Question:

I am 54 and have heavy eyelids, will my Teamster's Insurance cover any part of this Surgery ?

Answer:

If you have a field of vision test and it shows loss of peripheral vision, then an eye surgeon/ ophthalmologist can do the surgery on your insurance.

Question:

Julio, your old friend Greg Brown, want to meet and discuss doing me eyes, finally. Was told I’m a risky candidate , but I was hoping you could make it happen

Answer:

call the office at (702)870-0058 tomorrow and ask for Sandie. I will tell you to get you in and I will tell her it is no fee for the consultation. We can discuss the surgery and why someone thinks it is not for you when I see you

Question:

I read that another lower bleph isn't necessary, but another upper bleph may be necessary is 5-7 years. I thought only one upper bleph wasn't necessary. Does this imply the upper eyelid skin becomes more loose and sags withing 5-7 years? If so, thisi= is good news for me since too much tissue was taken from an area so I'm hoping the skin will sag or move down closer to my eyelid crease to cover that gap...should it in 5-7 years? So far, it's been 3 years and the gap hasn't moved closer to my eyelid crease.

Answer:

Whether your upper or lower eyelids require repeat surgery depends on many variables. These are sun exposure, what you do to care for your skin, genetics, and many more. I have performed secondary surgery on my patients but remember, surgery only removes quantity of skin, not quality of skin. To improve quality of skin, surgery will not work.

Question:

Upper Bleph Revision

Answer:

If there enough skin to revise the blepharoplasty I do them, yes.

Question:

I have a severe ectropion of one lower eyelid due to an aggressive bleph many years ago followed by an unauthorized injection of kenalog to soften the scar tissue which, of course, destroyed the soft tisse of my upper cheek. To make matters worse, the surgeon tried to repair it with a cheek implant that caused damage to the infraorbital nerve, resulting in semi-paralysis of the right side of my face. I've had a lateral canthopexy, a lateral canthoplasty, and a spacer graft, all of which have helped but have not resolved the dry eye and resulting (rather disastrous) cosmetic consequences. I am only in my 40's, so this is a devastating problem. I am now considering a medial canthoplasty as am additional way to incrementally improve the situation. Pros? Cons? What would you advise? I'm running out of options and hope. Thank you for your time and expertise.

Answer:

It is hard for me to see whether the medial canthoplasty will help without seeing photos. The amount of elevation that can be achieved from a medial canthoplasty is less than a lateral one. If you want, you can send some pictures to me at drgarcia@lvcosmeticsurgery.com and I might be able to give you more insight. I am sorry to hear about all the problems.

Question:

I had an artfully done canthoplasty 4 weeks ago. The sutures are in the upper orbital rim, about 2 cm from the outer corner of my eye. Unfortunately, one of the eyes is extremely irritated and inflamed because the sutures seem to be resting on the cornea.The constant foreign body sensation in my eye is making me utterly miserable. Lubrication and compresses (warm or cool) bring no relief. I have Lotemax which I use sparingly because I fear cataract formation; but while that helps with the secondary inflammation, it can't help with the primary cause of it.vI have a humidifier about 2 feet from that eye at all times, which seems to help a tiny bit.  I can't meet with my surgeon for at least two more weeks due to my schedule, his schedule, and the distance between us. (I'm not sure there's anything he can do about this even when I see him.) I wonder if you can clarify this matter for me: I assume my surgeon used absorbable sutures for this repair, yes? Is that customary? If so, at what point can I expect these stitches to dissolve completely? As I said, I just passed the 4 week mark. I'm not sure I can manage much longer. I'm a professor, so I need to read and write; but I can barely type this question. If these stitches won't dissolve, will he need to do this procedure again? I truly hope that won't  need to happen! Thank you for advice, Dr. Garcia. Happy New Year!

Answer:

the sutures used are commonly dissolving sutures but they can take 6 weeks in some cases, but at times even longer. The only way to remove the irritation is to clip the sutures and hope that the tissues have healed enough that the canthopexy corrections will remain.  I think the methods you are using are good, and I understand your fear of the long-term issues with your cornea as it is a concern.  Maybe the surgeon can call you in some eye drops with a steroid in it or a local anesthetic that you can use until you can see each other in person. Removing the sutures may not require a repeat surgery for the removal alone, but if after the sutures are removed, the correction fails, then yes, more surgery would be required. I wish you the best.

