Question:

How many days after a rhinoplasty does the eyelids stay swollen? What I am asking is how many days after a rhinoplasty must one wait to have bleph eye surgery? Since I can be awake for the bleph eye surgery, I would rather have it done separately than rhinoplasty so I will not have to be under sedation as long. I know hospitals put tape over your eyes when one is sedated, but is tape still placed over your eyes if you are sedated at the doctor`s surgery center inside their office? I thought about having the bleph eye surgery the day before rhinoplasty (so I can cut down time looking bad that I have to take off work), but tape probably has to be placd over my eyes whiel sedated for rhinoplasty? And, tape would interfere with the stitches on the eyelids?

Answer:

If you are doing the rhinoplasty first, it can be 2-10 days, all depends on how severe the swelling is initially.If you are wanting to stage the procedures per your desires I would wait 6 weeks, if you do the nose first. If I am operating on the nose or eyes I do not tape the eyes, instead we use an eye lubricant, whether it is sedation or general anesthesia.You can certainly do the eyelid the day before if you wish as the swelling from the eyes will not affect the rhinoplasty whereas the opposite order would. JG 1.12.14

Question:

PS on the eyelid skin grafts: If I manually stretch the skin of the upper lids, pulling the corners up and out toward the temples, might I be able to stretch it permanently and avoid the grafts? Probably not, but I forgot to ask each of the surgeons I consulted, so I thought I should ask you.

Answer:

I do not think you can stretch the skin that remains in order to avoid the surgery. JG 12.30.13

Question:

I had an upper bleph in August that was botched by a very experienced and credentialed ps. He took too much skin and now I can only open my eyes half-way. Four other surgeons (2 plastic, 2 oculoplastic) are telling me I need skin grafts. My questions for you are 1) Are skin grafts hard to do? Have you done them? 2) From where is that skin usually harvested? 3) How long is the healing process? 4) Will the results be very noticeable-- worse than before the bleph, which I wish I had never had done. How stupid of me to want to improve my appearance! I think I got what I deserved. Now this is going to cost me another $7,000. What a fool I am. THank you for your guidance.

Answer:

They are not difficult, all plastic surgeons and eye surgeons are trained in doing them. The skin in your case will likely come from behind your ear. The healing process is about 10-12 days to look better and total healing will be a few months. The results should only be visible as a skin graft when your eyes are closed, doubt it would look worse than you did before. Sorry to hear about the problems. JG 12.30.13

Question:

Thank you for your answer to my question about my sister`s peculiar swelling. You have set our minds at ease, Dr. Garcia. In general, about how long before all true edema and its side effects are gone following invasive eye surgery like that? 2-3 weeks? 2-3 months? More? We greatly appreciate your wise counsel and generosity.

Answer:

4-6 should be enough to see big changes. Hang in there. JG 12.29.13

Question:

I`m 2 wks post minor revision to a 12-year-old upper bleph to reduce lateral hooding in one eye. My surgeon removed a tiny bit of lateral fat and opened the old incision from the medial to the lateral point. I`m now completely unable to raise the lid, can`t blink normally, and the eye is dry. When I elevate the lid manually, the skin visually snaps and makes an audible noise (like bubble wrap popping). The skin also looks tacked down to the center of the incision line. There was very little post-op swelling, but my surgeon thinks it`s due to that and will be temporary. But this seems like a true malfunction of the levator and not a generalized weakness. Does this sound like the tendon of the muscle was detached and so can be repaired or like the muscle itself was transected and is therefore beyond any correction?

Answer:

Very unusual problem, although the levator can be injured it would appear that the risk would be low unless they did any work in the old area. I think I would hang in there for a bit and see your surgeon next week to be able to document any improvement. If the levator needs repair I would wait 3-4 weeks after the surgery so the tissues are less swollen and the levator will then be easier to see. I wish you the best and am sorry for the troubles. JG 12.26.13

Question:

PS about the hard palate graft: My sister just saw me and said I look like a Picasso painting from his Cubist phase. She`s right!

Answer:

hang in there, it is a very big surgery and it will take time to settle down. JG 12.26.13

Question:

I had a hard palate graft to one lower lid one week ago Friday. My ophthalmic plastic surgeon removed the tarsorrhaphy sutures this morning and the asymmetry is appalling. I would have preferred the ectropion to this. The operated eye looks Asian, the other looks Caucasian. I know that some of this is swelling, but even she admitted that most of the swelling is gone now. She just waved her hand as she left the room and said, They`ll never look symmetrical. You`ll get used to it. Stop being vain and be glad you can see. I don`t think I`m especially vain, but this really wounded me.I actually got sick to my stomach when I saw the results. I`m sure no other surgeon will want to touch the work of a respected colleague, I don`t want further surgery and I`m out of money. I put an eye patch on because it`s so unbelievably hideous. What should I do? Thank you so very, very much for this beautiful service you provide. God bless you.

Answer:

I think for now just give it time, I think perfect symmetry is difficult but I think there is still lots of swelling and lack of motion at this point out. I would go see a second surgeon for a second opinion 6 weeks after the surgery but likely would not advise a touch up for at least 6 and preferably 12 months if at all possible. Sorry to hear about how you were treated and you have to hang in there for a bit. I wish you the best. JG 12.26.13

Question:

I had a modification to an upper bleph on Monday, and my surgeon plans to remove the sutures on Friday because she will be away during the holidays. Isn`t that too soon to remove them? I recall that they were left in for 7 days after the primary surgery, but this will be just 4 days. Should I ask to see the surgeon who will be on call for her next week to remove them? On an unrelated topic, do you like the Roc line of skincare? Thank you, Dr. Garcia. Happy holidays to you and your family.

Answer:

if ut was just a small revision it would be OK to remove in 4 days. If there was any skin removed I think it best to leave them in a few more days. I wish you the best. JG 12.20.13

Question:

God bless you, Dr. Garcia. My daughter and I thank you from the bottom of our hearts. You`ve given us some much-needed courage and hope.

Answer:

have a Happy Holiday season and a healthy New Year. JG 12.10.13

Question:

What is a Y lift, and what is your opinion on it?

Answer:

A meager attempt to try to give an operation that most plastic surgeons perform by liftong the tissue in an approptaite direction, and just calling it a Y Lift because your name starts in Y. In short, not a big deal. Save yourself the inflated cost. JG 12.10.13

Question:

Thank you for that very helpful answer. Will the grafts be visible statically too or only in animation? If she were your daughter, would you advise her to proceed? It sounds as if you would. If the grafts turn out to be a full-on cosmetic disaster, can they be removed later? She might prefor the ectropion to looking like a corpse. Finally, we know that Dr. Yaremchuk is a magnificent surgeon, highly regarded and has decades of experience with this particular problem, but are there other surgeons you would recommend we consult who are equally as experienced before proceeding, or should we just stay with him? We think the world of him, but we want to be as careful as possible before doing anything else. It`s such a shame. My daughter is otherwise a beautiful woman, but this whole thing has utterly destroyed her face and broken her heart. We deeply appreciate your professional help!

Answer:

the lower lid moves very little so it will be abut the same in animation or not. I would have my daughter have the procedure with what you describe, yes.If there is a problem they can be revised or removed later. I think Dr Yaremchuk is an experienced surgeon and it would be hard to find someone better. Your daughter is still beautiful, and she will regain her prior appearance soon and be even more beautiful. I wish you all of the best. JG 12.10.13

Question:

I had an upper blepharoplasty several years ago and liked the results very much. In the past few months, my upper right lacrimal gland has become herniated and ptotic, making it look like I need another blepharoplasty. I went back to my plastic surgeon and he said repairing it would be a big undertaking and that I should just live with it. So I had consult with another surgeon who said it would simply require reopening the incision on the upper lid and suspending the gland to the orbital bone with a few sutures, and that this would not be a big deal at all. A third surgeon concurred with the second, but she said that while it was something that could be done, it wasn`t a small matter. Whom should I believe? Honestly, it`s like the Wild West out there for consumers. Thank you so much for giving us all your honest opinion and expertise.

