Las Vegas Blepharoplasty - Ask Dr. Garcia Library - Page 1

NOTICE: Las Vegas Blepharoplasty: Ask Dr. Garcia is intended for educational and discussion purposes only. It does not constitute a formal medical evaluation nor consultation. No doctor-patient relationship has been formalized by this communication. If you desire such, please feel free to call and schedule an appointment. Otherwise, please be advised that all information that has been given here should be cleared with your primary care physician before changing or instituting any therapy. Explanation of off-label use of substances may be discussed here in but does not reflect an endorsement nor promotion of such off-label use. All responses regarding Las Vegas Blepharoplasty are done personally by Julio Garcia.

I had blepharoplasty (under eye) 15 yrs ago , soon after always had a fluid pocket under the eye I now have ectropion of that eye Question Could ectropion be the cause of fluid pocket under my eye ? No one has ever been able to tell me what the cause of the fluid pocket is coming from. Thanks
Answer: usually it is due to scar tissue or excess skin being removed, fluid should not have that long term effect. Hard to say without seeing you but your fluid pocket might be a festoon that was aggravated by the swelling from the surgery but that likely would have gotten large over time without the eye surgery too. If you have etropion from muscle paralysis that can cause the fluid accumulation to happen too. JG 1.25.13
Are you familiar with an extended lower lid blepharoplasty? It`s supposed to help address malar bags. Is it a standard procedure for cosmetic surgeons or would I have to locate a specialist who performs it?
Answer: Not sure how you woud find the surgeon besides calling around , it is not a standard operation and I do not believe it works as well as many claim. JG 1.9.13
Dear Dr. Garcia, 10 days ago, my plastic surgeon revised the depressed lateral end of a scar from an old blepharoplasty. He used 3 absorbable 6.0 sutures, so I don`t have a follow up visit with him. After 7 days, as instructed, I removed the steri-strips and dabbed the incision line gently with hydrogen peroxide to dissolve a tiny blood clot. All looks well, but of course, I have little black ball of sutures there. I`ve put Aquaphor on it and carefully covered it with a tiny bandaid, being sure that the sutures were covered with gauze so that they won`t pull out. My question is, how long will these lovely sutures be on my face? He just told me that they will absorb with time, but he wasn`t specific. Anything else I should be doing to help this thing heal? Thanks so very much for your kind help. Happy Holidays to you and a healthy new year to you and your family.
Answer: The sutures can take 6-8 weeks to dissolve. Best if luck. JG 12.15.12
Can you tell me what methods are used in lower blepharoplasty technically. Can you also treat the area below the eyelid more on the cheekbones? What method do you use? Thanks in advance
Answer: either an external incision can be made or an internal or transconjunctival incision is made, but the inside incisions will not allow for skin removal. The cheekbone tissues are not adequately treated form a lower eyelid incision without taking larger risks of ectropion. JG 10.19.12
Several years ago, I had both a canthopexy and then a canthoplasty for ectropion following and aggressive blepharoplasty. It looks OK...sort of...but the lateral edge of the lower lid is everted. Could a simple tarsal suture be placed between the upper and lower lids to support it up without dissecting any tissues? Thank you.
Answer: likely to, it will probably need a little more, possibly a pennant flap in order to replace absent skin and yield better support. JG 9.11.12
What causes lower blepharoplasty swelling to last after 12 months? This was my second lower lid procedure (first one about 20 years ago). I am 71 years old. The surgeon injected a steriod shot in the more swollen lid 6 weeks ago and it is even more swollen. My eyelids were not even bruised or swollen after the surgery. The swelling started 2 1/2 weeks after surgery and has not improved. Thank you for any help you can give me.