Question:

Browlift or eyelid surgery?

Answer:

it is very common to think your eyes look better or more open if you pull your eyebrows higher. The limitation there is if your eyebrows were never that high, then you will look startled and different than you did before. If you had low set eyebrows to begin with that may lead to an unnatural appearance. Hairloss is not a large issue but a brow lift will, be definition, move your hairline back, stretching your forehead out and make you look like your hairline receeded. An eye lift is sometimes the better choice as it looks more natural, but less dramatic. Look at some old pictures and see where your brows used to be before choosing to do a brow lift

Question:
Answer:

I always use anti-virals with CO2 lase resurfacing. In your case, Valtrex at 500mg per day until healed is what I would suggest

Question:
Answer:

I think with those parameters that having the surgery will be fine. The laser will remove any recent sun tanning effect, but it typically does not lighten the pigment to such a degree that it looks white. Best of luck.

Question:
Answer:

I do not think you will have any problems with the proposed surgery with having only one kidney. Bless you, for making that sacrifice and I wish you the best with your surgery

Question:
Answer:

The number of eyelid surgeries that a patient can have depends entirely on how much skin remains. Skin stretches and ages and is is not uncommon that a patient may need repeat eyelid surgery. If only small skin removals are done at each sitting, it is possible that another one may be needed in the future. I would never make a blanket statement like "you should never have another eyelid surgery" unless there is a good reason preventing it.

Question:

I have a citracicial retraction of one lower eyelid (with lagophthalmos and exposure keratopathy) from an aggressive blephoraplasty and a botched repair many years ago.. I've consulted with 6 oculoplastic surgeons and--nor surprise--received five opinions. 1) AlloDerm spacer graft; 2) AlloDerm spacer graft with subperiostal midface lift (because the cheek on that side has descended markedly); 3) spacer graft from harvested upper third of the superior tarsal plate; 4) full thickness graft; 5) too complicated to do anything due to scar tissue; 6) no idea whatsoever to do.

The surgeon who recommended harvesting the upper third of the superior tarsus insists that AlloDerm grafts resorb; but the surgeons who recommend the AlloDerm graft suggest (and this seems right to me) that compromising the upper lid for the sake of the lower lid only compounds the problem. The full thickness graft seems radical and unnecessary to me, and it would permanently disfigure me. I cannot believe opinion #5 -- something must be possible to help me. I am leaning toward opinion #2, but the oculoplastic surgeon who suggested that can't find a plastic surgeon willing to work with him to do the subperiostal midface lift because it is "universally considered a highly risky procedure," according to him.  My question for you: Is that so? Is a subperiostal midface lift universally considered a highly risky procedure? If he can't find someone willing to work with him, we'll just do the AlloDerm graft. My next questions for you: 1) Do you agree with the surgeon who claims that they "always resorb" and fail? 2) If I can only do the AlloDerm spacer graft now, does that preclude doing a subperiostal midface lift later? I would, of course, like to do this all at once, but if I can't, I'd be willing to do it in two stages...IF doing so wouldn't compromise the graft. 3)  If you think I can do this in two stages, how long must I wait after the spacer graft?   So very sorry for all these questions, but this has been a really, really difficult, physically painful, and long journey (over a decade now). My vision is now seriously compromised by the keratopathy. It is so hard to get consistent medical advice -- even here in New Yor with major teaching hospitals. It's also been a really embarrassing/shaming process, as several of these doctors have blamed me for this iatrogenic injury. One even said, "This is what you get when you're vain and go down the path of plastic surgery."  I've had to screw up my courage for every consultation -- and all the necessary photos they take feel like they're photographing a crime scene for which I'm responsible. Just terrible.  Anyway, thank you for being there for all of us who are struggling to repair damage that was done to us, however inadvertently. It's a beautiful thing that you do.