Answer:

It is straight forward to perform, can be done through the same incision, just need to be careful to not injure the gland. It is a little more involved than the first but not a big deal. Some surgeons just like to do only easy cases. JG 11.30.13

Question:

How long do you leave your cutaneous sutures in for your bleph patients? And how many weeks before the subcutaneous sutures dissolve? Thank you.

Answer:

typically for about 6 days on the skin, the dissolvable ones below the skin will dissolve on a varying time table,depending on what type was used but usually 6 weeks or so is the average. Jg 11.30.13

Question:

I`m scheduled for a SOOF lift and canthal tightening to one eye in a few weeks to repair the damage from kenalog 10 years ago to my orbital rim, which dissolved all the subcutaneous tissue there. I`ve had 2 canthoplasties and countless injections of Restalyne over the years, but that has never really done much -- and cost me plenty! I`m concerned that SOOF lift will either do nothing or just further distort my face because it will lift and stretch the cheek fat pad, which belongs on the cheek. I`m also not confident that there will be enough tissue to fill in the orbit AND to continue to cover the cheekbone. The reconstructive surgeon who is doing this seems to think it will be fine, but I`m quite nervous. What do you think, Dr. Garcia? Are my concerns about the lack of adequate subcutaneous tissue founded? Would a canthal tightening and a fat graft to the orbit be a better option? Thank you.

Answer:

Hard to say without seeing pictures but the complication rate from a SOOF lift is about 15% and it involves lower lid retraction or malposition. I am sorry but I am not a fan of that operation. If the tissues are deficient from the old shots, there is likely little to be gained by lift the already atrophic tissue higher.Maybe seeing someone well versed with fat injections might be a safer and less complication ridden option. As to the canthal tightening, again, without seeing you I cannot say whether you need one or not but a prophylactic canthal tightening if you have nothing wrong to begin with is not something I would suggest.Sorry. JG 11.24.13

Question:

Hi, Dr. Garcia. I`m having some HA dissolved prior to a SOOF lift and canthoplasty to clear the palette so that surgeon can clearly visualize what he`s repairing. How long in advance of the surgery should this be done? The HA is holding up my lower lid, so I don`t want to do it too soon, as I cannot close my eye without that lower lid support. Thanks for your kind help. God bless you.

Answer:

' '

Question:

Hi, Dr. Garcia. I`m having some HA dissolved prior to a SOOF lift and canthoplasty to clear the palette so that surgeon can clearly visualize what he`s repairing. How long in advance of the surgery should this be done? The HA is holding up my lower lid, so I don`t want to do it too soon, as I cannot close my eye without that lower lid support. Thanks for your kind help. God bless you.

Answer:

a 3-5 days or so would be nice. Best of luck. JG 10.30.13

Question:

Hi. Dr., I`m wanting to save $ for an eye lift. I don`t believe the brows need to be lifted, my problem is more of hooding starting to happen above the eye. Does this sound like the correct procedure? Also, what is it that actually lifts the corners of the eye...same operation, or different one?

Answer:

hard to say without pictures, hooding can be from eyelid skin folding over but it can also be from the lateral brow tissue drooping. The procedure that lifts the corner to a higher location is a canthopexy. seeing pictures might help me give you more info. You can feel free to send them to me at drgarcia@lvcosmeticsurgery.com for me to look at and get back to you. JG 10.14.13

Question:

What email would I send a picture to ( in reference to the question of a brow lift or another upper bleph)

Answer:

sure, you can send it to drgarcia@lvcosmeticsurgery.com Please send a picture of the whole face at rest and then lifting your forehead, and then some closer shots of your eyes. JG 7.24.13

Question:

I had an upper eyelid lift one month ago. The surgeon did not follow thru with the previous incision that been done several years ago. There is a step down where he started compared to where the existing incision was.. I can see this because he did not go all the way to the inner end..Now it looks like I have a droop that didn`t show before. Like a bulge or a buckling over the incision..Can he redo it at the same level as the previous incision instead of a step down, and get rid of that appearance of extra skin? or what is your suggestion. When I pull sideways and upwards like in a temporal lift, it looks great, but he says a temporal lift will not hold for a substantial amount of time. What is the best solution> Thanks again for your fast answers...

Answer:

Fusing the old and the new scar into one is possible if there is enough loose skin in that area to allow it to be done without distorting the level of the eyelid itself, something I cannot tell without seeing you in person. I would suggest waiting at least 6 month before deciding in order to let all the swelling resolve so a valid appreciation so skin laxity can be done. As to the longevity of a temporal lift, if adequate tissue release and appropriate suspension is performed, it should last years. I wish you the best. JG 6.26.13

Question:

Dr. Garcia: I wrote to you a couple of days ago regarding a procedure I had: ectropion repair along with mid-face lift. I believe I mentioned I had a hematoma under each eye. My doctor realized I had a hematoma under one eye before I left her office and didn`t seem that concerned. I now believe I have skin necrosis under the left eye. I sent her pictures yesterday (I live 2 hrs away) and she said send her another picture today of the left eye...that she wants to watch it before our appointment which is not until Monday (3 days from now). On-line it says a hematoma should be taken care of immediately to avoid skin necrosis. I don`t want to have an unsightly scar under my eyes nor require a skin graft. Please, please, tell me how LONG do I have to treat a hematoma BEFORE the occurrence of skin necrosis? What should I do?

Answer:

the greater the pressure caused by the hematoma the faster the hematoma needs to be evacuated in order to avoid skin loss. I cannot say that without seeing you in person but with the weekend approaching, you have only two choices, go see her today or wait until Monday, wish I could tell you more but without seeing you and feeling the firmness of the hematoma, I cannot offer any more advice. I wish you the best. JG 5.31.13

Question:

Hi /Dr. Garcia: I had bilateral lower lid ectropion repair, along with a TarSys spacer and a mid-face lift in order to support the lower lids. I am only 5 days post-op but I look a mess. One eye looks wider and higher than the other (keep in mind my left eye had to have a FROST stitch)and underneath both eyes I have hematomas as well as torn skin (supposedly from excessive swelling) do not look human. QUESTION: 1. Do you think once the swelling goes down the eyes will appear more symmetrical? (2)By the description of my appearance, how long do you think it may take to recovery? One last question: (3) I had mild ptosis in the right eye prior to surgery - but now it appears to be more noticeable. Do you think this might resolve afer all swelling dissipates?

Answer:

I do think form what you are telling me that the degree of swelling you have is much more than the usual due to the things that happened and in time thing should settle down quite a bit. I think it will take likely 4-6 weeks to start looking pretty good and about 6-12 months for the final result. If nothing was done to the right upper eye, the degree of ptosis should return to what you had initially in time as the swelling resolves. I wish you the best. JG 5.29.13

Question:

I know it is important to have a lower eyelid bleph expert do surgery on your lower eyelid so your lid will not end up droopy, but what about upper lid bleph? Can nay plastic surgeon do that surgery or does it really require an expert so no droopy occurs? Is lid droopiness also a risk with upper lid bleph? I was thinking of having it done by a doctor who has a plastic surgery spa since I do not want to be sedated. Although upper lid bleph can be done in the office, many doctors still do it at a surgery center or hospital.

Answer:

I think an experienced surgeon can do both. Upper eyelid droop can happen but is rare in experienced hands. I do mine with general anesthesia ir sedation, NEVER under local anesthesia alone. JG 5.19.13

Question:

Dr. Garcia...I wanted to add something to my previous question (cg 5.18.13)regarding fat grafting to upper eyelids and ectropion repair using a spacer. My doctor has suggested using TarSys (made from pork) as the spacer. I have read on-line where one lady developed an allergic reaction to this material. Are you familiar with this material being used to repair ectropion?