Answer: I really cannot see how a blepharoplasty 12 month previously would cause swelling, it has to be something else I ma afraid. JG 6.7.12
About 8 weeks ago I had tear trough restylane done by my dermatologist, who is experienced. Had it done once a few years ago and only problem was big black eye on right side when adjustment of more filler was made. Bruising went away within a couple weeks. Don`t know why but this time not much bruising-only on right side but not a black eye. But results were awful! Left side within a day or two developed a pillow under eye. Right side still has a small bruise right under the eye. After 6 weeks, had the left side injected with dissolvent. No bruising and went down but still has a little pillow; was there before but seems a bit larger to me now. Asked derm if right side bruise was hemosiderin; he said he thought so and was confident it would eventually go away. Prescribed lightening gel (2% hydroquinone, some glycolic etc.) and Retin-A. Tried gel one time but stung. He said to apply cortisone cream in morning. Did that once but instinct said not to further aggravate. Only used Retin-A once too. Am religious about proper sun block. Anyway, became concerned discoloration was post-inflammatory hyperpigmentation because even though my skin is caramel colored, it is sensitive. Went to experienced plastic surgeon who examined and said he believes the discoloration is actually restylane that was not injected deep enough (Tyndall effect). Was surprised because it does not really look blue to me but maybe it is because my skin is brown. I did notice that it looks a little bubbly in that area. Said he can feel it and that it may have gotten into cheek hollow area but he could inject dissolvent if I want. He think that would dissolve it IF it reaches it. OR I can wait 12-18 months for it to disappear. He examined and touched my left eye and doesn`t think there is restylane left there. Looked at a before picture and noted a little pillow was already there (though it looks worse to me.) Question is- I am now scared to death that he is wrong and that another injection could cause hemo or PIH. I can cover the discoloration with makeup concealer but would rather it be gone. I am confused that my derm would not have recognized the problem; or maybe he just didn`t want to admit that he botched the procedure so completely (not to mention recommending bleaching gel that could really cause hyperpigmentation)? Questions: does plastic surgeon sound right? If I do not get dissolvent, as I at risk of this restylance seeping into cheeck hollow and the discoloration never going away? P.S. Plastic surgeon also does not think restylane in tear trough would address my concerns about hollows because right eye has a small space between cheek and hollow. thinks a blethroplasty (excuse spelling)would give me the results I really want. Thank you so much for your time and expertise.
Answer: I do agree more with the plastic surgeon, and since even the dissolving agent needs to be injected with a needle, there is a risk with that for bleeding and therefore the reactive hyperpigmentation. In view of that, if you can live with it until it dissolves on its own, it might be best. If you cannot, then dissolving it is a reasonable approach. I do not think the filler can seep into any surrounding areas at this point, so I would not worry about that possibility. Try to ride it out and then when all is gone, start over. I cannot give you an impression on the need for the blepharoplasty without seeing at least photos of the area though.I wish you the best. JG 4.11.12
I had upper blepharoplasty 3 months ago. I am not asian but I had very small eyelids 3mm. My doctor increased my eyelid crease to 7mm from my lid margin to my crease. I am unhappy with the size of my eyelids that show in the inner 2/3 of my upper lid when my eye is open. It is making my eyes look smaller because the lid crosses over the iris. The crease height is fine. The problem is that I want the lids thinner and to retract more. What can be done to correct this?
Answer: You need more skin for the skin to fold back, it might not be possible if too much skin has already been removed. JG 3.31.12
Dr., how do you decide whether to do a brow lift, temporal brow lift, or just upper and lower blepharoplasty(sp?). Is this a Drs decision ?
Answer: You need to look at what your face looked like 15 years ago, decide what has changed and fix that only. JG 3.11.12
Hello Dr. Garcia. Which is the best treatment for hollow lower eyelids - dermal fillers, fat transplant, midfacelift, or lower blepharoplasty? And also, which of these give longer lasting results? Thank you.
Answer: if it is the orbital rim, the fillers is the safest and easiest with the least risk. I do not think a midfacelift will help a hollow eye. If the eye is already hollow I do not think a blepharoplasty will help.I think fat grafting is unreliable and can lead to lumps due to the larger needles or cannulas used for infiltration. If the holowness is of the eyelid itself from excessive surgical fat removal, there might not be much that can be done. JG 1.17.12
I`ve had a blepharoplasty and canthoplasty but still have some bags under my eyes. My surgeon is suggesting CO2 resurfacing to tighten the skin. Do you think that will help? Thank you!
