Update; Plastic Surgery in Beverly Hills, Baby!

Last week Lori accidentally tore out her tarsorrhaphy while getting dressed; her shirt caught on the stitch and pulled it right out. Needless to say, that didn't feel very good, and sort of made mincemeat of her eyelids. Here's what it looked like after it came out.Her ophthalmologist said at that point, since she really hadn't regained any significant function, it was time to have something more definitive done; we couldn't do any more temporary tarsorrhaphies. Lori had been worried about this eventuality, but she had been talking with one of her friends one day, whose dad had a permanent facial nerve palsy resulting from a brain tumor. His eye had been giving him fits just like Lori, and he had tried all kinds of things including an implantable gold weight, none of which had really solved the problem for him. Eventually, though, he had seen a doctor in California who had implanted a metal spring in the eyelid, and restored his ability to blink. This intrigued Lori, and she had done some research into the procedure, discovering that the physician, Dr. Levine, was still practicing in Beverly Hills, California, and had performed thousands of these procedures over the past forty years or so. At one point, he had even called her personally to explain the procedure and answer her questions; she had been pretty impressed with that. As she looked into it more, she also discovered that Dr. Levine is the world's foremost expert in eyelid springs. If you have to have it done, he is the guy you want to do it, apparently. He has done thousands of spring procedures, has been doing it for more than forty years, and has, literally, written the book on the subject (well, there isn't any book, but almost any medical literature you can find on it over the past forty years has his name on it).

So, when this happened, we quickly began making plans to go down there, knowing that the longer her eye remained opened, the more uncomfortable she would get. Here she is with him having her preoperative evaluation.He is a nice, short little Jewish man in his seventies who, although he has been living in California for decades, still has a trace of New Jersey accent that betrays his eastern upbringing. After I got to know him, I asked him if he had ever though about retiring, to which he shrugged and dismissively replied, "I enjoy what I do."

The idea of the eyelid spring is simple, really; because Lori's ability to shut the eye is impaired, but her ability to open it is not, she needs an artificial, downward or "closing force" to balance out the unopposed "opening force" left over from her damaged nerve. By implanting a bent and coiled piece of metal within the eyelid, attaching one end to the bone above and the other end to the top eyelid itself, the needed closing force is supplied. Here's a picture of the spring as it appears before fitting; it will be shortened considerably on each end and then, when its implanted, each end is coiled and placed within a dacron pouch so that there aren't any sharp edges. If done right, the opening force still works, so that she can overpower the force of the spring and open the eye, but when she "turns off" the opening force in the act of blinking, the spring takes over and gives her a nice, quick blink that looks pretty much like the other eye and closely resembles normal function of the eyelid. Implanting a gold weight within the eyelid is another option which accomplishes nearly the same thing, the major differences being that the gold weight is more noticeable, and tends not to work when the person is lying down, since the "closing force" in that case is really just the downward force of gravity pulling on the weight. If you're lying flat or even tilting your head back slightly (as many people tend to do while sleeping), the weight actually tends to open the eye even more, so a lot of people who have weights tend to have to tape their eyes at night. Since gravity is slower to move than the "snap" of a normal blink, the weighted lid tends to lag behind the other one and, if it is too slow, it won't shut all the way during the blink.

Anyway, as it turns out, Dr. Levine's office is located in Beverly Hills, so we ended up staying at a hotel right at the end of Rodeo Drive called The Tower Beverly Hills all week while Lori underwent her evaluation and spring fitting, had the surgery, and her postoperative care. Before her first appointment we had a few hours, so we walked around the town for a little while. If you look closely, you can see a beautiful movie star that happened to be standing under the sign.He was kind enough to agree to let me come in during the surgery, so I took a couple of pictures in the operating room. Here is Dr. Levine on the right, with his assistant, Norma, on the left.They actually woke her up at a couple points and had her sit up and open/close her eyes to make sure the eyes were more or less symmetric during blinking. Like all good plastic surgeons, he took some photos (for the tabloids, I guess).To look at her today, you couldn't tell because her eye is swollen completely shut, but I saw it during the surgery and it was looking really good.Dr. Levine also tightened up her lower lid, and lifted up her right cheek, which were both sagging a bit. This makes it easier for the lids to meet during a blink so that she will get a nice, smooth film of tears covering the cornea and protecting it from the harm that comes when it dries out. You don't realize it, but you blink your eyes about every 4 seconds while you're awake. If you don't think losing your ability to blink is a big deal, try keeping your eyes open without blinking and see how long you last. For the past 2 months, Lori has basically been involved in one big, long staring contest with her right eye; it is easy to see why that was making life difficult for her. We are excited for the swelling to go down so we can see how it all turned out.In the postoperative photo, Lori looks like she is grimacing a little on that side; during the surgery another surgeon named Dr. Joel Aranowitz used some really long sutures to lift up the sagging part of her right upper lip; the "lift" is a little exaggerated right now because of the swelling, but should make her face look and function more normally once the swelling subsides. We are, of course, hoping that this will be temporary, just for a few months. We remain optimistic that she will regain most, if not all, of the function in her face. But, everything we have heard has indicated it will be several months, or even up to a year. This will be, if nothing else, a very nice, temporizing measure. They can take the spring out again, later, and we certainly hope that is what will happen.

Lori's friends had this really pretty flower arrangement sent to her in our hotel.We have wonderful, supportive, loving friends and family who have supported and loved her during this difficult time. We don't have words to express the gratitude we feel for them.