Answer:

I think it is better to use your own from the hard palate. JG 5.19.13

Question:

Hi Dr. Garcia: I am scheduled for surgery in one week (5/24) and am afraid I am undergoing too much surgery at one visit. I am suppose to have fat grafting to upper eyelids (hollow eyes)and ectropion repair to lower lids (repaired with a spacer on one eye). Here are my concerns: (1) Excessive swelling (having so much done to the eyes at once) may cause the fat grafting to fail; and (2) my eyebrows are already too high (due to prior surgery) and I`ve read adding fat to upper lid may elevate brows. I am thinking about postponing the fat grafting for another time. Do you believe my concerns are valid? And, if so, do you think it would be wise to only opt for one or the other at this point? Thank you so much. cg 5-18-13

Answer:

It can all be done but there wil more swelling than if broken up, might want to split them to make sure yiu still want the uppers done. JG 5.19.13

Question:

I had my eyelids done about five years ago and it made my eyes look more rested but that was about it. In the last couple of months my upper lids have become very hollow. Could this just now be an effect from the surgery? Could it be from aging. Also I had a nasty blow to my forehead a few months ago. Could that be a cause. It has just happened so suddenly I don`t understand. My age is 69. g? I am 69 now. I also had a bad blow to mly forehead a few months ago.

Answer:

That can be from fat loss that can occur form normal aging or aggressive fat removal during prior surgery.I do not think the blow to the forehead would cause it. No matter which of the two things caused it, it can at times be partially improved with filler injections.JG 4.26.13

Question:

I read that upper or lower eyelid bleph surgery can be done in the office. For either, will your eyes swell after surgery so you will not be able to see to drive home? I just plan in having numbing shots without any pain or anxiety medication. But I want to know if I can drive home after the procedure.

Answer:

I would never let my patients do that. JG 4.14.13

Question:

I do not know if it is because the CO2 laser might have not been used directly under my eyelids where I have dennie`s lines, but they are still prominent. Does the CO2 soften dennie`s lines much? I was thinking about getting these lines cut out. I just wonder if it is possible? I mean could it make my eyelid look droopy? The amount to be removed might be about 1/16 of inch. I just have a couple of lines close together that need to be cut out. If the dennie`s lines are cut out, will it make my eyelid swell even with a number injection? I just want to know if I can drive home after the procedure.

Answer:

I have never heard of dennie`s, if you send some pictures to me at drgarcia@lvcosmeticsurgery.com I might be able to give you some options. JG 4.9.13

Question:

I think I have what you call a double eyelid= excess fold in upper eyelid crease. In my 30s, I was concerned the muscle was weakening in one eyelid since it looked wider or droopier than the other. What I discovered is the excess skin in double lid has sagged making the eyelid appear wider or droopier. The other eyelid with double eyelid does not show clear fold of skin above eyelid. The skin just looks loose there. Why would these two double eyelids look different? Is an upper bleph done to correct this type of problem?

Answer:

I am having trouble visualizing what the problem is, if you would like you can send some photos to me at drgarcia@lvcosmeticsurgery.com so I might be able to give you more insight. JG 3.28.13

Question:

Hello Dr. G. Botox does not last long on me. 2 months at best. Given the cost and the unpleasantness of the stinging shots, it is disappointing. My cosmetics doctor told me of Zytaze, which is supposed to help Botox last longer. So here is another way for me to add to the cost of maintenance . What are your thoughts and does Zytaze work? I have been taking zinc as I was told Zytaze is a form of zinc but my doctor recently told me just taking zinc won`t work, and I will need to take Zytaze. Thank you as always for your generosity in sharing your knowledge. I hope you enjoy the long weekend.

Answer:

I have seen the `reports` regarding Zytase and I think any effect would occur only in patients that were deficient in zinc, in my personal opinion. 2 month is pretty short. My questions would be how much is being injected, and along with that I must say that he should be using one bottle of Botox per patient,it is clearly stated on the bottle that it is for single patient use, bottles should not be shared and if they are sharing, they might have diluted and prepared the Botox hours before and the effectiveness dwindles the longer it is mixed, it should not be mixed and stored for more than 4 hours. Some docs breaks the rules and share the bottles and at times the Botox you get was mixed days before and not used and you might have gotten what was left in the bottle form the day before.JG 2.15.13

Question:

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

Question:

I had an upper and lower bleph and canthoplasty several years ago with less than stellar results. I have pretty big scars lateral to both eyes and their shape was strangely altered. My plastic surgeon recently diagnosed upper eyelid ptosis on my L eye, and he`s right. I look mildly intoxicated much of the time and I don`t even drink! He told me that the levelator muscle will need to be repaired. He doesn`t perform this procedure himself, so he sent me to an occuloplastic surgeon at the Massachusetts Eye and Ear Infirmary. Because I had so much previous surgery, the surgeon to whom he referred me doesn`t want to get involved. What do you recommend I do? I assume that this is a difficult problem to repair under the best of circumstances, but even harder with scar tissue. Even if I can find someone to do this, I`m concerned that the assymetry could be made even worse by the correction. Thank you for your help.

Answer:

Just see another eye surgeon, that doctor may not want to help but others will. It is not easy surgery but it us something eye surgeons do all the time. Don`t give up. JG 19.22.12

Question:

Hi Dr., this year I will be turning 50 and to celebrate I am considering taking some years off my eyes. They were indeed, at one time, my best feature. They are now quite hooded ; one a bit worse than the other. No matter how long and made up my eyelashes are, by the end of the day they seem to be camouflaged by the look of swollen upper lids. Given the two choices of just an eyelid lift, or an eyebrow lift, which would you recommend and why. I have seen before and after of both, and results look pretty much the same. Thanks a million!

Answer:

what you need depends on what is causing the hooding. If one does an eyelid procedure when a forehead lift was needed it will not look the way you and if your do a forehead lift and you needed an eyelid surgery, again, things will not look right. I might be able to give you a little more info if I see pictures of you. I would need to see photos straight on and on a 3/4 view, without you lifting your forehead, so totally relaxed. You can send them to drgarcia@lvcosmeticsurgery.com

Question:

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

Question:

Thanks for the answer about the arcus marginalis. I`ve already had a midface lift to correct the sag, but the triangle beneath my eye, lateral to the nose, still sags and is puffy. Can the arcus marginalis itself be reattached (not just the midface tissues)? If so, will it help with the sagginess and puffiness?

Answer:

the arcus itself is a very narrow thin piece of tissue that acts like a dam, I am not sure that such a structure alone can be repaired. JG 7.18.12

Question:

Several years ago, a plastic surgeon performed an ill-advised arcus marginalis release on one of my eyes when he was doing a lower bleph. As a result, my midface on that side sags and my lower lid is perpetually puffy. Can it be reattached?

Answer:

the midface should be able to be elevated, reattached and the fat treated, yes.JG 7.18.12

Question:

I had upper bleph on one eye 3 weeks ago. However, the PS made the incision quite low in my opinion, and now it looks like I still have the extra skin or worse than before. Is this an illusion because the scar is a little red and raised, and will clear up, or what can I expect and how long will it take to look better? Thanking you in advance..

Answer:

I think it is a little early to make a decision. I think since that skin is so thin, you need to give it time for the swelling to go down and the redness and scar tissue to soften. I would give it 3-6 months before making a decision. All the best. JG 7.13.12

Question:

Hi Dr G: I had a lower and upper blaphroplasty about 3 years ago. The surgeon did not remove enougth fat from under my right eye and now I have a fat pad uner my right eye. How can this be corrected?? Do i need to have the surgery again which I can`t afford? I am very upset with this surgeon because I told him after the procedure I was not happy with the pad left behind and he refused to remove anymore. Now I`m back to square one. Also I`ve been told by a couple of surgeons offices that the surgeon does not do just one eye. Should I return to the original surgeon and ask something be done with a discount?? Should I do Radiesse? I`m aggravated over this.