Answer: it depends on where the bags are, if they are herniated fat pockets or a festoon, I do not think the CO2 laser will help. If it is persistent fat pockets, it needs more surgery, and if it is a festoon, it will also likely need more surgery, but not through a blepharoplasty. Sorry. I wish you the best. JG 1.19.12
Hello Dr. Garcia..Is it advisable to have a Blepharoplasty procedure for hollow eyes, wherein they stretches the skin below the eyes to make it firmer? Is it long lasting? Thanks..
Answer: I thin the degree of improvement of the hollows by merely tightening the skin of the lower lids will be very short lived and the hollows will be visible again in a few months, once the swelling is gone. Sorry. JG 12.5.11
I`m considering orbital rim implants to support my lower lids following severe ectropion from an aggressive bleph. I had a canthopexy and two canthoplasties and still have the problem. What are the pros and cons of the ORI from your perspective? Some surgeons say they will help by supporting the lower lids; others say they will make the ectropion worse by exerting a downward pull on the lids. Which is correct in your view? Thank you for your help.
Answer: well, the problem is that it might give some structural support but at the same time as they will enlarge the area, they will pull on the skin and may potentially make the ectropion worse, although not in all cases. As your case is from an aggressive blepharoplasty, I would doubt you will get any benefit and the negatives outweigh the positives, in my opinion. JG 10.13.11
I had ear cartilage spacer grafts and a skin pinch blepharoplasty 8 days ago. I know I am early in the healing process but am worried the graft on my left eyelid may be bowing out or something - that eye looks like it has an eye bag (I never had eye bags before, only lid retraction and excess skin). How do I know if it is just swelling or if it is the graft becoming misshapen? My Dr. says it is probably swelling but I just wanted a 2nd opinion. Also, can ear cartilage grafts become misshapen after surgery (even long after surgery)? My Dr. says he applied a kind of meat tenderizing treatment to the cartilage to soften them but I am still concerned. Thank you so very much for your time.
Answer: Very early but I think it is swelling, usually if the cartilage is going to warp it does not happen this fast, it takes time. Hang in there and I wish you the best. JG 9.8.11
Hi Dr. Garcia, My son is 24 years old and has had bags and dark circles under his eyes ever since he was a small child. Although the dark color has gotten better over time he still has puffiness that makes him look as though he is very tired. Would blepharoplasty help him or is there another option for him as he only needs change under the eye. Thank you so much for your help.
Answer: At that age using fillers at the orbital rim would be a better option. those fillers should last 8-10 months and then can be repeated until he is older and needs something more than just fat removal from his eyes. JG 5.6.11
Hi Dr, Sorry one more question regarding the webbing at the corner of my eye...do you think it is better to go to a Ophthalmic, Orbital and Ocular Plastic surgeon? Is the revision at the corner of the eyes complicated and require a specialist? I don`t want any more skin out just a revision to stop the slight webbing and scarring in the corners from a lower lid external approach. thanks so much
Answer: it might be best to seek a specialist as what you will need is likely more complex than a blepharoplasty. You likely will need skin brought is and a flap or a skin graft, rather than more skin removal. All the best. JG 4.15.11
Hi Dr...I have asked you so many questions, and I really don`t know how you have the time for this, but thankful for your patience with all of us. My question: supposing botox lifts only the lateral brow, which I presume is the tails , does it then decrease the appearance of the very slight hooding at the very end of the eye, near the end of the brow? I know what I really need would probably be a blepharoplasty of the upper lids, but can`t afford the downtime or the cost, so going through the options and respect your thoughts.
Answer: if the hooding is slight, it will help, but the stronger the pull of your muscles, the less dramatic it will be. Just might need a good strong dose of the Dysport or Botox there. Best of luck. JG 3.29.11
Dear Dr G:: Can you please help me I had a Transcutaneous lower Blepharoplasty 3 years ago. I can see the scar and small dents at the corner of my eyes. It`s like the incision is not made to a point at the outer corners, the upper and lower lids don`t come together. What can I do? Everything I read now says Transcutaneous lower Blepharoplasty is an out of date procecdure and should not be done as skin tightening can be achieved with peels etc. Can my lower lid start to pull down in the future? I am scared.
