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Doctor's Orders: Slather Your Skin in Sunscreen!

Chatting with an Ophthalmologist about skin rejuvenation, botox and more

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Gregory T. Hofeldt, M.D. is an Ophthalmologist, Eye Plastic & Cataract Surgeon at Center for Sight in Fall River. Greg has been with the practice since 2007, settling in Bristol with his wife Erin O’Leary, M.D. and their two rescue dogs, Pokey and McShrimpton (aka Shrimp). As a child growing up in Portland, Oregon, Greg was an admittedly poor, but enthusiastic sailor. So many years later, his goal is to find some time to relearn the skill. We talked about eyelids, skin rejuvenation and Botox – all this from an eye doctor!

What is Ophthalmic Plastic and Reconstructive Surgery?
Plastic surgery of the upper face, including removal of benign and malignant tumors around the eye, as well as cosmetic and functional surgeries. For example, if a lesion is cancerous, I completely remove the tumor. The art of surgery then begins with the reconstruction afterwards. With surgery involving the eyelid, the goal is to restore full function with a cosmetically pleasing outcome. Eyelids are a challenging medium due to limited tissue, requiring experience and creativity. Basal cell carcinoma is the most common type of cancer and is prevalent in this geographic region, perhaps due to the popularity of outdoor activities. It occurs most commonly on the lower eyelids, so this area requires careful examination.

What is the most common plastic surgery you perform?
Blepharoplasty removes excessive skin and fat from the eyelids to restore vision and rejuvenate the tissue around the eyes. If droopy upper eyelids significantly obscure vision, medical insurance will often cover surgery. Office-based tests can determine if visual impairment meets the criteria for coverage. If vision is not impacted, the surgery is considered cosmetic making the patient responsible for the cost. I also perform lower lid blepharoplasty, removing “bags” underneath the eyes. Both of these procedures help to freshen up the face.

What are your thoughts on eye creams to help with wrinkles?
More important than eye creams is the daily application of sunscreen. Many facial moisturizers include UVA and UVB protection that are light and easy to wear. I recommend daily use of a moisturizer with at least SPF 30, typically available at your local drug store. Be sure to apply to the entire face, including eyelids, ears and neck. While sunscreen and moisturizers do not remove wrinkles, they help to delay the progression or addition of wrinkles. Increased sun protection will most importantly help reduce the incidence of skin cancers like basal cell carcinoma.

I never thought of an eye doctor working with Botox!
An ophthalmologist actually invented Botox (a type of botulinum toxin). Ophthalmologists were the first to inject Botox for treatment of “crossed eyes” and facial spasms. Later, Botox was documented to reduce or even erase wrinkles, becoming wildly popular as a cosmetic agent. A bacterium produces this protein called botulinum toxin, the active ingredient in products such as Botox, Xeomin and Dysport. I mostly use Xeomin and Botox in my practice. The other injectable options that tend to get less press are dermal fillers. Generally, botulinum toxin is used to rejuvenate the upper face and dermal fillers the lower face. Dermal fillers help to replace age-related volume loss in areas such as the temples, lower eyelids, lips, cheeks and lines around the mouth. I use different fillers based on the area being treated. All of these agents are safe in the hands of an experienced physician and result in a relatively immediate improvement.

What is the average age of your patients for cosmetic procedures?
Women usually start to inquire about injectables and surgery in their mid to late 20s, while men begin in their mid to late 40s. My oldest patient that wanted cosmetic surgery was a spry and athletic 94-year-old!

What are some of the things you discuss with your patients before they take this step?
Managing expectations is the biggest part of my job. I tell my patients that the goal is to rejuvenate their face, resulting in a fresh, well-rested appearance. I want the procedure to blend with the rest of their face, without looking artificial or overly augmented. Many describe a psychological benefit to looking and, therefore, feeling their best. However, I tell many patients that the best facial treatment to achieve a youthful and fresh appearance is a smile. As simplistic as it sounds, smiling creates many objective benefits. It contracts the facial muscles, which tightens up skin, lifts cheeks and smoothens the lips. It also adds a twinkle to your eye. So smile big and often!

Center for Sight 1565 North Main Street, Suite 406 Fall River. 508-730-2020.