Answer:

The sub-periosteal mid facelift is risky with about a 17% complication rate and will do some but not too much to correct the issue as it is the lid that is scarred and not the cheek sagging that is causing the problem.  The Alloderm is used as a spacer until the area heals in, what we refer to as an expanded position. That is what always happens and it is expected. It can typically last a year and by then the improved position of the lower lid should be stable. Doing it in a staged fashion is OK and you might realize by then that the mid facelift is not needed. A delayed mid-facelift will not compromise the Alloderm. I would wait at least 6 months after the Alloderm and maybe up to one year before considering the other surgery. It is disheartening that that is what you have heard from the physicians. Rest assured that their comments are based on more of a turf-war than anything honest, truthful and helpful. I have seen plenty of post-operative complications from occuloplastic surgeons in my practice over the past 28 years and they should not be throwing stones like that. It is infantile and certainly not helpful, except to bolster their egos. I would go with the Alloderm graft, it might require a small skin graft to be placed to accommodate the expanded area that skin graft, albeit a full thickness graft, does aid in the tissue not scarring down as much, if there is an issue of the outer layer or lamella of the eyelid, external to the muscles. I wish you all the best, I can imagine it has been difficult, but do not lose hope, there are options for you out there.

Question:

I'm going to have upper & lower blephoplasty. I have dark circles under eyes is there anything that can be done for them? Can fillers help I am 60 yo. Also with a Transconjunctival on lower lid does it leave a hollow look being that fat is removed? 

Answer:

The dark circles can be from the bones not being prominent, from allergies, and also from loss of fat. When doing surgery on the lower lids in patients with dark circles already present,fat removal should  be avoided. Rather a repositioning of the fat leads to a better result with less hollowing out of the lower lid in time. It can also help lessen the dark circles. In patients not having surgery who have dark circles, usually the option is then fillers to elevate the skin. The darkness may remain but the contour will be improved and make the use of make up more effective.

Question:

I saw an ENT surgeon about ptosis and hollowing of my lower eyelids due to a blepharoplasty that was overdone. I'm only 43, so my lateral canthi are too tight for a canthopexy, and he claims it would alter my appearance significantly even if he could do it. Because the problem is soft tissue loss, he is recommending a subperiostal dermal fat graft. (The tissue loss is so extensive that fillers haven't really worked.) I'm writing to lear if you think this may be an effective correction (I know we to get sufficient vascular supply to support the grafts, and that's a big unknown), if the grafts will be visible lumps once/if they take, and if this is a big surgery from which to recover. I wish I lived near you. I would come to you for this surgery if I could! Thank you.

Answer:

Trying to fill in the lower lid with a dermal graft is likely going to look very artificial and stiff if it actually survives. The dermal grafts are doen for loss of tissue but the tissue of the lower lid is exteremely thin and is not replicated with a dermal graft which is much much thicher than any lower lid skin. It will possibly end up like a stiff piece if thickness underneath the skin of the lower lid. They work well in places like the cheek pad or chin itsefl, but not in areas such as eyelids,not thin enough. You do not have a lot of options from what you say, and I understand you wanting something done, but you might trade one problem for a completely new and different yet as troubling as the one you have now.

Question:

Thank you for your answer about the tear trough implants. Very helpful. One of hte reasons I am asking is that I had a plastic surgeon, now retired, who did a good job with the HA injections and a back-up dermatologist who did a pretty good job, thouht not fantastic, sometimes resulting in contour defects. In both cases, of course, I was often left with bruising that lasted up to 2 weeks, not ideal when it needed to be repeated every 5 months, as it did in my own case.  Now I've moved and I've interviewd 4 plastic surgeons and 5 dermatologists about this, and while they will all inject HA's on the orbital rim, they won't inject above it out of safety concerns but theat's where I need it due to a wildly aggressive lower bleph that left me with no fat at allin the medial pocket and also stripped the muscle from my lower lids, leaving the ptotic. Ini short, without the filler, I actually look 35-30 years older than my real age and suffer extreme dry eye from the dropped lid. So two follow up questions: Is this reluctance to place the filler where it's needed a new and almost universally regarded standard of care for problems like mine? And what do you think of a subperiostal dermal fat graft above the infraorbital rim, which has also been proposed to me? (Fat injections famously don't last, which I've experienced myself, or worse, last unevenly.) Your kind assistance is much appreciated!

