NOTICE: 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.

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• Hi Dr Garcia. Had upper and lower eyelid surgery two weeks ago. I now have two pea sized lumps in the outside corner of one of my eyes. One on bottom and one on the top. I`m not sure if this is normal and what can I do for it. Would heat help it? Should I massage the area? That eye is also alot more swollen than the other eye. Feeling very stressed.

  Answer:  not uncommon, can be some swelling from the stitches placed beneath the skin, warm moist heat, light massage and time should help them go away. Not uncommon for one eye to be more swollen than the other at this point, should even out over the next 3-4 weeks though. Hang in there, it will get better with time. JG 1.31.12

• Dr Garcia, is a temporal brow lift a lift that only lifts the outer corner of the eyes? I like the position of my brows, I just don`t like the corners starting to droop. I feel like a brow lift would give me a surprised look. I have tried Botox twice....once didn`t make hardly a difference (in fact I wondered if I`d been injected with water), and the other time I developed bags under my eyes and very, very slight lift. Would I benefit from a temporal brow lift, or any other suggestions.

  Answer:  A temporal brow lift will only lift the outer part and may be exactly what you are looking for. JG. 1.29.12

• I have been considering lower eyelid surgery for baggy eyes and wrinkley loose under eye skin. I am 54. Prior to deciding I had filler (restalyn) injected under my eyes and a bit of botox between eye brows. It certainly was an improvement. The Dr was very conservative and suggested a 2nd visit after 2 weeks to evaluate to see if more was required. I really appreciated this. I now think that bit of botox for crows feet and a bit more filler for a small baggy area not done under eye would make all the difference. woud this also help the wrinkles by slightly stretching? I do not want to be puffy. Woud a small amount of filler at brow bone lift upper eye lid a bit as well? I am not looking for any dramatic difference just enough to help the oh you look so tired comments stop. Thank you

  Answer:  I do not think there wil be much change in the wrinkles with a filler injection I am afraid. Sorry. JG 1.22.12

• Im 60 and 10 weeks post Upper/lower eyelid, neck lift, mini brow lift and my righ eye is big an beautiful but my left eye is small and sunk in. My PS acts surprised every time I bring it up. Can this be corrected another proceedure

  Answer:  the size might be able to be altered, as to the sunken appearance, I cannot say whether anything can be done without seeing you, if it is over aggressive fat removal, there might not be much that can be done. JG 1.9.12

• Dr. Garcia, What kind of treatment can I get to reduce the undereye circles?

  Answer:  Topical creams can help in some people, if it is just the circle where the eyelid meets the cheek, then fillers might help. JG 1.17.12

• I am 9 days post op- had upper and lower lids done with lower lid muscle suspension and lateral brow lift. All stitches were removed on day 6. My lower lids seem tight and are slanted, especially right side. PS says it will relax and loosen with time. Is that the case and if so, how long does it take? Also my right upper lid has a pulled area ( not sure if this is from brow lift or actual muscle was cut). But since swelling has decreased, it looks like a dimple-hard to describe. Will this resolve? Thanks do much.

  Answer:  it is common for the lids to be slanted, especially when mixed with muscle tightening and a lateral brow lift pulling. No way to say how long it will take, but it will look better in another 3-4 weeks. Final results might take a few months. As the sutures below the skin absorb, the dimple should also get better. All the best. JG 1.15.12

• I`m curious as to my malar mounds/festoons, I`m 34 and believe that I have them from years of sun damage. After doing a lot of research I have a feeling when I go to see a specialist they are going to tell me I need a lower blaph., is there anyone in the VA Beach area you know of who could give me the best evaluation even if it is a direct excision (which I`m very open to)? Also, how long/big are the scars on the cheek and do they improve with time after a direct excision? Thanks so much for having this great site, much appreciated!

  Answer:  might suggest James Carraway. The scars will vary in length depending on how big the festoon is. Best of luck. JG 12.24.11

• Hi Dr. Garcia. After my blepharoplaslties I continue to have conjunctiva edema four weeks out. I have tried warm soaks, light massage from the corner of my eye up. By 5 pm each day my eyes are dry and feel like there is a foreign object rubbing them. I use lubricating eye drops. Is the duration of this normal? what else might help and would a steroid eye drop help to resolve the edema.I have no problems with vision. I look like I have jelly eyes. THanks for your input.