Answer:

it is either more surgery, but at times the excess fat pocket can be hidden with the injection of fillers to the surrounding areas to make the area more uniformly smooth. As to more surgery by a different surgeon, one only operates on the one eye if needed, so they might have been trying to tell you that their surgeon did not want to take over another surgeon`s prior patient. I would certainly speak with your original surgeon about how he can correct this for you, that would be the best option. JG 6.30.12

Question:

My right eye by the lateral canthus seemed to develop a large wrinkle out of nowhere, that is two rather puffy folds that come together and form a wrinkle right from the crease of the eye and extend out over a cm. Stange that this would occur so spontaneously out of nothing. Even if I lift the skin to simulate an brow lift something can still be seen under the skin in both areas puffing it out. This has gone on over a month so I am pretty sure it`s permanent. If there has been perhaps some localized fat deposits in the area that occured as that`s how it looks to me can they be removed via microliposcution? This wrinkle really does not look like a skin atropy thing causing the wrinkle (I didn`t even have fine crows feet lines there yet), it looks more like a sudden hypertrophy in the area.

Answer:

An acute deposition of fat is highly unlikely. There might be some edema for some reason. I suggest seeing an Ear Nose and Throat specialost for am evaluation. JG 6.28.12

Question:

Thank you for responding to my question about postopertive lower lid swelling. I think I was unclear in my question. My eyes had some puffiness before surgery. After the surgery, for 2 1/2 weeks there was no bruising or swelling. The swelling appeared 2 1/2 weeks after the surgery. After 13 months it did not improve and a steroid injection in my right eye one month ago made the swelling worse. Could it be residual fat or scar tissue?

Answer:

Hard to believe it could be scar tissue and the surgery should not make it look like more yet, it would either be the same or less. JG 6.12.12

Question:

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

Question:

Thanks for the reply about the arcus marginalis release/repair. Unfortunatley, i`ve been doing injectiable fillers and because the underlying structure is messed up, it always ends up just looking puffy -- no matter the material or no matter the extremely experienced hands the filler is in. So instead of an old orbital fracture, it looks like a new and swollen one with filler in it! Sigh. Even with the potential for failure, might it be something you`d be willing to try to repair? I understand that no one wants to inherit another surgeon`s problem, but that reasonable position ends up effectively stranding those of us who have been left with visible deformities. Thank you again for your time and consideration, Dr. Garcia.

Answer:

please send me some pictures, straight on, three quarter view, with mouth open and closed, no smiling. send them to drgarcia@lvcosmeticsurgery.com and let me see what is going on. It might help to have a copy of the operative report before the surgery for the surgeon to see what was done too. JG 5.21.12

Question:

Several years ago a plastic surgeon who was stuck on the idea that the correction for all lower lid problems was an arcus marginalis release performed one on my right lower lid. Well, ever since, my right midface sags at the lid-cheek margin. He thinks it looks fabulous but I`ve seen several other doctors who think I look like I have an old orbital fracture. He definitely created a deformity. My question is can this ligament be reattached? I know you don`t like taking on other people``s patients, but I wonder if it`s a small enough procedure that you might consider doing it. Thank you for your consideration, Dr. Garcia.

Answer:

actually, it might seem like a small procedure, but what he likely did was separate the tissues of the cheek off of the bone and try to reposition them higher, the complication rate is over 15% in the hands of the surgeons that invented the procedure. To repair it, the same thing has to be redone and has a high risk of failure again I am afraid. You might be better off doing something else, like injectable fillers. JG 5.21.12

Question:

What is the cost of fillers under the eyes? How long will it last? Do you still do portrait laser for wrinkles under the eyes if so what is the down time?

Answer:

the price varies from office to office, depending on the size syringe used and whether it si the doctor or a nurse injecting, I would say an average cost is about $500. There can be a little bruising for a few days that can be hidden with makeup. One can return to normal activity the next day and we are seeing it last about 8-10 months. JG 4.6.12

Question:

Would you put fillers under the eyes for wrinkles and dark circle. Is so what? Would you use botox for crows feet? What do you think about the liquid face lift. Thanks for your time

Answer:

I use fillers for the dark circles but not for the wrinkles of the lower lid, I do use Botox and all other neuromuscular modulators in the crows feet to soften the wrinkles during animation and to lift the lateral brow. As to the liquid facelift, I have been doing it for years and am quite happy with it. All the best. JG 4.6.12

Question:

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

Question:

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

Question:

What is your cost for a temporal brow lift? I live here and need to start saving!

Answer:

it would be about $5100. JG 3.9.12

Question:

Dr. G., you are whip fast in your replies. Thank you! Actually, there was skin removed. My PS cut out a little section at each corner and pulled the skin up (because I was complaining - after $7000 - that my eyes looked pretty much the same). So he took a small section of skin out at each corner (not underneath the eye as he said he didn`t want to put anymore tension there.) So do you still feel the same about him taking out the stitches today? Thank you!

Answer:

yes, I think it is still OK,all the best. JG 3.2.12

Question:

Hi Dr. G, well I went through with that revision work on my eyes. I posed your question about what happened and why my upper/lower lift didn`t do much. While I don`t recall getting a specific answer, I did also ask why more fat wasn`t taken out (since you posed the question to me). I was told there was no fat to be taken out, that my problem was a lack of fat. My PS had originally wanted me to put some filler in above my cheeks (at ad additional $1200 to me when I already spent $7000 on the eyelift) because he said that I needed to fill in that area so it would give more of a shelf. I didn`t do it. I don`t want to be all puffed up like far too many women I see. Anyway, he just did the revision on Monday (late afternoon) and already intends to take the stitches out today. Is this too soon? While there are only a few stitches on each corner of my eyes, is 4 days all that`s needed? I feel he`s rushing because he (nice life) is going on vacation next week. Thoughts? Thank you!

Answer:

the eye region heals quickly and there was no skin removed so there is little tension, so taking the stitches out today is OK. All the best and hope all looks better once you are healed. JG 3.2.12

Question:

Had upper and lower eyelid surgery Feb 2nd, with internal brow lift. Left eye appears larger than other. Plus there is a horizontal indentation above crease but below brow on left upper lid that resembles a scar, but isn`t. Also 13 days after surgery, left upper eyelid became swollen and red, and just above cheek looks like a small pocket of fat remains, and is still red in that small area today. Went to doc, who say it is lymphedema, and I should use antibiotic/steroid drops for six weeks after surgery. My left eyelid is bright red from crease down to eyelashes. The other eye is okay, but it is a lot more hooded than left. Also using Refresh thick eyedrops 3-4 times a day. I am miserable, and look horrid. I don`t want anyone to see me. It actually looks like two different doctors did the surgery. PLEASE, what can I do? Oh, also the outer part of left eyelid is numb. Something is wrong here. HELP! Deanna

Answer:

I think eye drops are OK, but you likely need oral antibiotics too. As to the crease you see, it should get better as the scar tissue softens over time. I would give it at least 6 months, if not more, to decide if you need any more fat removed too. If you continue to be frustrated, you could see another surgeon for a second opinion in person.The numbness will continue to decrease with time also. I wish you the best. JG 2.29.12

Question:

Hallo Dr. Garcia Do you receive patients from other countries in my case, Sweden, and is there an opportunity to do the initial consultation via email and a photo. In my case I need surgery for my malar bags, Thank you;)

Answer:

We do perform surgery on people from outside the US. Please feeel free to send photos and your concerns, aling with your medical history and list of medications and prior surgeries to drgarcia@lvcosmeticsurgery.com. Looking forward to hearing from you. jG 2.23.12

Question:

Dr. G, you`re the best. I needed to follow up on my question (dated 2-16 *below* re: eyelid surgery). I`m a bit confused. What I`d first like to ask is how is it possible that - even though I have a scar which means my PS did surgery - can my eyes look minimally improved? (My mother and sister actually say they look exactly the same). How can this be? Here in NJ, I spent a LOT of money on this upper/lower eyelift and its upsetting. Honestly, I`m thinking of asking for my money back (though I don`t really know how. Too late to do a dispute on my credit card). And truthfully, I don`t want to do this. I`ve had other surgeries with this PS and they were good. The ONLY option he`s given me is doing an incision off to the sides of my eyes. He said he`d put the scar in the crow`s feet - but (believe it or not, at 46, I don`t even have any crow`s feet so I`m not sure why he even said that - perhaps he was assuming crow`s feet are a coming eventuality at my age?) When I smile I have a slight crinkle but that`s all. Nothing if I don`t smile. You mentioned (below) something about *not* excising any skin. How do you not excise any skin? I`m assuming I`m getting a local (in his office, ugh) and he will do a small incision and then tighten up the corners. He does not want to do any more surgery directly under the eye. Would you say this is right on his part? Thank you!!!!