Answer:

They doctors you have questioned my be just being careful, the man reason for it might be that no filler is FDA approved for that area, although it is legal to use off-label there.  Some docs do not feel comfortable injecting in some areas where less people have done it before.  Let’s say that lower tear trough filler, for as popular as it is, is not ‘main stream’, so they are just being cautious. I will say that there is no standard of care for any filler in the area you speak of, neither fat or an off the shelf-filler. It is considered a personal choice by the surgeon, they take precautions, but there is no standard of care that has been established for the peri-orbital area. Just seeing it in medical journals does not make it the standard of care. I think a sub-periosteal dermal fat graft will help for a time, but unless it creates new blood flow, difficult to do when placed on the bone, it will dissolve in time.  Sub-periosteal placement avoids visible bumps though as it is so deep.  There are docs out there that are willing to inject in the medial and lateral sub-brow and brow. I do it. I think in the end, it is best to find a doc that is comfortable doing what you desire. Asking someone to go outside of their comfort zone is never good. Keep searching, they are out there.

Question:

Over-resected lid in an upper bleph has led to severe dry eyes. My ophthalmologist, who specializes in dry eyes, recently put me on Restasis, which of course takes some months to work. But I don't understand if/how it can help when the problem doesn't seem to be so much the production of tears as the retention of them, which unless I get my eyelids back, isn't going to be fixed. Am I right to be skeptical of this as a solution? I can't even fully close one of my eyes. It's a mess. Any other suggestions? Thank you for your time and help.

Answer:

I am sorry to hear about the issue. Using the drops will help, espcially if the surgery is recent and there migtht be an expected descent of the upper lid. If it has been some time since the surgery, the drops will help but will not fully correct the problem. It might require repeat surgrry where a skin graft is placed into the upper eyelid to allow it a larger excusrsion so it can close. You would need the eyes done in a staged fashion as the grafted eye wil require  a patch for a little time until the skin graft heals

Question:

Hi,

A few years ago, I had lower blepharoplasty surgery. Recently I noticed when I smile my eyes appear squinted. Will Upper Bleph surgery help to eliminate this?

Answer:

Having surgery on your eyelids will only remove excess skin. It will not create more elastic skin or create collagen. When you squint, the skin folds due to excess skin as well as loss of elasticity of the skin. If you have an upper lid surgery, the excess skin that folds over at rest will be improved, but unfortunately, the skin will still buckle when you squint. No way around that. Sorry.

Question:

I had lower Blephs done a few years back by Dr. Garcia; can I get Upper Blephs done now without any worry? What outcome can I expect from getting upper Blephs done?  Currently when I smile, I look like I'm squinting, and I'd like to change this. Thanks

Answer:

Having surgery on your eyelids will only remove excess skin. It will not create more elastic skin or create collagen. When you squint, the skin folds due to excess skin as well as loss of elasticity of the skin. If you have an upper lid surgery, the excess skin that folds over at rest will be improved, but unfortunately, the skin will still buckle when you squint. No way around that. Sorry.

Question:

Maybe not the right sub for this question, but has anyone here tried either of these products? What did you think of them? Where did you buy yours? (Careprost isn't legally sold in the US, and website buying seems sketchy)

Any advice or suggestions very appreciated.

Answer:

The product is sold by prescription only. It does work, but if you stop using it all the improvements disappear. Also you need to avoid getting it into your eye as it can change blue eyes to brown

Question:

Hi Dr. I had an upper eyelid lift a week ago. It was a very conservative approach, done under local. The interesting thing is that the results seem to fluctuate. Some days the skin above the crease appears swollen and fatty, especially upon waking, but other times it seems as if it tempers down a bit. I wanted a very conservative surgery because I never did have the round, doll eyed look, and my surgeon essentially agreed. I just want to know about this upper swelling, and how long before it actually begins to subside, in your opinion. I've had no complications other than we learned I probably have a mild allergy to antibiotic skin ointment.
 

