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. All responses are done personally by Julio Garcia.

• Dear Dr. Garcia, I am 3 weeks post op after having lower eye canthopexy along with a facelift and lateral browlift. Your informative website has made me more aware of possible side effects with every procedure. My main concern are my eyes which now are smaller and almond shaped. I cannot look in the mirror without crying. I speak at different events and I do not want to wait too long to have a revision done.My doctor says he can relax the muscles using a local in his office. Is that the same as cutting the stitches of the canthopexy? How soon can I have it done and how complicated is the procedure? Thank you so much. A.M. 2/24/08

  Answer:  well cutting some sutures that suspend the tissues might be able to be done under local anesthesia and might be best to do them soon before scar tissue becomes too well formed. Best of luck. JG 2.24.08

• Hi Dr Garcia. 1-How is the surgery * widening the eyes and giving them an almond shape * performed? 2-Why is it called Asian Surgery or Surgery for Asian eyes? ( I am not Asian but a Caucasian and would like to have this surgery performed just to WIDEN my eyes and give them an almond look , WITH the EXTERIOR canthus SLIGHTLY higher than the interior ) 3-I HAD upper and lower Blephaloplasty performed 5 years ago and i am satisfied , so how different will be the widening eyes surgery . Can you give technical details , no site or search i could find ... ( i think that canthoplasty will not either achieve it ! ? MANY THANKS

  Answer:  well the alomond shape is done with a canthoopexy by shifting the lateral ligament of the eyelids higher and might appeard wider but will make the aperture smaller actually. It is called Asian eye surgery becasue it can cant the corner of yoru eye up to look more oriental. I will say that what you desire is not always possible. JG 2.24.08

• Dr,What is your opinion re: Cosmelan ? You had recomended a series of YAG laser treatment at 1064 setting to get rid of the dark skin under the eyes that i ended up with as a result of Blepharoplasty and the PS using a light TCA peel for the bruise that would`nt go away.My course of treatment per the new PS is as previously mentioned Light micro dermabrasion, which you agreed with. Which treatment would help me the quickest (1) micro dermabrasion (2)Cosmelan? or the YAG LASER. I will be in Las Vegas in 2 weeks and would like to see you. Will you be available? .If you could give me your opinion re: the 3 treatment options or others . Thank you for all your help.

  Answer:  I think the YAG laser is the best and more specific, the Cosmelean will help but has the risk of reactive hyperpigmentation. JG 2.23.08

• Dear Dr, I have two questions, I am a 37 year old Indian male who has recently suffered Adrenal fatigue and developed dark circles and puffiness around the eyes and aged several years in 5 months with wrinkles and sagging which I have never had before. I am in recovery, but I do not think the dark circles will go. Can you recommended what I can - will surgery help? I know it is difficult to treat in dark skinned people. Someone recommended Amelan cream? Also, what can I do to tighten the skin again? Will a laser treatment work such as Rhytec? Thanks for your advice

  Answer:  the creams and lasers will not work as it is due to loss of the fat below the skin, it might be helped with fillers such as Juvederm or Restylane short term, but they might not help as much as desired. JG 2.22.08

• I am considering a bleph. using laser. I am a little skittish after reading some of the problems with surgery. Does the laser decrease the issues with swelling and bruising? I had botox for wrinkles in the corners of my eyes and bruised quite bad. Thanks Sally

  Answer:  lasers do not decrease anything during a blepharoplasty, it does increase the surgoen`s wallet due to promises made from marketing.JG 2.21.08

• Dr. Garcia: A doctor that I consulted with out of state has recommended a levator fixation for small ptosis in one eyelid. What is involved with this procedure? Are there incisions? Will I have stitches and if so, how long will the stitches have to be in before removed. Thanks.