Answer:

as to how it can look the same, it might have been minimal fat removal or an inadequate release of the fat pockets and the sutures that were placed to hold the fat did not hold and broke loose. As you have had surgery by the surgeon before, I think being frank with him is the best approach. You should explain to him what you saw before the surgery and now, and ask him how he proposes to correct what is there now from only a crows foot incision. If he can do all of that from the crows foot incision now, why could he not do it that way before. Wish I could suggest more. Thanks for the kind words and I wish you the best. JG 2.20.12

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

I had a bad lower eyelid surgery. I did not do my research before hand and did not make a wise choice. I have found out too late that this surgeon has a history of doing very bad work. I am now visiting PS who do revisions and am confused as who to pick. Each one has a different suggestion on what they would do. I do not want to make a second mistake and am so confused! Any suggestions? One of my choices is a Chief of Plastic Surgery. Also the doctor who did my original surgery is saying there was no operative note done, and he says he did not take after photos. He took them 2 different times. I persisted and he came up with one and said he had to destroy all but one because blurry photos. He is now saying he no longer has my records. Can a PS do a revision without my operative note? Is there any reason the original PS does not want to give me all my records? Thank you for your help!

Answer:

although records can be lost, it sounds like your previous surgeon might be trying to hide something if the story changes as you say. I do think the operative report would help the subsequent surgeon but not absolutely needed. At times the second surgery can sound like something quite big, but it is common for a revision to be larger than the original surgery. I would say that when deciding on the revision surgeon, make sure that whatever they do does not burn any bridges for further surgery in the rare instance that more surgery is need later. I wish you the best. JG 1.8.11

Question:

Hi Dr Garcia. Happy New year! I had slight hollows under my eyes and had fat grafting to them a few weeks ago. The fat dissipated within 3 weeks and I now have lower hollows( i.e further down my cheeks), than prior to the fat placement. Could it be that the cannule have destroyed good tissue and what can be done about it? Normal fillers do not last well in my face either.I am very disappointed as I now have to wear glasses to disguise my ugly hollows. Not a good look!

Answer:

more likely is just some swelling that is temporary from the cannulas being pushed through normal tissues, doubt that the new areas will have a permanent issue. If it is hollows of the eyelids themselves, I agree, no fillers work well, the fillers work for the tissues over the orbital a rim much better. Not alot of options for the hollows due to excess fat removed surgically or from the aging process. JG 1.1.11

Question:

Hi again Dr Garcia Thank you for answering my previous question about under eye hollows from fat removal where you said `not a lot of options` to fix these. Are there any options at all?

Answer:

I know some surgeons had used a thin sheet of Alloderm placed as a sling, it has worked well on some and has dissolved in others, not super reliable. That is about all I can suggest I am afraid. Best of luck. 1.2.11

Question:

Hi Doctor G. Last year my plastic surgeon told me in about a year they will have a new procedure out which sucks the fat out from underneath your eyes(bags) without surgery. Have u heard of this and if so what is it called?

Answer:

not heard of anything safe like that, sorry. JG 1.1.11

Question:

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

Question:

Hello Dr, I am interested in having a procedure which will lift the brow subtly similar the the look Kyle Minogue has. Can this be obtained without surgery? I have tried Botox but it only lifts a small degree. I was reading that thread lifts are an option? Thank you

Answer:

The threads break and then you look uneven, it will require surgery for it to look even long term. Sorry. JG 12.16.10

Question:

Hi, Dr. Garcia. A few years ago, I had a bilateral canthopexy which left me with 2 cm scars lateral to each eye. Had I known this would be the outcome, I would not have opted to do it. The left scar looks sort of OK because its trajectory is slightly downward, making it look like deep crow`s feet (which I never had before). The right side scar looks absolutely terrible because its trajectory is upward, making the whole right side of my face looked pulled up as if on a puppet`s string. My ps agreed that the outcome was absolutely terrible so he has tried to revise the right scar twice with no discernible improvement. In the second and last revision (15 months ago), he made the very bad decision to excise a bit of lower lid skin at the inferior margin of the scar, thinking that doing so would lower the scar. It didn`t lower it; rather it simply sacrificed what little remained of pointed end of the palpebral fissure. Now it`s completely rounded, and it looks like there`s a wall of skin running straight up and down what used to be the outer *corner* of the eye. Honestly, I look like I`ve been in a terrible accident; in fact, I usually say that is what happened because it`s so disconcerting for most people to look at me for any length of time, particularly in conversation because it`s hard to look at my eyes which are now devoid of expression. (And I`m a therapist, so if I can`t talk to people, I`m out of work). I saw the surgeon again last week, and he wants to refer me to an oculoplastic surgeon for a tissue expander and/or a skin graft. Understandably, I am very reluctant to make this horrible situation worse; so he suggested that I could try to improve this on my own by pulling the skin at the corner of the eye out and down when I am driving or whenever I can devote a fair amount of time to stretching it manually. He claims that this will simulate the action of a tissue expander. I`d rather do this than undertake another risky and disfiguring surgery, but frankly, this suggestion sounds to me like that home-grown rhinoplasty strategy of pinching one`s nose with a clothespin in the absurd hope of reducing the cartilage! What do you think? Thanks so very, very much for helping us all out. Really, you`re like NPR`s Click and Clack, but for plastic surgery instead of auto repair. We`d all be getting even more ripped off and chopped up if you weren`t around to set us straight!

Answer:

I am sorry to hear about your travails. I think massage and pulling might soften the scar tissue but it will never approach anything near a tissue expander. I cannot say 100% without seeing you in person to tug on the tissues, but the tissue expander option normally would avoid the need for a skin graft. The best option for changing the direction of a scar that runs against the grain, so to speak, is to use a Z-plasty technique. It can be done as a single Z-plasty, or a series of smaller ones. This elongates the scar and re-orientes the scar in the opposite direction. A skin graft, if required, could be harvested from the upper eyelid and placed where the recent skin was removed. A tissue expander will stretch skin, allowing more skin laxity, but I will say that while it is in place and being expanded, you will look like you have an ever expanding tumor on the side of your eye, likely will need to be the size of a Kiwi fruit or larger. Thank you for the kind words of encouragement and I wish you the best. JG 11.11.10

Question:

Hi, Dr. Garcia. I see that you`ve advised other posters that malar mounds can be improved by suturing the muscles that have separated, resulting in fluid accumulation between them. I assume that the incision for this procedure is transcutaneous. Can it ever be done transconjunctivally to avoid a visible scar? If not, can the fluid that collects between the separated muscles simply be aspirated? I`m beginning to look like a hound dog (lovely), but I obviously want to avoid scars on my cheeks. Thanks so much for being there for all of us!

Answer:

sorry, but no, it has to be done through the skin. The fluid, if successfully aspirated, read here almost impossible to do, will reform in a manner of hours I am afraid. All the best and thanks for the words of encouragement. JG 10.19.10

Question:

Hi Dr. Garcia, I am 2 weeks post mini-facelift with lower lid bleph. Overall, I`m very pleased with the results, however, the scars on my lower lids are more red and visible than I thought they would be. Is there anything I can do or use on them to make them less visible? Thanks so much for this wonderful website!

