Cosmetic Enhancements & Oculofacial Restoration

Dr. Kimberly Cockerham will help you restore and enhance your eyelid, eye muscle and facial function and form. The face- including the eyelids- can be altered by neurologic conditions, autoimmune disorders, surgery, trauma and aging. As a decorated US Army veteran who served at Walter Reed Army Medical Center, Dr. Cockerham is committed to working with you to create a personal plan to help you achieve your goals and optimize your outcome.

Botox, Eyelid/Facial Spasms, Double Vision, Eyelid Retraction, Ptosis, Entropion & Cosmetic Concerns

Botox was initially FDA approved for patients with double vision and then was found to be helpful in patients with a variety of medical problems and cosmetic concerns. 

Botox injections are an excellent medical treatment for eyelid/facial spasms but are also effective at combatting double vision following eye stroke, drifting eyes, eyelids that won’t close or close too much, eyelids that role in (entropion). 

But Botox is best known for its use for a variety of cosmetic concerns including frown lines, crow’s feet, forehead lines, lip lines, lip shape (lip flip). 

Botox is a purified protein that is synthesized from the naturally occurring bacterium, Clostridium botulinum. There are seven known forms, the most used are Botox, Dysport, and Xeomin. All are botulinum type A. The effects of Botox typically lasts 12 – 15 weeks before it wears off. Over time the nerves that are affected by Botox recover and form new nerve endings. Multiple injections are more effective than increasing the volume of the injection.

Blepharospasm and hemifacial spasm are typically aggravated by voluntary facial movements. They are increased with fatigue and emotional stress, and may be suppressed with sleep, relaxation and hypnosis. These spasms begin with twitches and increases in frequency and severity over time. Women are affected 3-4 times more often than men. These spasms may be localized to a single muscle (eyelid) or involve multiple muscles of the face. The cause of blepharospasm is poorly understood; rarely the spasm is due to a brain stroke or multiple sclerosis. Spasms located on one side of the face can be due to dysfunction of the facial nerve (called hemifacial spasm) or can follow Bell’s palsy (aberrant regeneration of the facial nerve). Many patients with migraine headaches that are unresponsive to oral medications can benefit from Botox injections.

Informed Consent: Bruising is the most common unwanted side effect of Botox injection. To minimize bruising, there are several medications that you should avoid two weeks prior to injection. These include aspirin, Motrin (and other pain relievers other than acetaminophen), fish oil, flaxseed, Vitamin C and E and garlic tablets. Additionally, there is an herbal supplement called Arnica, which can decrease bruising. This is taken by mouth and should be started two days prior to injection. Other less common risks of Botox include numbness, double vision, drooping eyelids, headaches, flu-like symptoms, muscle weakness and death (in children given very high doses).

Dermal Fillers for Treatment of Scars, Post-surgical or Traumatic Deficits & Facial Augmentation

Dermal filler comprised of varying molecular sizes of hyaluronic acid molecules are the most popular. Brand names include Restylane (Refyne, Defyne, L and Lyft) and Juvederm (XC and Voluma). While the fillers were initially FDA approved for cosmetic augmentation of wrinkles, lips, cheeks, tear troughs, temporal fossa and other concerns, they are also helpful for some medical concerns. Fillers are an excellent medical treatment for post-surgical or traumatic deficits of the eyelid and face.

A youthful midface is characterized by high, strong cheekbones that defines and balances out well with the lower eyelids. Also, the midface is where many patients start losing facial volume.

As our face ages, the skin, underlying muscles and soft tissue descend, and with the loss of fat volume, the resulting deep lines and hollows can create a sunken or tired look. Today’s dermal fillers can quickly and easily address these conditions.