  Answer:  It is unusual unless canthoplasties were also done. I thinks syeroid eye drops would certainly help it resolve. Best of luck. JG 12.11.11

• Hi Dr Garcia, do you think using a filler like radiesse would work as a filler to plump up in high cheek area going in through the mouth, to help minimize festoons or would it make them just stick out further. Thanks so much

  Answer:  I think going through the mouth has a higher infection rate and you need to go through muscle, whereas you do not when you go through the skin. I think it would not help a festoon when done through the mouth. JG 12.10.11

• So if festoons are caused by a separation of the cheek and orbital muscles, why can`t those muscle edges be sutured together to eliminate the gap and so to prevent the accumulation of fluid in the hole?

  Answer:  they can, but they are very difficult to reach through an eyelid incision without causing skin damage to the skin from the eye lashes to the festoon. JG 12.7.11

• I had upper bleph about a month ago....the lines are still quite thick..is this normal. Will the eye are in general, continue to improve..or is what I see now, pretty much the end result. Thank u and Merry Christmas from Canada. Jg

  Answer:  it can be normal, it varies from patient to patient and can be more common in cases where sutures were placed that dissolve on their own as they cause more irritation. I think you will probably look much better in a few more weeks, that skin is quite thin and even small amounts of swelling can look disconcerting. Give it some more time, I am sure things will get better. All the best and a Merry Christmas to you too! JG 12.6.11

• Hi Dr Garcia, thank you so much for this very informative website!! I was wondering what your opinion of the new Dr adam Scheiner procedure for removing festoons by laser? He was on the Dr oz show, talking about removing the top three layers of skin by laser to get down to the layer for new skin to grow. Thus removing the festoon. I was wondering do you think it could work and what you thought about it. Thanks so much for your help and providing us so much helpful information.

  Answer:  I think the improvement will be short lived as the cause of the festoon is not a skin issue but a separation of the muscle of the orbit and the muscles of the cheek, in that watershed area, edema becomes trapped and causes the swelling. Sorry. JG 12.6.11

• Good evening doctor. Had upper bleph yesterday afternoon...skin removal only One eye (lid area) is considerably redder than the other eye. Is this normal. (no redness in the eye area itself). Guess it is somewhat naive to think both will heal at the same rate. Thank u and have a nice weekend. Jg

  Answer:  Very normal at this point, they will even out over time. JG 11.12.11

• Dear dr Garcia, I have two unrelated questions: the first one is about pearl grafting to the lower lids. Some doctors claim that the results are permanent, but isn`t fat grafting always impredictable? I had some fat injections in 1998 and all the fullness disappeared within 3 months. A new doctor said the reason was that the fat was injected too superficially. Could that be the case? The second question is about prominent veins on my temples. Can they be eliminated? I remember seeing an ad in the UK that advertised a laser procedure for bulging blue veins in the face a couple of years ago, but I`ve asked around in Italy, where I live at the moment, and on the face they would only treat small (red) thread veins. Thank you for your service, sometimes it is impossible to find impartial opinion on these matters.

  Answer:  They can claim all they want, but it is not permanent, actually pearl grafts being large, have a higher resorption rate and higher chance of lump. For the fat to survive it needs new blood supply and injecting it just underneath the skin, will not work, with that I agree.I do not think the veins in the temple can be removed, but they can be hidden by injecting Sculptra to thicken the covering over them. All the best. JG 11.11.11

• Evening doctor. I am having upper bleph surgery on Friday and my doctor has asked me to take 1000 mg FOUR times a day of vitamin C for three days prior and one week after.. That seems like an awful lot. I am also taking Arnica and Bromelaine. Just wanted your opinion on the vitamin C. Thank you.

  Answer:  I think at that does it is no longer an antioxidant and becomes an oxidant. Unless you have scurvy, taking that high dose is not needed, once per day is more than enough for healthy people.JG 11.9.11

• Hi Dr. I am having some skin removed from the upper lids (upper bleph) on Nov 11...will I be ok with makeup to be seen in public. Thank you.