  Answer:  it is a surgery done through an eyelid incision to re-attach the muscles of the lid to the cartilage so the eyelid opens more normally. Sutures are usually in place for about one week. JG 2.20.08

• Dr, Thank you for your prompt reply to my question re eyelid surgery. I will be coming to Las Vegas in 1 month. I have seen another PS here in Miami, his course of treatment is to give me Mela-D (a skin lightening cream) and do a series of very light micro dermabrasions( once every 2 wks). He also said which i agree with, is that i do have a lot of hyperpigmentation. Is that an acceptable course of treatment? I was told that i would see results after about the third treatment? As i come to Las Vegas atleast 1, sometimes 2 times a month i would like to see you re the YAG laser treatment. Would the laser darken the skin before it fades away? Also have you heard of cosmelan? Please advise re course of treatment and if you concur with the PS. I would like to schedule an appointment with you either way when i get to Vegas? Thank you once again for all your help.

  Answer:  I thik what they have planed is a good course of action for now, it can always be done more aggressively if needed but that should be avoided if possible due to higher risk profiles. The YAG treatments are something that need to be done every 4 weeeks in a series so twice per year is likely not as good or worthwhile. JG 2.20.08

• Dr, In early dec 07 i had a Dermafiller injected under my eyes. 10 days later i had under eye surgery with fat Tranplantation. 4 weeks later the bruising under the eyes had not gone. I went to see my PS who decided to put a light tca peel on the bruise. 2 weeks later the bruised area was darker than ever, under both eyes. The PS then injected the area with hyaluronidase he did this a couple of times.The area under the eyes is badly discolored, i am a male of mediterranean descent and have dark olive skin due to a lot of sun exposure and also do suffer from mild Hyperpigmentation.The darkness seems to be fading, but as my business demands me meeting people face to face everyday i feel terrible. I need to get this resolved asap. Also i never want to go back to the PS who did this. Is there any thing that i can do to get rid of the severe discoloration or is it still bruised.? Please let me know,what can be done i am willing to get on a plane to come and visit you if need be. I live in Florida. You come highly recomended. Thank you for all your help in advance?

  Answer:  well, I am a little confused as to the course performed as a TCA peel will never help a bruise and hyaluronidase wil help dissolve a hyaluronic acid filler but will not help a bruise either. I think you might benefit from a laser like a YAG at the 1064 setting, it will likely be a series so I suggest finding a dermatologist or plastic surgeon near you to make it more practical. I am also confused why there was a filler injected and then a eye surgery so close afterwards. Best of luck.JG 2.20.08

• fat transposition - a doctor stated that after a procedure like this their are sutures along the tear trough area, which will need to be removed in a few days. the bone has a touch coating called the arcus marginalis, which coats to the bone of the eyesocket. This is lifted up which has a lot of good blood supply. then tuck the arm of fat under this tough coating and secure it with a suture. The suture prevents it from slipping back into its original fat pocket. after a few days the fat is glued down, and the temporary suture can be removed. He had a lady contact him that her fat transposition didn`t work that her fat returned to previous right after the swelling went down. after investigating - he found that the surgeon didn`t use those temporary sutures along the tear trough area that allow the fat to glue down. What is your opinion on the fat transposition lasts if a doctor uses the temporary suture along the tear trough in order for the fat to have time to glue down and not slip?

  Answer:  I think fat transposition fails in some cases for different reasons, lets stat by saying that putting sutures in place for a only few days will prevent it from moving is not true, and actually, the more aggressive the pull is, the less likely it is to hold. The fat is not meant to be placed over the rim, and unless it is really bulging quite a bit, any pulling of the fat out to an area where it does not belong, can fail. The reason the line is visible as we age is twofold, one is because the fat might bulge out, and in the past when the fat was agressively removed, down the road, it left a hollow appearance. The other thing that makes the line visible is that there is fat loss over the line and what is being attempted is to move the fat you do not want to remove over the area where it has been lost, the poblem is the tension, if there is tension the sutures fail or the fat moves back and the correction is inadequate.Nature likes to pull things back to where they belong and transposed fat does not belong where they are putting it, it is therefore a compromise. JG 2.17.08

• Hi, I have a question for you. I had a upper/lower bleph on Nov 5. I am fine with the upper but feel the lower looks awful. I seem to have way more wrinkles and they start on top of my cheeks when I smile. They are very deep. Way worse than before. The PS says there is still some swelling and I am a slow healer and that they should get better but they do not get better, only look worse.My question is, if too much fat taken out and what kind of revision would you be able to do.Thank You also I have several bumps under my eyes which he says is milia and will take a very long time to heal. I look older rather than refreshed. I am just sick about this. What are your thoughts? Thanks so much...Kim

