even if you are having surgery under local anesthesia in the office. If you live alone, you need to arrange for someone to stay with you the first night after systemic anesthesia.

How often does Dr. Phan perform these procedures?
Dr. Phan operates every Friday.

What do I need to do before surgery?
Dr. Phan asks that patients discontinue blood thinners such as Aspirin and other NSAIDS (i.e., Ibuprofen, Motrim, Advil, Aleve, etc.), fish oil, vitamin E, ginseng, gingko and garlic supplement two weeks prior to surgery. Dr. Phan also asks patients to discontinue other anti-coagulants, such as Plavix, Aggrenox, Xarelto, Eliquis, Pradaxa, and Coumadin, five days before surgery. Since these medications are usually prescribed to prevent a life-threatening conditions, Dr. Phan asks that patients discuss discontinuing these medications with the prescribing physician before doing so.

If surgery is to be performed under sedative or general anesthesia, Dr. Phan requires that the patient sees the primary care physician for cardiorespiratory clearance within one month of surgery. If the patient has a cardiologist, the patient should see the cardiologist in leu of the primary care physician.

What do I need to do after surgery?
Most patients will bruise and swell for 1-2 weeks. Some patients with thicker skin will swell longer, for a month or more after surgery. Unless specified otherwise by Dr. Phan, you should ice the surgical area 20 minutes on and 20 minutes off the first three days while you are awake. After icing for the first three days of surgery, you may switch to warm compress four times daily for 15 minutes each time. When sleeping, you should elevate your head at a 30 to 45 degree incline for the first week and lay on your back for the first month after surgery. These measures will help with the bruising and swelling. Icing constricts the blood vessels and stop bleeding and bruising; warm compress and head elevation assist in draining the blood cell and serum collection.

The followings are suggestions of effective ice pack and warm compress. For icing, many patients find frozen peas in a small Ziploc bag effective and comfortable to use. You may want to place a clean, wet gauze or paper towel underneath the Ziploc bag and toss this away between icing. For warm compress, you may use a hot tea bag in Ziploc bag. This typically stays warm longer than a wash cloth. Beware that the tea bag is not too hot to cause burns.

While many patients find taking Bromelain and Arnica 3-5 days before and 5-7 days after surgery help alleviate the bruising and swelling, research studies demonstrate equivocal results. Therefore, the census is that these herbal supplements likely do not hurt and may help the recovery.

Many patients inquire about scar revision creams. Dr. Phan does not feel strongly that they are necessary for routine eyelid surgery. The skin of the eyelid is the thinnest of the body, and the incision is typically placed in a crease or wrinkle. Therefore, incisions on the eyelids heal very well and hide nicely as well. For patients who have a tendency to form keloid or hypertrophic or hyper-pigmented scars, you may try silicone-based gel or sheet, like Biocorneum, two weeks after surgery. It is typically applied twice daily. These gels or sheets are typically thick; so a tiny amount is sufficient for the eyelids. Silicone-based gels or sheets have been shown beneficial in deep scars, but not necessarily thin scars, so they may help and likely do not hurt the incisions.

Scars form most actively two weeks after surgery to two months after surgery. The incisions may feel tightest during this time. The tightness will subside after the first couple to few months. In some cases, after the initial month, Dr. Phan may have patients massage the scars with Biocorneum four times daily to relax the scars.

Dr. Phan strongly recommends avoiding the sun on the incision line to prevent hyper-pigmentation. Patients should wear sunglasses, hat or sunscreen with SPF 30+ that is safe for use around the eyes. Sunscreen may be started two weeks after surgery.

In terms of activities, Dr. Phan asks that patients avoid heavy lifting more than ten pounds, excessive bending or straining and swimming for the first week after surgery. Patients may shower the day after surgery. Patients should gently pat dry the incisions and not rub or pull on the incisions for one month. The skin heals within a week for most patients, but the deeper tissues underneath the skin takes at least one month, if not three to four months, to heal completely. Patients may resume work 2-3 days after surgery, as long as they can observe these few restrictions.

Will there be bandages?
Generally, there will be no bandage or patching. In some cases wherein one eye is worked on, Dr. Phan may apply a pressure patch on this eye. The patch may be removed either after 24 or 72 hours. In other rare instances, Dr. Phan may apply a Steri-strip tape over a small area of incision after suture removal if that area appears to need more support for healing.

What kind of sutures does Dr. Phan use?
Dr. Phan uses super-fine Nylon sutures, which are less likely to cause inflammation and thus scaring of the skin. Because they are super-fine, these sutures will break if they are pulled on. They are kept clean with antibiotic ointment once daily at bedtime. The ointment is made for the eyes and safe for in and around the eyes, but it will blur the vision as it melts and gets into the eyes. Superficial sutures on the skin are removed 7-10 days after surgery. There may be other sutures, depending on the type of surgery, that are removed 3-4 weeks after surgery.

Do I need to pick-up medicine from the pharmacy?
Once surgery is decided and confirmed, prescriptions for topical antibiotic and oral pain medication (Norco) are sent electronically to your pharmacy of choice. For in-office surgery, anti-anxiety medication, either Xanax or Valium, can also be sent electronically to your pharmacy. Please pick-up these medications before surgery. Xanax or Valium and Norco may be taken 30-45 minutes before in-office surgery. These are not necessary for surgery under sedation or general anesthesia. Antibiotics are typically started the evening after surgery.

Please be aware of common adverse effects of anti-anxiety and pain medication. These medications can cause drowsiness; so you may not drive while being under the influence of these substances. Pain medication with narcotics can cause nausea, vomiting and constipation. Please eat something before taking narcotic pain medication and take stool softener if you have a history of constipation.

Is it normal for my eyes to feel dry after eyelid surgery?
Yes. When the eyelids are swollen, they may not blink fluidly or close completely. Therefore, the eyes can become dried from exposure. You may use any preservative-free artificial tears four times daily or as often as you need. If the dryness is more moderate, you may consider a thicker drop, like Blink gel or Celluvisc gel, four times daily or as often as you need. For severe dryness, you may want to add Refresh or Retaine PM at bedtime. These are eye lubricants with little or no preservatives.

Dry eyes are typically temporary for the first couple to few weeks after surgery. However, in patients who have underlying Dry Eye Syndrome, this may or may not have been previously diagnosed, the dryness or increased dryness may become a new baseline. Other symptoms of dry eyes include burning, grittiness, sandiness, red eye, sharp pain, blurriness, and reflex tearing.

Do I need a referral to see Dr. Phan?
If you are a member of a HMO plan, then you will need to have a referral from your primary care physician before seeing Dr. Phan.

How much does a cosmetic consultation cost?
Initial cosmetic consultation fee of $75 will be applicable to future treatments. Costs of surgeries, treatments, and subsequent visits will be transparently provided.

Why are there no before-and-after photos on the website?
Out of respect for the privacy of patients, Dr. Phan does not post photos of patients on the website. For applicable procedures, photographs are available for review during your visit.

What should I expect during a visit?
Please see Patient Resources.

Does Dr. Phan see patients on the weekends?
The office does not have regular hours during the weekends. On rare occasions, Dr. Phan will see patients on Saturdays and after hours by prior arrangement only.