Q: I have excess skin on my eyelids, which I would like to have removed, non-surgically. I’ve heard that Botox could help but don’t know if this is safe or if Botox would affect my eyesight. Please can you advise. I am 85.
Name and address supplied.
A: When the upper eyelid droops, it’s known medically as ptosis. In some people it becomes so severe they have to tip their head backwards, or arch their eyebrows, in order to see out clearly, which is understandably both annoying and distressing.
Sometimes ptosis develops due to a neurological condition, as a result of damage to the nerve supply to the eyelid muscles. But, generally speaking ptosis is a problem of age, as the muscles become overstretched and less effective.
I respect your reluctance to undergo surgery, but this offers the most effective available treatment. The appropriate procedure, called an upper lid blepharoplasty, can be carried out under local anaesthetic and does not require an overnight stay in hospital.
Botox — which is the brand name for injectable botulinum toxin type A — works by paralysing the muscles into which it is injected. In fact, a drooping eyelid can be a side-effect when Botox has been poorly administered.
Botox — which is the brand name for injectable botulinum toxin type A — works by paralysing the muscles into which it is injected (stock photo)
I’ve seen this as a complication in my own patients, when the injectable botulinum has been over-administered in an attempt to banish stubborn frown lines: the drooping eyelids occur when the Botox migrates downwards, due to gravity, weakening the function of the eyelid muscles.
Fortunately, the effect wears off after several months. I know some practitioners do offer it as a treatment, but I wouldn’t recommend Botox or other localised cosmetic procedures for your problem, for which the only effective treatment would be blepharoplasty.
Q: One night several months ago I was woken by a very bad foot cramp. It arched my foot so badly it damaged my anterior tibialis muscle. The foot became badly swollen, leaving me unable to walk for ten days. This has left me with four toes drooping, despite regular physiotherapy. Will my condition ever improve?
Roger Keen, Luton, Bedfordshire.
A: Foot cramps occur when a muscle contracts involuntarily — this can be for a number of reasons, including dehydration, low potassium levels, nerve damage, even tight shoes.
They are a common occurrence and are rarely a cause for concern, but in your case the painful spasm was so severe and prolonged that it squeezed small blood vessels within the muscle of the foot, causing them to burst and haemorrhage.
This created the swelling you describe in your foot that’s taking months to resolve.
The cramp also led to the compression or squeezing of the peroneal nerve, a branch of the sciatic nerve, that supplies movement and sensation to the lower leg, foot and toes via the tibialis anterior muscle, one of the main muscles in the front of the lower leg.
Foot cramps occur when a muscle contracts involuntarily — this can be for a number of reasons, including dehydration, low potassium levels, nerve damage, even tight shoes (stock photo)
What puzzles me is why the haemorrhage in your cramping muscle was so severe. It leads me to wonder whether you are taking regular aspirin or other medication that could be described as a ‘blood thinner’ — as muscle cramps are a known side-effect.
If not, I would also suggest you consult your GP, who may order a blood test to check your platelet count (platelets help form clots that prevent bleeding around the site of an injury — a low count may have led to increased bleeding and explain the severe swelling you experienced).
In the meantime, rest assured that your regular, supervised exercise regimen will strengthen the muscles, reverse the foot drop and restore normal mobility. This could take up to a year, but please persevere with your treatment — it will be worth it.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: [email protected]. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context. Consult your own GP with any health worries.
In my view… Broken promise for the over 50s
Are we not all firmly committed to the mantra that prevention is better than cure?
Well, the Government, for one, seems not to be.
Osteoporosis is the fourth greatest contributor to disability and premature death in the UK, yet a commitment to include it in last week’s Autumn Statement has been broken.
It was meant to provide for more fracture liaison services (FLS), where anyone over 50 should be sent if they suffer a fracture, in order to identify — and treat — osteoporosis to prevent future episodes.
Only 51 per cent of NHS trusts in England and Wales have an FLS: this compares with 100 per cent in Scotland and Northern Ireland. There was a promise that this discrepancy would be corrected, but not a squeak on the subject from the Chancellor.
Quite apart from the personal costs in suffering long-term pain, disability and worse, in the next year £88 million will be spent treating fractures that could have been prevented, yet FLS services would only cost £27 million per year.
Who is responsible for this illogical, costly — and, I would say, shameful — decision?
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