  Answer:  it is very difficult to replace over-resected fat, but that will not always give you more wrinkles. The milia are easy to take care of, they just need to be opened by your doctor with a small needle. As to the wrinkles though, I suggest a good moisturizer and lets hope it is just the swelling that stretched the skin out and it will snap back. JG 2.14.08

• I just entered a question re temporal brow lift/upper bleph. Forgot to mention that I the whole of my head of insenstive - it has been 3 months now. Am I still healing? Thank you once more

  Answer:  probably nerve stretching causing the pain. JG 2.14.08

• After my temporal brow lift and upper bleph (not lower bleph) of 3 months ago now, I am still having problems. The area above my brows and sides of eyes are still tender and feel hot all the time. My cheek area appears a little swollen and has a rounded up look (even though I only had upper bleph). 1. Is it possible that I am still healing after three months and should this improve? 2. What can I do to improve this rounded under cheek area? Thank you so much for your help

  Answer:  it is hard for me to say without seeing you in person but it is all unsual I feel, the hot feeling might be nerves that were stretched and they are trying to come back. JG 2.14.08

• 7 months ago I had fat grafting done to my left upper eyelid for hollowness. The lid looks fuller but now my lid is 0.5 mm ptotic and does not match the other eye. When I lean my head back; the eyelid with the fat grafting protrudes forward some and when in upgaze; there is more lid on the side with the fat grafting. Can anything be done for the ptosis?

  Answer:  tough call, it might hbe better with the fat being removed if it is due to the weight of the fat, possible. Also a likely issue is the needle used to inject the fat could have damaged the muscle of the upper lid and a muse repair might be needed to correct the problem. JG 2.13.08

• I had ONLY a lower lid bleph with excess skin removed done about 13 weeks ago (3 months and one week). This was done with an incision underneath the lower lashes. I had terrible swelling and bruising of both the top and lower lids. I have bulging under both eyes and on the right eye the color is very light almost white. It is the size of a quarter, but half of it (like a moon shape or banana shape). The left eye is less noticable, but bulges. The doctor finally told me 2 weeks ago he transferred fat in the left eye and that it is fat. He has been injecting me with cortisone shots in both bulges. He has done this 3 times already with 3 week waiting time. Will this ever dissolve? Or is the shots a waste of time and/or will I need to have this redone again? He has not told me what the right eye bulge is... I think it`s fluid, but it could be fat there as well. Can this be drained? HELP me please.. Thank you.

  Answer:  the resposne to fat injections or fat transfers to steroids is unpredcitable so it might need more surgery to correct the problem I am afraid if it does not respond in the next couple of shots. The fat cannot be drained and I seriously doubt that there is any localized fluid from the surgery that can be drained either. Best of luck. JG 2.12.08

• On a consult, a ps suggested that he would do an u/l bleph - with the lower bleph he`d just do a skin pinch, but when I asked if this would take care of the undereye puffiness - he told me I bad a small amount of fat protrusion - not much - he`d take only a little fat out, and then after three months I could have restalyne in the tear trough. I really don`t want a continual maintenance program that I`d have to adhere to? Why would I need the restalyne with what he is going to do? Does this mean that by taking a little fat - it may make me look hollow towards the eye? Someone else recommended fat transposition, but I thought on your website you mentioned the fat doesn`t always stay in position. I`m confused on what would be the best choice. Maybe just do the upper and leave the bottom alone? Can I just have the skin pinch and leave the little fat? Do you have an idea of what is the best choice for best outcome in this type of scenario? I`ve never been told I have hollow eyes now? I don`t want to create hollow eyes and have to use restalyne regularly.

  Answer:  fat removal might not correct the darker line of demarcation at the orbital rim and that is why at times a fller is needed. You are correct, I feel that transposition of the fat can at times be unreliable too. It certainly is possible to do the upper and only skin on the lower, might be the safest. JG 2.12.08

• Hi Dr Garcia, I underwent a Rhynoplasty and upper and lower blephoplasty 10 days ago, i seem to be healing ok with hardly any bruising. I have noticed i have quite a lot of whites showing on the bottom, and i look quite scary, is this normal? If it doesnt go can it be corrected.