Answer:

good moisturizer maybe, it is a hard palce to use the creams we use elsewhere for fear of it getting into your eyes, they get better pretty fast though, just give it a few more weeks. All the best. JG 10.18.10

Question:

Hi Dr. Garcia, Thanks for your response about the small hematoma on my right cheek one week after mini-facelift surgery. I also had a lower lid bleph, which seems to be healing well (sutures removed on Thursday). Would it be okay to use the TNS Recovery Complex (with growth factors) on the suture line to speed healing? I had been told by another PS this is what they recommend for their patients but forgot to ask my PS about it on Thursday. Thanks for your willingness to provide this wonderful site!

Answer:

I do not think that product should be used there nor will it help healing on an incison, it is meant for skin peels and lasers, not incisions. Best of luck. JG 10.9.10

Question:

Hi Dr. Garcia. I have emailed you several times. I had laser resurfacing 3 times for wrinkles and it caused puffiness on my lower eye/upper cheek. Some days it looks better but most of the time it is like a pocket that fills with fluid. My left eye is worse than my right. You are the only doctor that I can find that does direct extraction. The bags are not huge but it is like an extra pinch of skin... I live in CA. I would trade a little scar for the puffiness anyday

Answer:

please send me some photos directly to me at drgarcia@lvcosmeticsurgery so I can see the issue and let you know. Straight on view, three quarter view with over head lighting and no flash please. JG 10.1.10

Question:

I had tarsal strip performed almost 1 yr on my left eye. That eye is looking strected up and smaller then the right. will it ever losen even abit?...also I get alot of twtiching and its effecting the left cheek and now my upper lips and all. I dont know what to do. I get the twitch on the left eye randomally when i look up down and am shocked at somthing. now sometimes it happens to my right eye too. ALmost like both eyes are narrowing down. (right eye was down canthopexy earlier) and i am only 30. Please help. the eye specialist said yes, he agreed my eye shape changes when i look around randomally , suggestion: can i use botox to freeze these muscles so they dont move or twitch while looking around and randomally making expressions? will this help at all?? I dont want my eyes to look scarey and weird while looking at people face to face, coz i can feel it happening and its very embarrasing. please help with the eye shape(left eye being smaller) and the twitching results... tnks

Answer:

I think you have likely gotten as much loosening as you are going to get by this time. The twitching might get better over the next 6 months though, it could be nerve irritation, and in most cases that will settle down. Botox can help to some degree, I agree. Not much more I can offer, sorry to hear about the problems, that much eye surgery is uncommon in a person your age though, not sure why it happened. Best of luck. JG 9.14.10

Question:

Hi Dr Garcìa: 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

Question:

I was born with a few deeper wrinkles under my eyes. Due to aging, I have developed slight wrinkles below those deeper wrinkles. Although the deeper wrinkles are not due to aging, they look like it due to aging. Funny how I can temporarily lessen the appearance of the wrinkles caused by aging with creams, but I can;t do that with the deeper wrinkles I was born with. My question is if the skin right under the eyelid (where deeper wrinkles are) can be cut out? If so, what is the maxium number of centimeters or inches that can be removed?

Answer:

if there is exceess skin, it might be possible, but without seeing you in person, I cannot say 100%. The amount of skin that can be removed is that which is present and can be pinched and then not have it pull the lower lid down to cause scleral show. JG 8.24.10

Question:

Is there any other filler u recommend then beside restylane or Perlane that is more long lasting than. I live in Europe, and the filler i have tried which i think is amazing is Evolence, because its the very long lasting. Is there any other you rather recommend to fill out the upper eyelid? Thank you very much on advance. Sincerely.

Answer:

sorry, those are the only ones I would use, Evolence was removed from the market here due to many problems. JG 8.10.10

Question:

Ok. thank you for youre answer, but can you fill upp the inside corners of the upper eyelid and the whole/most of the upper eyelid only then? Just wonder what part of the Upper Eyelid u can fill up? Since u said that not all of the eyelid can be filled. I dont need to fill on the eyelid itself, i think the upper is what need the filling. Is Evolence a good filler to use? And isnt it fuller in texture than restylane? I have heard that restylane easily disapears also. And i have used evolence in my lips with extremly good results.Thank you very much on advance.

Answer:

just the part over the bone is all. I will no longer use Evolence due to the numeous problems reported here n the medical news. It is no longer sold here in the US. I do not think it is any fuller in texture than Restylane though. JG 8.10.10

Question:

Hi Dr., Have you heard of RapidLash (OTC lash growth), and does it do anything? For $49, it sure beats Latisse, which is about $125, but not if it doesn`t work. Thank you!

Answer:

sorry but I have not had a single patient use it so I cannot say. JG 8.9.10

Question:

Thank you in advance Dr. Garcia for answering my question. I had upper/lower eyelid surgery 6 weeks ago. How long does it take to completely heal. I still feel some tightness in eyelids and some tearing in one eye. Is this normal?

Answer:

should be much better in another 6 weeks and final healing is 6-12 months.Tightness at this point is not uncomon, as is tearing. You should bring those issues up with your surgeon to make sure you do not need some eye drops in the intervening time. Best of luck. JG 8.9.10

Question:

hi im the one with the tarsal strip smaller eye problem and twitching. thank you for replying back. ok the twitching make the upper eyelid and lower eyelid move and along with some on cheek. I know without seeing you , you cant say but how much unit of botox would you normally do to that area to predict? and would the aperature of the tarsal eye gradually open abit more after one year? when will it fully stay the way it is? thnxx

Answer:

I would likely start with 20-30 units and supplement from there after waiting at least 10 days. I do not think the aperture will open much over time I am afraid, most of whatever loosening will take place is between 6 weeks and 6 months, little after that. At one year you will be at final result. Best of luck. JG 8.3.10

Question:

I had lower eyelid done and I was told too much skin was removed. The lower eyelids are very tight and pulled pretty straight. Will the skin loosen up where I have a more natural rounded lower eye lid, or will the lid always stay straight and look unnatural. It has been almost 5 months now. I was told it is amazing how much skin can stretch. My top eyelids also have a rounded droopy shape that goes down now instead of the almond shape where the top eyelid is going slightly up. I don`t think that will change as time goes by? Thank-you!

Answer:

it will loosen up but it might never resume the normal shape you had before as the skin will likely not relax in that exact way. I wish you the best. JG 7.22.10

Question:

Dr. Garcia, I am post-op 2 1/2 wks. from upper/lower eyelid surgery. I had ripped out some side stitches and now have a more visible scar. When can I start using Mederma? Will this help reduce the look of the scar? Thank you. I also had cantopexy (I think that`s where I ripped the stitches). They were restitched the next day.

Answer:

once the wound has healed and there is skin or scar over the incision, it would be OK to apply the Mederma. It will help some, but it will not make it look as good as it could if the incision had not been left open to close by secondary intent. If they were restitched and then the sutures were remvoed as advised, then it should heal as it would had bene expected if it had not been ripped open. JG 7.12.10

Question:

How long after upper/lower eyelid surgery can I start using Mederma? Thank you Dr. Garcia and have a good day

Answer:

a couple of days after the sutures are out is OK. JG 7.7.10

Question:

I meant to say that stitches are now removed but how long will it take for scars to be less noticeable. Is there a product I can use that will make scars less visible? Thank you again DR. Garcia

Answer:

see adjacent response.