Answer:

the swelling can vary a great deal during the first 2-3 weeks due to sleeping position as well as amount of salt injected with food. By the end of the first month, that should all be gone and the fluctuations be minimal to none. All normal though.

Question:

I'm scheduled for an upper eye lid lift. In looking at some before and after pictures, sometimes it looks like the eye shape becomes smaller. Is this just a phenomena that happens on some people? Does it have to do with the original shape of your eye? Or, is it when too much skin is removed?

Answer:

That can happen when an over aggressive canthoplasty is performed on the lower lid. Should not happen on the upper lid though

Question:

thanks for your response about the shrinking eye with the blepharoplasty. I'm so glad to hear that the upper lift should not affect the aperture of the eye. In watching some upper blepharoplasty procedures on you tube, I've noticed that some surgeons will extend the incision to the lateral portion of the eye, which seems to give a nice lift to the lateral area, while some surgeons do just a crescent shape not extending the incision out and up. Is this the patient's preference, the Drs, or is it dictated by facial features?

Answer:

It is dictated by what the patient needs. It also comes with a longer incision that has to be accepted by the patient as a trade off for what the longer incision can provide.

Question:

Hi Dr., is there any truth to the assumption that an upper blepharoplasty will make your eyes smaller? I once heard this. I'm having a rather conservative blepharoplasty under local anesthesia done next month, but now am considering backing out because I don't want smaller eyes. The crepey, aging skin on my upper lids drives me crazy, and the fact that I can no longer line or use eye shadow on the upper lids bothers me greatly. I thought this would be a great solution, until I read about the "shrinking" eyes.

Answer:

The smaller eye issue can come up if the lower lid is tightened with something called a canthopexy. This is done to support to older lower lid so it does not droop or pull down. A well-done canthopexy will close the aperture some, but well done, it should just return it to the old state. The upper lid should not affect the aperture of the eye, so you are safe.

Question:

Is it common for the eyelid teases to be cut uneven during upper eyelid bleph meaning one eyelid looks wider than the other? How long does one need to wait to have a revision? Can just the end where it is wider be cit or will the whole eyelid need to be cut across?

Answer:

where the lower incision is made on the upper lid in order to remove the excess skin controls what your are seeing. I would give it at least 3 months or more for all the swelling to go down before doing a revision. How much would need to be done will depend on how long the area is and I cannot say without seeing you, but usually it involves the majority of the scar.

Question:

If you have upper eye bleph at age 40, will you need another one? How long doe sit usually last? I figure if it took 40 years for your upper eyes to sag, it might take another 40 for them to re-sag?

Answer:

Impossible to say. It depends on environmental factors, smoking history, sleep patterns and genetics mainly. In most cases a re-operation of some type can be beneficial in 10-15 years. All depends on how conservative they were at age 40. You will not get another 40 years out of it as the aging process has continued

Question:

How long does noticeable swelling after upper eye bleph last?
And are dissolvable or regular stitches used?
 

Answer:

It can take 3-5 days for most of the swelling to go down but it will take weeks for all of it to go down. You usually look fairly presentable after 10-12 days or a little less, depending on how swollen you got to begin with. As to the sutures, I usually use sutures that are taken out after 5-7 days as I find they cause less redness long term.

Question:

Are antibiotics prescribed after an upper eye bleph?

Answer:

It is up to the surgeon but it is not required.

Question:

How many hours does it take for severe eye swelling to go down after upper eye bleh so one can see clearly or read again?

Answer:

Maybe a day or two, depends on how swollen you got to start with.

Question:

Would it be better to have upper eyelid (bleph) done separately from rhinoplasty or does it make no difference? If it is done at the same time, would the rhinoplasty or the upper eyelid surgery be done first? I know that both procedures make your eyes swell. I don't know if the eye surgery should be done first since the eyelids might already be swollen after the rhinoplasty or maybe there needs to be no swelling there to start the procedure?