  Answer:  a day after the stitches are out you can apply make up, but not until then. JG 10.14.11

• Hi Dr. Garcia, now that I`m getting my eyes done (upper and lower) how can I achieve the best result? And how should I take care of myself and my eyes to make sure everything heals right? What are the cons of this procedure? I`m sad to said that many in your profession (not you, of course) seem to make a point of omiting key information. Had I known years ago, for example, that getting lipo would make my cellulite worse I most likely wouldn`t have done it. But my PS conveniently left that out. Thank you!

  Answer:  the important things are to follow all of the instructions your surgeon gives you, do no lifting after the surgery until you are cleared to do so. Avoid any OTC products that might thin your blood like aspirin, Motrin, Alleve, ibuprofen. Take your pain pills in order to control your blood pressure and take it easy. The cons are really minimal, if you have excess skin and fat of the eyelids, it is likely time to proceed. I wish you the best. JG 10.8.11

• Dr Garcia I contacted the local university of opthalmologist as you suggested. Thank you for that. I had one surgeon in mind but was not sure of. the uni assured that he is a great eye surgeon. I hope he is. I am planning to see this one . So thank you for that...

  Answer:  keep me posted. JG 10.6.11

• DR GARCIAAAA.....................I had canthopexy and tarsal strip done on my left eye after surgeon telling me I have dry eyes on my left. Im 31 now and was 29 then. I hate the result and mmy right eye is different from (lower corner point then the left). The aperature of my eye is so small with my left. I saw this new surgeon who at the consultation told me he will help correct (Im not going to the surgeon who performed it because he keeps telling me there isn`t anything wrong or the right eye needs a surgery too) I seen the new surgeon again today and this time he was so hesitate to even do anything about it. He told me canthopexy won`t be able to be reversed and he just won`t touch it. And he told me he will put fillers on my lower right eye , under the muscle to lift it high as the left. I`m so upset. I want this problem to improve somehow. My left is alot smaller then the right. I don`t think the filler will change it. He said things like the first surgeon actually did a good job this time..etc... and something about court*. I can assure him (if he asked me directly) I am not planning on suing I just want this problem to be fixed. DR GARCIA.... please tell me if this can be reversed ? or will the fillers even help to lift the lower eyelids?..... I want both my eyes to look the same... I`m so upset. Please suggest something.....

  Answer:  undoing the canthopexy is not always possible due to scar tissue. That having been said, certainly the canthopexy can be cut and an attmept at repositioning it, but it can be a very difficult thing to do. I am not sure why there was a change of heart in the docs. Might suggest seeing an opthalmologist at your local university for the to render you an opinion and possibly correct your issue. I wish you the bast. JG 10.6.11

• Is there a procedure out there that can remove fat under neath the eye without surgery. I had a lower eye surgery done 2 years ago and the surgeon did not take enough fat from under my right eye. Mt left eye looks great byt under the right eye I have a little bit of fat that is quite noticeable. How can I fix this,

  Answer:  For fat removal, there is only surgery. Sorry. JG 9.15.11

• I`m the one with the ear cartilage questions - I`ll only bother you 1 more time! You get back to me faster than my actual Dr., so thank you! 1. The swelling under my left eye is much worse than the right. (I don`t sleep on side or the other.) Is this normal? I`m now 10 days out. 2. will the ear cartilage graft eventually incorporate with the surrounding tissue?

  Answer:  it is more common for swelling to more on one side than the other, one side always swells more, and in the eye area, small differences look bigger. The ear cartilage will eventually form firm scar tissue, not true incorporation, and the ear cartilage does not survive in the same state as it did before, yet it can still support the tissues and skin. JG 9.9.11

• Wow, thanks for your fast response. So is it likely that the cartilage grafts will warp in the future? About when would I know? Do they settle down once they have healed (do they incorporate with the tissue around them)? Thanks again.

  Answer:  They do not always warp, it can happen slowly over time, hopefully with the tenderizing, it will not happen. JG 9.8.11

• 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

• Thanks Dr Garcia about the question of the lower lid ectropian.(New Zealand) I think there was indeed a misunderstanding! I will get him to contact you again directly at the email address you gave me.