Question:

I had upper/lower eyelid surgery with cantopexy 2 weeks ago. I had to have some of the stitches on side of eye re-done since I had ripped them. Stitches are not out what can I use to make scars less noticeable. How long will it take for scars to disappear. Thank you so much Dr. Garcia

Answer:

once stitches are out you can use Mederma or ScarGuard, it will take a full year for maximum fading of the scars though, best of luck. JG 7.7.10

Question:

Dr. Garcia, I had upper and lower eyelid surgery 13 days ago. I still have numbess on the upper lids and swelling. The bruising is almost all gone. Also, I notice some uneven healing - is this normal at this point?How long before everything looks normal Thank you

Answer:

all normal at this point, most of the swelling will take 4-6 weeks to look better and final results might take up tp 6 months. Hang in there. JG 7.5.10

Question:

Hello Dr. Garcia . I have dark circles under my eyes , I have previously had a lower bleph. and CO2 laser which helped a great deal for a number of years . My surgeon would like to perform another lower bleph. to eliminate the dark circles but I have no loose skin in that area and am afraid I will end up with that `hound dog` look . Would CO2 laser be the way to go here? I am also getting `crepey` on the upper eyelid. Instead of upper bleph. could I tighten it up with Co2 here as well? many thanks Jenny

Answer:

well the CO2 might help the crepey skin and the only surgery that might help would be to place fat underneath the dark circle to fill it in and help the light reflect better. Best of luck. JG 6.27.10

Question:

hi dr garcia thank you for your advice regarding my my post op malar bags,you are a kind man to take the time to help people,you suggested a mask for sleeping,would it help if i put some kind of pressure on the bags to move the fluid ?or maybe have lymphatic drainagein the area i seem to have some fat on upper right cheekbone too.it looks like a little bulge ,i have cut salt from my diet as i know that helps,i have heard of a muscle flap op that can sometimes help sorry to be a nuisance but it is making me depressed wish i had found your site before i had surgery, kind regards j.

Answer:

sure, moist tea bags work well too. Lymphatic drainage likewise will help. I have not seen any muscle flaps work for the bag I am afraid. All the best. JG 6.27.10

Question:

Hi Doctor.I had a L/Bleph a year ago.Took some to settle down but overall pretty pleased with the result and its had a benefical effect on my eyes overall wrt how they feel etc.(My lower eyes were pretty bad) I had a good surgeon (UK)and he was realistic about it all etc. but I have been left with some lines and loss of volume although he made me aware of this.Contemplating laser treatment but still wary as to what kind etc..My question is would a pinch op in the future help with a little tightening/lift or would skin quality be a big factor in this.PS bought your pep cream and loving it. God bless you and yours.x

Answer:

most likley the laser is a better option at this stage as it is likely more a skin quality than a skin quantity issues. Removing skin is only for excess quantity. Glad you are enjoying the peptide and all the best. JG 6.24.10

Question:

hi dr,i had a facelift and upper and lower bleph 10 weeks ago, i now have prominent malar bags i am looking for some way to reduce them my ps refuses to excise them because of the scar, would laser resurfacing help or fillers ? or would a temporal lift improve them i, i know they are difficult to treat .do you know of any creams that help to shrink them i have to wait 6 months for anymore surgery i know, but i am really self concious about them now, i am using diroseal for the redness ,thank you j.

Answer:

I do not think laser, fillers, creams or a temporal lift will help, they are caused by fluid seeping out under the skin between the the muscles of the eyelid and cheek where a small dehisence or separation occurs with age and the fluid collects there. They can occur after the surgery you describe but usually get better with time. Head elevation, avoiding salt, and even at times using the light blocker masks that people wear over their eyes at sleep time to avoid the light getting in can apply some slight pressure that will help in some case. I think in time it will get better, but vrry slowly. All the best. JG 6.23.10

Question:

Thank you so much for your thorough answer below about the palate graft. Would you please clarify one thing you wrote? You said that the graft is likely to be lumpy due to post op swelling, which I would expect. Are these grafts usually smooth in appearance after that swelling subsides or are lumps more or less inevitable as a permanent outcome of this surgery? Thanks again and sorry for asking two questions in one day!

Answer:

in most cases, over time, the grafts do flatten and smooth out, yes, but SLOWLY. No worries about the questions, that is what I do, best of luck. JG 6.21.10

Question:

Hi, Dr. Garcia. I read a reply you wrote to someone a few weeks ago about a hard palate graft to correct an ectropion after an aggressive blepharoplasty. My plastic surgeon has recommended the same thing for me and has referred me to an oculoplastic surgeon at a major teaching hospital. I haven`t had that consultation yet. Before I meet him, can you tell me where the graft is usually placed -- under or above the muscle? I assume that if it`s under the muscle, it will be less noticeable, but I may be wrong. After one bad surgery, I`m worried that I`ll now be trading badly drooping eyelids for a permanent bulge/lump under my eyes. Is that a common problem with this surgery? Any other questions you would recommend that I ask the surgeon when I meet him? Finally, would you yourself undergo this procedure if you needed it or do you think it`s just too risky? Thanks so much for your help. Have a great summer!

Answer:

the hard palate graft is placed under the eyelid muscle, it actually replaces the mucosa and the cartilage tarsal plate of the inner lid, the pink mucosa that lines the inside of the eyelid, and then the other tissue, with or without a tissue advancement or skin graft is placeed over it. It will look like a large bulge as there is significant swelling after the surgery but it might be the only way to get your eyelid back to where it needs to be. I think asking the eye surgeon if they plan on doing a skin grat or lifting your cheek tissues up is a good thing to know so they can describe it more in depth for you. Best of luck. JG 6.21.10

Question:

I have had an orbital rim fracture and cheekbone(tripod) it was in 2001 its been repaired somewhat....dont think the rim was quiet back in place...and to put the plate in they cut the bottom eyelid and went thru that way causing teathering, one doctor put some nose cartilage underneath the lower lid to hold it up...looks more like a stye...ugh....i have hollowness under the eye....and the eye is wider. my question is....wil resty help this or do i need implants or re break it all and re set....ugh here is my youtube video.... http://www.youtube.com/watch?v=RiOHOERFP9E

Answer:

I think you will likely need both, I am afraid, sorry. JG 6.3.10

Question:

Thank you for your (remarkably swift!) answers below about orbital rim implants. You suspect that a hard palate graft might be necessary. Would you kindly tell me what that would involve and how it would correct the problem? Would tissue be taken from the roof of the mouth and placed beneath the eye? With transconjunctival or transcutaneous incisions? Is this a procedure you yourself have performed, Dr. Garcia? If so, might I contact your office for a consultation? Thank you for your time and help.

Answer:

only if you have an ectropion, if your issue is just a smaller and rounded opening of the eye and no ectropion, then the hard palate graft will not help. I cannot say that would be indicated in your case without seeing at least pictures, but an in person exam is better.If a hard palate graft is required, it is taken from the roof of the mouth, yes. It is placed through a transcutaneous incision in most cases. I have performed them. I might suggest sending at least pictures to drgarcia@lvcosmeticsurgery.com and that way I can give you a better idea before coming in. JG 5.27.10

Question:

To clarify my question below concerning orbital rim implants: Are they likely to push the lower lids more forward (i.e, to make them more projected) than up (to make them more lifted)? Even if they are more likely to increase the projection than the lift, might the implants help to lift the lids even a little? Thanks again.

Answer:

in cases like yorus, where there is not enough skin to begin with, my fear is that the orbital rim implants will stretch the skin even more and pull the lower lid away from the globe of the eye, I cannot see how that would help you. A hard palate graft will sometimes be needed but that is more for ectropion rather than a rounded canthus. I do nto agree with the plan but it is hard to say 100% without seeing you and touching the tissues to see their pliability. JG 5.26.10

Question:

I have the dreaded round-eye syndrome following an aggressive blepharoplasty. My face resembles a child`s doll. I wear glasses I don`t need -- and more of than not, sunglasses -- to disguise the problem, but with little success. I`ve had a canthopexy and 2 canthoplasties over the past 6 years, and they haven`t really helped. My surgeon is now suggesting we consider orbital rim implants to support the lids. In your estimate, might this help, or would it usually extend the lids` projection without lifting them? Thank you for your valuable advice and time.

Answer:

hard for me to say but in most cases of a rounded canthus, it is due to not enough skin and further tightening usually will not help, it many times will need a skin flap to replace some of the previously excised skin and allow the length of the eyeid to get longer, not shorter. Best of luck and sorry to hear about the problems. JG 5.26.10

Question:

would it matter if co2 is performed and lift is performed after? im planning to get co2 but surgeon still evaluating the lift process. im seeing two different surgeons for each procedure. will this make a difference to which is performed first with the end results?

