I am a 63-year-old man with drooping eyelids that bother me not just for aesthetic reasons, but also because they disturb my vision. When Prime Minister Ehud Olmert underwent surgery for his, and Shimon Peres before him, I became curious whether this operation helps and if it is dangerous. F.N., Haifa
Judy Siegel-Itzkovich replies:
The Mayo Clinic Health Letter reported recently about blepharoplasty, the operation you were referring to. The skin around the eyes is naturally thin and delicate and, over time, the eyelids stretch, muscles weaken and fat tends to gather over and under the eyes. Thus, drooping eyelids often accompany aging. Sagging eyelids can affect vision and produce a tired appearance - no matter how much you rest. Blepharoplasty may be done to improve your ability to see without obstruction, as well as your appearance. Health insurance usually pays for the surgery if drooping eyelids are interfering with vision.
For a drooping upper eyelid, local anesthesia is used, as an incision is made along its natural crease. Excess skin and fat may be removed through the incision. The incision is closed using a technique that hides the stitches as much as possible. In lower eyelid surgery, the incision is made just below the lashes in the skin's natural crease. Blepharoplasty is known to be safe, takes one to three hours and is done on an outpatient basis. However, whether you undergo surgery to improve vision or appearance, eyelid drooping can recur over time.
I remember that my children, raised in the era of cloth diapers, used to get diaper rash quite often, and my grandchildren, who of course wear disposable diapers, get it quite rarely. But they still get it. How can one avoid the skin condition, which makes them - and my daughter - miserable? M.B., Bnei Brak
Prof. Mary Spraker, an expert in dermatology and pediatrics at Emory University in Atlanta, Georgia, comments:
Diaper rash is diaper dermatitis, and there are two common forms - simple "irritant" diaper dermatitis and Candida (yeast) diaper dermatitis. Irritant diaper dermatitis occurs when feces and fecal enzymes, especially when combined with urine, inflame a baby's delicate skin if they are in contact with it for a long period of time. The best way to prevent this type of diaper rash is to remove a soiled diaper as soon as possible.
Over the years, there have been considerable improvements in the design of modern disposable diapers and, as a result, severe diaper rash is not as common as it once was. Studies have shown that infants who wear today's disposable diapers get fewer diaper rashes than those who wear cloth diapers. The super-absorbent gel that was added to the core of disposable diapers in the mid-1980s can absorb many times its weight in moisture. It also grabs on to the wetness, trapping urine in the center of the diaper and leaving the surface of the diaper that touches the infant's skin almost completely dry. Since wet, softened skin is less healthy, it is more easily irritated by fecal material and more easily infected by Candida. The introduction of this super-absorbent gel marked a significant advance in preventing diaper rash.
In the 1990s, a breathable membrane similar in design to the popular fabric in hiking and sport outerwear garments that keeps rain out but "breathes" to prevent excess perspiration was added to higher-end disposable diapers. This membrane allows water vapor to escape through the cover of the diaper, which reduces the humidity inside the diaper and keeps the diapered skin drier and healthier.
To prevent and treat persistent diaper rash, promptly change diapers containing stool. Since urine by itself is not irritating, mildly wet diapers do not need to be changed immediately. Most parents change a baby's diaper an average of six or seven times a day. Clean fecal matter with baby wipes, which do not irritate. For treating diaper dermatitis when it occurs, apply a barrier cream that contains zinc oxide or petrolatum. Avoid using unnecessary products, such as powders, on baby's bottom; baby powder should be avoided, as babies can breathe them in and develop pneumonia. To treat the Candida type of rash, your pediatrician will prescribe an antifungal cream or ointment specially formulated for infants. A new ointment for treating this contains 0.25 percent miconazole nitrate in a base of zinc oxide and white petrolatum. This prescription medication contains a lower concentration of the active ingredient miconazole than the amount present in other antifungal topicals formulated for adults.
Rx For Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx For Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to email@example.com, giving your initials, age and residence.