Cosmetic Procedures (Oculoplastics)

Ptosis (Blepharoptosis)

Ptosis or droopy eyelid, also known as Blepharoptosis, is when your eyelid margin sits lower than normal. In general, this means your upper lid covers 1-2 mm of the cornea. In Ptosis, the lid often rests over the top part of the pupil and obstructs vision.

Most cases of acquired ptosis (ptosis which is developed over time, not ptosis you are born with) result from stretching or disinsertion of the attachment of the levator muscle. Patients often note that the eye seems small and complain of a limited field of vision, difficulty reading, fatigue, and headache. Acquired Ptosis can occur at any age, but it is more commonly seen in older adults.

To determine if Ptosis repair is a medically covered procedure, measurements are taken, as well as photographs, are taken demonstrating how droopy the eyelid is. A special test called a ptosis visual field is performed to demonstrate a loss in the patient’s superior visual field. Once all the testing and visual complaints are obtained, the surgery can be scheduled as an outpatient, same-day procedure. Most cases scheduled with our office will also go through a pre-authorization or pre-determination process with your medical insurance. 


Dermatochalasis is defined as loose and extra eyelid skin. It is often found in combination with orbital fat herniation. This extra skin can droop down and may cause hooding of the upper lids, where skin overhangs the eyelids without the presence of ptosis. This can give similar visual complaints as mentioned for ptosis above.

On some occasions, dermatochalasis is medically significant and, if found to be interfering with the vision, it can be considered reconstructive in nature, and surgery may be covered by insurance. In other cases, it is purely cosmetic and will not be covered by insurance. A cosmetic Blepharoplasty can be performed in the office under local anesthetic (completely awake) or in the surgery center under sedation or under General Anesthesia on its own. 

Dr. Silbert has been performing Laser eyelid surgery with a CO2 laser for over 20 years.

CO2 Laser eyelid surgery can be performed on the upper or lower eyelids and can be combined with full-face or peri-ocular CO2 Laser resurfacing to tighten the skin of the face and/or the skin around the eyes. Dr. Silbert performs the surgery at Physician’s Surgery Center LGH with light sedation to enhance patient comfort.

Instead of using a blade, a laser is used on cutting mode to remove the skin and the fat during the procedure. The laser serves to both cut and cauterize the skin and fat and is able to close blood vessels while it cuts, minimizing bleeding. The laser is also able to make a very precise incision that heals with minimal scarring. Using the laser Dr. Silbert is able to minimize bleeding and bruising, which can help patients heal more rapidly.

The procedure is used to remove excess skin from the upper eyelids and to remove fatty bags of the upper lids and below the eyes. Although results of eyelid surgery can be very good using a blade to make the incisions, Dr. Silbert believes that the laser provides for a more exacting surgery with less black and blue, and quicker healing.

Botox & Juvederm

David Silbert, MD, FAAP has been administering Botox since 1993, when it was originally used to treat strabismus and other eye conditions. Ophthalmologists have been using Botox for over 30 years to treat these, and a variety of other disorders, including eyelid spasm and eye muscle disorders.

Dr. Silbert precise eye and experience have made him the “go to” physician for patients looking for refined and careful Botox treatment. 

Botox’s smoothing effect on skin is effective in eliminating or reducing wrinkles on the face, such as crow’s feet, smile line, forehead lines caused by raising eyebrows, and the space between the eye brows over the bridge of the nose. Botox injections relax the muscles in these areas, causing them to not move as much while the patient makes certain facial expressions.

Juvederm is a “next-generation” filler that is made from hyaluronic acid. This naturally occurring substance in your skins helps to add volume and hydrate the skin. The effects can last up to one year. A Juvederm injection flows easily into the skin and a provides a smooth, natural look and feel as it fills wrinkles, laugh lines, or other areas where wrinkles are prevalent.

Juvederm and Botox nicely complement each other, and can be administered at the same visit.



Actual Patient Photo Before Ptosis Surgery
Actual Patient Photo
Before Ptosis Surgery

After Ptosis Surgery
After Ptosis Surgery

Actual Patient Photo Before Ptosis Surgery
Actual Patient Photo
Before Ptosis Surgery

After Ptosis Surgery
After Ptosis Surgery

Before Botox Treatment
Before Botox Treatment

After Botox Treatment
After Botox Treatment

Cosmetic Services for Adults


Usually inherited, the skin of the eyelids become loose and fat bulges forward, also known as hooding. A Blepharoplasty is the surgery that is performed to remove excess tissue from the eyelids. Blepharoplastys can also be performed for medical purposes. A Lower eyelid blepharoplasty is almost always considered cosmetic.

Abnormally low upper eyelids can develop when the tendon of the muscle that lifts the upper lid stretches causing the upper lid(s) to be low. This occurs with one or both upper lids. Surgery can be performed to lift the lids. Most often, a ptosis repair is performed to improve vision and, more often than not, is covered by insurance.

Brow Lift

Eyebrow and Forehead Lifting addresses eyebrow position and loose or wrinkled forehead skin and underlying tissue. Eyebrow position changes as we age. Our natural eyebrow position, the effects of gravity and fat deflation, how active our eyebrow and forehead muscles are, and previous eyelid, eyebrow or forehead surgeries, all contribute to the position our eyebrows are in today. There are several types of eyebrow and forehead lifts. The type you choose will depend on your current eyebrow position, facial structure, and on what is possible to maximize your appearance.


BOTOX® (onabotulinumtoxinA) are injected into problem areas on the face such as crows feet, brow lines and wrinkles.

Medically, BOTOX®  can be used for uncontrolled muscle contractions of the eyelid called a “blepharospasm.”

Both products do an excellent job of smoothing wrinkles, facial lines and crows feet. The benefits typically last 3 – 4 months and can take years off your appearance.


Each filler is a clear gel of hyaluronic acid that is specifically formulated to act like your body’s naturally produced hyaluronic acid. Initial results last up to 6 months and most patients follow a regimen for longer lasting results.

Laser Treatments (Resurfacing)

Laser resurfacing is a treatment to reduce facial wrinkles and skin irregularities, such as blemishes or acne scars. The technique directs short, concentrated pulsating beams of light at irregular skin, precisely removing skin layer by layer.


Upper eyelids can develop laxity or looseness when the the muscle that lifts the upper lid stretches causing the upper lid(s) to droop. This can occur with one or both upper lids. Surgery can be performed to lift the lids. Most often, a ptosis repair is performed to improve vision and, more often than not, is covered by insurance.

Skin Tightening

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Conestoga Eye provides the full range of medical care for your eyes, including but not limited to the conditions listed below. As always, please call our office to talk about your specific concerns and schedule an appointment.

More information and images on Conestoga Eye’s cosmetic procedures is coming soon.

Services – Adult Cosmetic

Updated on 2022-06-09T15:49:06+00:00, by admin.