Answer:

It can be done together, and you are correct that the degree of swelling on the eyes will be more than usual, but it is still do perform them together. When I do that surgery I usually do the eyes first to be bale to operate on that thin tissue before any swelling sets in.

Question:

If an upper eye bleph is done to remove excess fold, can the fold to cut out be seen as well if a patient has local number injections instead of sedation? I don't know if the local number injections will make the upper eyelid area swell so the fold lines can't be seen as well? Does it make any difference whether a patient has local number injections or sedation for this procedure?

Answer:

local anesthesia will make the tissue swell and that is why all of the markings are placed before any injections are done. As to whether it is straight local or local anesthesia with sedation, I feel it is more comfortable to have sedation and local anesthesia. I do not know of anyone that uses just sedation and no local anesthesia for that procedure.

Question:
Answer:

we certainly do. Please call the office for a consultation where we can discuss it and perform it the same day if you desire

Question:
Answer:

I would estimate that in the last 26 years I have done about 1,000-1,100 upper lid patients and about 850-950 lower lid patients. The stitches are typically in for 7 days. Black or blue eyes for maybe 7-10 days, can be covered with make up after the sutures are removed.Swelling, yes, but not enough that will block your vision, look pretty good in 7-10 days.You will continue to improve and final results are seen in 3-6 months but you are about 50% there in 4-6 weeks, the last little swelling and minimization or fading of the scars take a bit longer and that is the 3-6 months after the surgery.

Question:
Answer:

The improvements by this time are about finished so if there is still a problem you need to follow up with your surgeon and see what can be done now.

Question:

Unfortunately, I had an upper bleph in which the surgeon ended up essentially amputating most of one lid. I have less than half of the skin required to close my eye. This happened in November, and now my cornea is damaged because it`s so dry. I consulted an oculoplastic surgeon about a skin graft and he thought that it wouldn`t be effective. I don`t understand his response. Do grafts not enable the lid to close? I would think they would. I don`t think I`d need a weight in the lid, just more skin. Is this the kind of thing that I could go through only to discover that this surgeon was correct -- that it will further disfigure me AND not protect my cornea? Alternatively, if it does work and provides the cornea with adequate coverage, can the damage to my eye be reversed or is the damage that I have accrued thus farr permanent? I don`t want it to get any worse. Incredibly painful and impairing my vision terribly. Thank you for your kind help.

Answer:

a graft requires skin taken from another placed and then placed on the area needed, but it requires a base to receive the graft and allow blood vessels to grow for it to survive. It sounds from what you are describing that there is insufficient of a recipient base for that to be performed. An option to correct it is with a flap, where a full thickness of skin is rotated into position is performed, alleviating the need for the recipient bed and blood vessels. I think if the cornea has been damaged it might require a corneal transplant to correct as the cornea can only heal with scar tissue as its blood supply is almost zero. Sorry to hear about the problems but there are likely solutions. I wish you the best.

Question:

Hi, Dr. Garcia. It`s the upper lid ptosis repair lady again (one week post op). Sorry for another question. I had dry eyes before this surgery and, predictably, the procedure seems to have made it worse. I am using all the prescribed drops, lacrilube, artificial tears, etc., but I am very surprised to discover, counterintuitively, that tears are running down my face all day, especially when outside (though I wear protective glasses), but my eyes are still dry. Is this what severe dry eyes means -- tearing up endlessly without lubricating the eyes? Or is this just an early reaction to the surgery? (Absorbably sutures are still inside the lid; wearing bandage contact lenses.) If this is what it`s going to be like for the rest of my life, I would definitely have opted for the ptosis over this. Thanks for any predictions you can offer. You are an angel, Dr. Garcia.

Answer:

Once the swelling goes dowm the lids will function better and oppose the globe in better posiyion and the tears will then stay in place to keep your eye moisturized. Hang in there.

Question:

Hi, Dr. Garcia. Happy Spring! I had a bilateral posterior ptosis repair of my upper lids earlier this week. The swelling is unbelievable -- and remarkably uneven. One eye is twice the size of the other. How long would you expect the swelling to last? My surgeon says a few weeks, but I suspect it will be longer. Thank you for your very kind help.