Answer: I disagree that it is outdated, I think for the proper patient, it remains the gold standard, but is not for ell eyes. The curving of the incision away form the corner can be due to over aggressive skin removal causing some webbing, as you age, that can be revised with a small surgical procedure. I do not think that a trancutaneous blepharoplasty will prematurely age your lower lid skin. Best of luck. JG 3.24.11
Hi Dr....my question is twofold; I don`t like the scar that the blepharoplasty leaves over the upper lid, can that be disguised in any way?....and also, is a canthopexy a completely different surgery or is it a blepharoplasty that includes lifting the tails of the brows? Thanks for taking the time to educate all of us.
Answer: some people will heal better than others, but there will always be a scar, visible only when the eye ids closed. A canthopexy is an additional procedure on top of the blepharoplasty, it is usually done when the lower lids is not laying against the eyeball in its normal position. It can be used to alter shape of the lid, but it is most commonly used to correct problems that are not cosmetic in nature. Neither a blepharoplasty or a canthopexy will lift the lateral part of the brow, that will take a brow or forehead lift. All the best. JG 2.12.11
Dr Garcia, after much research and much help from you...I have decided that what would most be suitable to correct my problem is an upper blepharoplasty . I have read that some surgeons do this as an in-office procedure. I would like your opinion on this...do you do this? Also, for only the upper lids what is the ballpark cost? Thanking you in advance.
Answer: I think in office, as long as it is a certified operating room is safe, otherwise, I think it not a wise choice, just in case you need IV medications or something else. Prices vary from surgeon to surgeon and region of the country, so you need to call docs in your locale for the price variations. Best of luck. JG 1.28.11
Hi!! I had a transconjunctival blepharoplasty just to retire fat 4 years ago, i had a very strong vomit because something i ate in the morning today, and i made a great effort even i tried to close my eyes and no to do it, i have now small red points in my eyelids that i suppose are broken capillars, and a little swelled my eyelids and small pain, the question is that if it is possible the fat go out again because of the effort even if i had surgery.
Answer: I do not think that will affect the fat. JG 12.21.10
Dear Dr Garcia I had a lower transcunjunctival blepharoplasty 5 weeks ago. 2 weeks after surgery a hard lump appeared on my lower lid. The PS thinks its scar tissu and suggests warm compress. Ive been doing so (4-5 times/day) for 3 weeks but nothing changed. It did not soften nor decrease in size. Do you think scar tissu will resolve? Does it need to be surgically corrected? How soon after surgery can 5FU or kenalog be injected to soften scar tissu? Many thanks dr Garcia
Answer: it still might get better on its own and I would likely hold off on the injections for at least 6 to 8 weeks, all the best. JG 12.12.10
What would you recommend to get rid of the sagging at the jaw line and thin skin/wrinkles under the eyes?
Answer: a facelift and a lower lid blepharoplasty. JG 12.10.10
Hi Dr Garc�a: I had transconjunctival blepharoplasty 4 years ago (lower eyelids), just fat, not skin. I have had cried sometimes in the last days, i am pregnant and you know, the emotions are different. Sometimes i see a little swellen my eyes, but not as before the surgery. The questions are, could fat appear after a blepharoplasty if i cry or sleep bad? are those factors a cause of fat in the eyelids?, or, are the results of taking out fat of the eyelids definitively?, Is there something i can do to avoid that fat appears again?. Thank you
Answer: fat does not regrow, it is likely just swelling from all the changes you are going through. All the best. JG 8.27.10
Hello Dr Garcia, You are a saint to answer all these questions, it is all so helpful. Thank you! I am 53, in very good physical shape, no real problems with my body, but I had a hysterectomy 3 years ago and had surgical menopause and since then I`ve developed a sort of double chin with the slightest jowling. The rest of my face looks pretty good if you ask me, it doesn`t look like an obvious face lift need. Is there something I can do just for the neck to get my tight jawline back? Are there options with less downtime? Also, what is the best way to remove wrinkles and light bags under the eyes? Thank you again for all you do.
Answer: well a pure necklift will not fix the jowl region as it only pulls horizontally but a mini facelift might be able to tigthen the neck enough and lift the jowl region superiorly into a better position to give you the desired improvement. As to the eyes, if you have both of those issues it might be a lower lid blepharoplasty with skin excision and fat removal or repositioning. Best of luck. JG 7.18.10