  Answer:  No worries, would be happy to see him and offer some advice. JG 7.14.11

• Hi Dr Garcia Your staff said they received the photo sent of my DH`s lower, post blepharoplsty eyelid problem (from New Zealand,) but I have received no reply from you. He is in a bit of a state about it and a reply would be very much appreciated. Thanks

  Answer:  Uour letter said he was going to contact us,putting it in his hands is what I believe you said. I am sorry if you had not received the response, it was from my private emal and in the subject matter it read : from Dr Garcia. I would be happy to see him qn to offer some short term care while he is here but he will likely require more surgery to correct his ectropion. JG 7.14.11

• Hi Dr Garcia Did you receive the photo I sent from New Zealand? I sent it a few days ago.Just wondering if it arrived OK

  Answer:  yes, we did. JG 7.13.11

• Dr Garcia My husband has just had ( 4 weeks ago) a lower bleph and has what looks like a complication. Am I able to send you come pics please. We are `downunder` but he will be in Las Vegas lecturing in a few weeks. His eyelid surgery was was to correct ectropian but his problem is much worse.I am very worried as eyes are so important.

  Answer:  Please send pictures to drgarcia@lvcosmeticsurgery. JG 7.9.11

• I was informed by my Opthamologist today that I have periorbital edema and fat pads. Can this be corrected by surgery? Does the edema and fat pads always get worse or can they stabilize

  Answer:  The fat pads an be treated with surgery, but not the edema. JG 7.5.11

• It`s me again Dr. Garcia. It`s not almost 5 mos. since too much Botox inject. and have fluid/puffiness/fat pad under eyes. It is absolutely devastating. Can this fluid travel to rest of face or stay in orbital area? How long can it take to go away and will the undereye skin ever be same? Thank you so much. Right eye is worse than left eye

  Answer:  no, it cannot travel to other areas. I have never seen it last more than a few weeks, and typically gets better as the effects of the Botox start to diminish. Sorry to hear about the problems. JG 7.3.11

• In your last answer you stated since I had too much Botox injected the obicularis oculi muscle is relaxed not damaged. Does that mean in time the undereye fluid/puffiness will go away. Thank you Dr. Garcia

  Answer:  yes, it should go away. JG 6.29.11

• Dr. Garcia, thank you for answering my other question. I have fluid/puffiness under right eye after Botox injection undereyes/crows feet/between eyebrows. I realize I had too much Botox.It has been 4 mos. now if obicularis oculi muscle was damaged will the fluid/puffiness go away even though it has been 4 mos. Thank you again.

  Answer:  well, you had too much Botox, and you had it in the wrong unapproved area. The muscle is not damaged, just weakened as any muscle would be after being injected with Botox.Its is all the injectors fault. JG 6.28.11

• Thank you so much for answering my prev. question regarding undereye fluid/swelling after botox injection. Is it unusual that it now has been 4 mos. and it has gone away under the left eye, but not the right. There may also be a slight lump under right eye. Needless to say I am very concerned. Thank you again. Is it true that if it is fluid surgery cannot be done?

  Answer:  yes, surgery cannot repair swelling, if it were fat, then maybe it could help. JG 6.28.11

• In my previous ques. I forgot to mention that within a 2 mos. period I had about 140 units of Botox (crows feet/betwen eyes/undereyes I am so worried this is why after 4 mos. I still have fluid/swelling particularly under right eye. Do you think I permanently damaged muscles and this will never go away. I am so worried and concerned that the undereye bag (fluid) is permanent. If it is permanent could this be corrected by surgery

  Answer:  I don`t think it will be permanent, and if it is swelling only, there is no surgery to correct t it. JG 6.28.11

• Thankyou for taking my question. Four mos. ago I had botox injection under the eye and now I have fluid and swelling is this permanent or will it go away. It has been 4 mos. now and I am very concerned. Do you think I had too much undereye botox inject. and ruinted the muscles and it will never go away.

  Answer:  It will go away once the Botox wears off. Botox should not be injected into the eyelid because of that and the risks of ectropion. Best of luck. JG 6.28.11

• Dr Garcia what`s your opinion of the new 3D tech. face lift I`ve seem advertised? Is it just another advertisement gimmick? thanks!