Answer:

Uneven swelling is very vommin and I agree with the couple weeks at least to get better. Hang in there.

Question:

what is recovery like after under eye fat pad removal? Is there usually a lot of bruising and swelling and how long does it usually last?

Answer:

Bruising for a week or so, no lifting more that 20 pounds for two weeks, swollen for 10-14 days visibly but it will take a couple of months for a final result in swelling.

Question:

What is the approx. cost for lower eye fat pad removal? What is the recovery time for it?

Answer:

A;;-inclusive, except for your prescriptions it is $3,400. You should be pretty much back to light activity in one week and full activity in about three weeks.

Question:

I`m scheduled for a posterior ptosis repair of upper lids in a few weeks -- Muller resection. In this surgeon`s experience (it`s pretty much all he does), this procedure lasts about 10 years. I`m fairly young -- 46. So when I get to 56, if that muscle has been removed, then what do we do? I had an overly aggressive upper bleph a few few years ago to try to repair this, but it did nothing; so now I have no extra skin to excise in the future. I just don`t want to remove that muscle which might give a short-term improvement but produce a long-term complication that then can`t be repaired. Thanks for clarifying this for me, Dr. Garcia.

Answer:

In the future you can have a levator advancement if you need it. Best of luck.

Question:

Hello again Dr.Garcia...thanks for your time again. I had asked your opinion a few months ago whether you would recommend a brow lift or upper bleph to improve the turtle looks inside my eye lids. You said upper bleph but the PS said I was not a candidate for that due to having already had a brow lift and a upper bleph, plus dry eyes. So-I went to someone else that recommended removing the medial fat pad in the inner lid, by the nose and removing a little skin and only requiring about 2 sutures in each eye. What is your opinion to this and have you done it, would you recommend it? I will send pictures again and would appreciate your opinion as always. Thank you so much! Any other comments or suggestions would be greatly appreciated. Thanks for helping us all with difficult and scary decisions as we continually try to remain youthful looking !

Answer:

glad to help and will get back to you as soon as I review the pictures.

Question:

Is upper bleph recovery shorter than for a lower bleph?

Answer:

yes, the swelling resolves faster.

Question:

I have upper lid ptosis and have been to several consultations. I have decided to book the surgery with an oculoplastic surgeon who does Muller muscle suture resections 15-20 times/week and who has come highly recommended. What do you think of this procedure? Would you yourself have it done if you had lid ptosis? Too risky? Safe enough? Thank you, Dr. Garcia.

Answer:

I think you arein good hands,if the levator muscle is not reattached, your ptosis will not be corrected and a Muellers resection is a good way to do it. I wish you the best.

Question:

hi Dr. Garcia , even eyebags are caused by a structural loss of support from loss of elastin and collagen fibers within the skin and not the muscles ? ... i thought is is because the muscles underneath the eyes lack integrity already so they do not provide enough support already .. thus eyebags happen .. ( i am referring to sagging underneath the eyes - eye bags and not the dark circles / hollow look underneath the eyes ) :) , thank you very much Sir

Answer:

in a small number of cases that can happen but you can tell which are those cases because if it is due to the muscles getting weak, then the lower lid begins to fall and the white of the eye starts to show below the iris.

Question:

Hydroxatone is temporary skin tightener for eyelids. Is there any risk that its ingredients can, in the long term, dry out that skin and make it worse, even the skin appears for short while after application tighter? I don`t want to make my situation worse. Also, would CO2 resurfacing of the lids eliminate the need for such a product? I`m nervous about lines of demarcation. I don`t want to look like a raccoon for the rest of my life! Thank you so much for your time and help.

Answer:

I think the risk of negative side effects is quite small. I think CO2 laser for the lower lids is relatively short term improvement as you cannot use to much energy on that think skin so there is not a long lasting improvement, maybe 12-18 months before back to baseline. Lines of demarcation are rare as you cannot use too much energy and that means the depth and color change is of low risk. There will be pink skin though for a number of weeks requiring coverup makeup. Best of luck.