  Answer:  it can be normal at this point due to swelling and should be better in the next few weeks. JG 2.10.08

• Can you perform a blepharoplasty on the upper eyelids to make them smaller, and get the wider-eyed look, as Jessica & Ashlee Simpson were rumored to have done? I`m a 24 year old female.

  Answer:  sorry but I do not do that and am not sure what they could have done to have that effect. JG 2.9.08

• Hi Dr.Garcia! I just had my corrugator removed via eyelid incisions. My eye lids are incredibly bruised at 10 days. I mean solid black and purple - not a hint of non-bruised skin showing through. It almost looks like giant blood blisters. Realistically, how long before they are completetly gone? 6 weeks? I`ve had a ton of surgery and never bruising like this. I`m not a heavy bruiser. This is plain nuts!! Thanks much!!

  Answer:  I think if it is that bad that 6 weeks is likely a reasonable number. Warm packs, light massage and Arnica Montana will help, best of luck. JG 2.8.08

• hello dr Garcia. I want my eyelashes to regrow after having it fall out from the eyelid surgery. Will Jan Marini eyelash product work?

  Answer:  it wil help what is there get thicker and grow faster but you better hurry becasue it is being taken off the market for patent infringement violations. JG 2.7.08

• hello dr Garcia. I had Canthopexy. I lost my lashes from the outer corner... PS said he never touched my eyelashes... but they fell out. Will they grow back. PS said he didnt touch them so they will grow back but it feels like the scars are on my outer corners and thats where my eyelases were extending to. SO now I dont have eyelashes at that part .. will they growww backkkkkk??? Thankyou

  Answer:  could be just from the pulling and swelling frm surgery, in almost all cases they grow back when that happens. JG 2.7.08

• It`s been over 2 months now since I had the upper eyelid surgery. The eyelid still look tender and red without make up and still doesn`t feel or look natural. Will all these heal and feel natural in time, and when? Also I really miss going swimming, is it okay to start swimming again, if not, when will it be ok. Thank you Dr Garcia for being here for us. Answer: I think swimming is PK and it will get better in time, some people just talke a little longer is all. Hang in there for a little while longer. JG 2.5.08 doc, please tell me what PK means. Thank you.

  Answer:  uncommon but still not out of the normal range, some people`s skin is just very sensitive and that can happen, I think swimming is OK at this point though, hang in there. JG 2.7.08

• Hi doc i have a question on the white part of the eye. before i start using hard lense contact lense, the white part of the eye used to be very bright, but after using the contact lense for about a year they white part is brownish with vessesls showing. so i stop using the contact lense for about 6 month now but its still has many vessessls in it. it dont itch or burn, so it might not be infection. is there anything or any procedure to whiten the white part of the eye. thank you very much, doc

  Answer:  nothing the eye doctor would likely do for a cosmetic issue, although lasers can reduce the red veins if the doc is willing. JG 2.6.08

• Thank you for your response to my question Dr but forgive me for asking, what does PK means?

  Answer:  don`t recall the question you are referring to, sorry. JG 2.6.08

• Re the problems I have with upper bleph, apart from the fact that my eyes seem smaller and outer corners tighter. I also feel a tingling under the whole of my under eye area. When I look up there is a pulling/stretching. Remember only had upper bleph. I was trying to put some drops in my eyes and found it more difficult than before to open my eyes to do this properly. My surgeon is out of the country and will be for a month. Am I still healing after 3 months? Why do you think this is happening? Thank you so much

  Answer:  it should not be that way after three months, especially after an upper lid blepharoplasty, hard for me to tell what has happened though, sorry. JG 2.6.08

• I still have problems with my upper eyelid surgery. The outer corners of my eyes feel really tight, the width of my eyes smaller. I have a pinched in feeling. What could be causing this?

  Answer:  it can be the sutures placed for the canthopexy or the tissues scarring in where the canthopexy suture was placed. I think you should go see your surgeon to have them evaluate you. JG 2.6.08