  Answer:  Yup , gimmick. JG 4.26.11

• Dr Garcia what`s your opinion of the new 3D tech. face lift I`ve seem advertised? Is it just another advertisement gimmick? thanks!

  Answer:  Just a gimmick, yes. JG 4.26.11

• I have been diagnosed with Intraorbital Edema would eye surgery be helpful in this situation. Thank you for answering my question,

  Answer:  Well, it would not be eye surgery that would help. It would require breaking the bones to eliminate pressure on the eyeball , but treating the edema usually does not require that. JG 4.25.11

• Dr garcia What is your opinion of ultherapy for tightening the neck? Thanks

  Answer:  don`t think it will last too long, the FDA approved the face and only followed the patients for 3 mo=nth,s what happens after that, one can only guess. JG 4.20.11

• Dr. Garcia, Thank you for taking my question. I had a neck sprain and going to physical therapy but now have edema under my right eye. Is this permanent or can something be done? I am miserable and am looking for answers

  Answer:  not sure why you would have swelling around the eye form a neck injury, you should see the doctor who sent you to therapy to get an exam, I wish you the best. JG 4.17.11

• 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. If i have severely dry eyes, is a bleph still a possibility. I am 55 and have a slight droop right eye (looks like lazy eye but it`s not-forgot the name of it the PS told me) and the left one is also starting to develop this. thank you

  Answer:  can be as long as the skin removal is conservative and a canthopexy is done to avoid lid retraction. JG 4.4.11

• Answer: 

• Thanks you for your answer regarding to much skin removal that causes webbing at the corner of my eyes as I age. I have another question. If I have surgery to fix the corner of my eyes, wont that take out more skin and make the problem worse?

  Answer:  removing more skin is not always done, it many times is rearranging what is there to reduce the tension at the incision, done with small skin flaps. Best of luck. JG 3.25.11

• 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.Garcia, can you address the difference between a regular/endoscopic brow lift and a temporal brow lift .

  Answer:  between the endoscopic and the open forehead, the open forehead removes scalp that is in excess and I personally feel yields a better and more long lasting result. As to a temporal lift, it is just the outer side portion of the brow, lifting the lateral aspect of the eyebrow and not doing much to the central forehead or eyebrows. Hope that helps. JG 3.6.11

• 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

• What is price for lower eyelid surgery? Although I do not have a fat pad to remove, I have a couple lines of deep wrinkles I was born. I am hoping to have the skin with those lines removed. Would this cost a lot less than lower eyelid surgery? Also, can this be done with local?

  Answer:  I do mien under deep sedation or general anesthesia, never under straight local as I do not want you moving when I have a scalpel in my hand and the fee is about $3,325, all inclusive. JG 2.4.11

• 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

• In your answer to my previous question regarding an eye lift you explained that the eyebrow lift should only be considered if the eyebrows have descended which I don`t believe is the case. I actually like the position of my eyebrows, which may explain why the botox lift didn`t do much. My question is; in the other surgery that just addresses the laxity of the skin above the eyes...will the tails of the eyes be lifted? I am thinking this is what I really am finding is the problem...at the end of the eye, where a more youthful eye kind of arches upward, mine is starting to have a hooded effect so I am wondering if this kind of surgery lifts that area? Sorry to be so lengthy, kind of hard to explain the look .

  Answer:  surgery can remove the skin but if you are trying to elevate the corner, that can be done with a canthopexy but will make your eye look different than it did when younger as the end point of the eye opening will be lifted upwards. JG 1.24.11

• I have a question about the skin on the eyes, directly above the lashes...at 48 years old I am noticing that the skin is very lax now and when using eyeshadows the color just seems to hide in the folds of the skin. It is very upsetting and makes me feel old . Does an eyebrow lift address this, or is this better corrected with the surgery that actually removes that lax skin. I should add that it has taken away the almond shape of my eyes causing the outer sides of my eye to look almost hooded , but not as bad as some. Can you give your professional opinion as to what type of surgery needs to be done here and approximate cost? I thank you kindly.

  Answer:  if the eyebrows have dropped, then the eyebrow lift is the better option, but if the eyebrows are in normal position, then the eyelid skin is what needs to be removed. Lifting the brows if the brows were in good position to begin with will leave you looking surprised. All the best. JG 1.15.11

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