Answer:

well, if you know you need both it might be best to do the CO2 laser second, if you are unsure that you need the surgery, then the CO2 laser first is OK to do. JG 5.24.10

Question:

had my eyes small from eye surgery. I hate it. its been long time now. can eyes be large again with some kind of surgery? or is it permenant? is there any surgery to cut them open? i know it sounds crazy

Answer:

if there is enough skin left and if there was a canthopexy performed at the time of the original surgery, it might be able to be reversed in some cases.

Question:

Hi, I had upper and lower eye surgery six months ago and I am very depressed. I had been gone for my hometown for a year and upon my return everyone is saying What happened to your eyes? . I don`t even want to go out anymore, I am so embarrassed. I told the doctor that I just wanted to look refreshed and he has made me look like a deer in headlights. A ps here told me that he took too much skin. My eyes look completely different and really small. People I have known for 15 yrs don`t recognize me! Can anything be done to make me look more like myself again? Also, my left eye will not close when I try to sleep and I wake up during the night with water streaming from both eyes (and I`m not crying). I also have a cyst that has been on the outer corner of my lower lid that is getting increasingly larger and it hurts. Can I have that removed? It looks horrible! PLEASE HELP!

Answer:

I cannot say what can be done without seeing you and knowing fully what was done in the operation, in many cases some of it cna be reveresed though. I ma sorry to hear about your problems. I suggest seeing your surgeon, or someone else in the plastic surgery realm that can see you in person to determine what can be done. All the best. JG 5.24.10

Question:

I had lower eyes done awhile back and my eyes are considerably smaller. Once the healing process is finished, I was going to see if anything can be done to enlarge the eyes, meanwhile my eyeball is changing shape to fit the smaller round eye. When I stretch out the skin at the outer corners of my eye to the size they used to be, there is now a gape and the whites have gotten smaller and changed shape. Will the eyeball change shape to fit if the eye shape is enlarged or will a gape remain? Thanks

Answer:

sounds like you had some type of canthus tightening procedure at the time of the eyelid surgery to avoid the lower lid form pulling down. In time the tisue might loosen but I cannot say 100% how much looser they will get, they might stay smaller always. JG 5.21.10

Question:

Hello Dr. Garcia. I just had Dysport injections in my forehead and crows feet and Perlane under my eyes and in the folds around my nose. Will you do upper and lower eyelid surgery despite the Dysport and Perlane or do I have to wait for them to dissipate? Also can you give me an approximate price range for the upper and lower eyelid surgery? Thanks you so much for your time. BTW, you recently did a good friend/neighbor`s face lift, and he looks great! We live on Mt. Charleston.

Answer:

no need to wait for it all to wear off, and as to the upper and lower eyelid price, all inclusive, is $4600. Thnaks for the comment also on our previous patient. JG 5.20.10

Question:

Hi again. You said a light laser might help sagging skin a few years post bleph. what kind of laser should I look for? I know all PS don`t do lasers, so wondering where to go. I could come to LV. thanks again.

Answer:

The laser would best be done near you so the follow up visits can be done properly, I suggest a CO2 laser, might want to see a dermatologist if you cannot find a plastic surgeon that has the laser. JG 5.20.10

Question:

Hi, Dr G: If one had a U/L bleph a few years ago, but skin on lowers appears to be sagging a bit again as I approach age 60, what procedure can address this? Thanks for everything you do!

Answer:

maybe alight laser. Best of luck. JG 5.19.10

Question:

I had lower eye surgery about 10 weeks ago. My incisions go down instead of across like I was told they would. One is just over 1/4 long and the other is 1/2 long and I have some extra skin above the incisions. One surgeon couldn`t understand why my PS made the incisions so long, he said he could remove the extra skin and the incisions would then move and go across instead on downwards. I went to my friends surgeon and he agreed the skin needs to be removed, but the incisions would still go downwards because that is the way they were cut. He also did not understand why my PS made such long incisions. Will the scar move upwards or stay downwards after the removal of skin? I have lost all faith in my PS because he keeps telling me it is not extra skin, just swelling. I am almost 3 months and don`t understand how I can still have swelling, especially when I have been told by 2 others that it is skin. Everyone who has seen me has made comments on how small my eyes are now and everyone has said I looked better before. I hate to admit it, but they are right. My PS said my skin still will stretch and I will get my big eyes back. I don`t understand how that is possible because my eyes are a lot shorter in length because of the way he stitched the lids together. My eyes are short and round looking now, not long and wide like before. My PS keeps saying skin stretches and I would be amazed at how much it can stretch. Would I not notice something by now? When is this stretching suppose to start happening? Thank-you!

Answer:

typically the incisions are placed in pre-existing wrinkles, usually the deepest one, so if you had a wrinkle that was angled that was more appropriate, that may be why. The more skin that has to be removed, the longer the insision is, and no two eyes are ever the same. Claiming one can remove all of the skin with a certain size incision is disingenuous and might leave residual skin in many cases. The lateral crows feet incision will likely not move up or down, but stay where it is. As to the amount of skin removal at the lash line, it is always easy to say more skin can be removed, but it is always better to go back and take a little more because taking too much out can leave you with scleral show and potential corneal exposure and injury. The aperture of your eye might be smaller now if a canthopexy was required to avoid a postoperative lagging lid. I understand your friends making those comments but I would venture to say that most times they have never looked at your eyes preoperatively as critically close as they are now. Don`t get me wrong, I am not saying that your concerns are not well founded, but it is always easy for another surgeon to crticize someone else`s work. If you have lost confidence in your surgeon, you certainly should not go back for more surgery, but be wary of those that only say what was done wrong, for most likely, they have had similar occasions of less than optimal results that they have not volunteered to tell you about. I wish you the best and ask you to give it a bit more time before having more surgry. JG 5.14.10

Question:

In answer to your question on previous question, he did tighten the upper outer lid to avoid the skin downward, I remember him saying that when I asked why it was tightened that way. He still insisted that my eyes will get bigger again. I told him I didn`t see how. How soon does a reversal need to be done and will there be longer scars? Can it be done where I am partially concious and sitting up so he can see what he is doing? Will the excess skin be able to be removed at the same time? Will the results be worth it to get this done? I am not sure if I trust him since he was so adament about me getting the surgery when I was hesitant, and then trying to talk me into getting check implants and even a tummy tuck. I weigh 103 lbs and I told him I was happy with my body and I said I could live with what ever little belly I had. He kept insisiting I would be happy with a tummy tuck and there is no way I am getting one or need one! I should have ran out there as fast as I could! Now I have to live with a mess around my eyes and it is to the point where I hardly ever go out anymore because I am embarrased and I feel so ugly! I always got compliments on my eyes. If he would have been honest with me, I would never have had this done! It is not worth all the anguish. How will I know if it can be reversed successfully? I don`t trust him anymore. He just keeps adding on time to how long before I look beautiful again, just to keep my happy and not bothering him. Thank-you again!

Answer:

I would give it at least 6 months if not longer. The scars are the same. It is a personal preference on awake under local or general anesthesia. If there is exess skin it can be removed at the same time, yes. I think if it bothers you then it is worth doing it. If you have lost confidence in him I think it best to see someone else. JG 4.24.10

Question:

I had sent a question but did not see it post so I am going to try and send it again. I wish I would have come across your site sooner, if I did I would not have had lower eye surgery. I went to this PS for first time for botox and he pointed out what he called fat pads and how they should be removed. I did not even notice them until he pointed them out and I told him that I felt I did not need to have them removed yet, and he kept insisting how much more beautiful, younger and refreshed I would look. I asked if it would change the shape of my eyes because I loved my eyes and he said no. I had the surgery done close to 8 weeks ago and I regret it so much and have ruined my eyes and I try not to cry every time I look in the mirrow. My friends that haven`t seen me until a couple of days ago noticed right away that my eyes were a lot smaller and a couple have said it looks like I have excess skin above the incisions and that the scars go downward. I told them that I thought it was excess skin also, but my ps surgeon insisted it was not. He also told me that my eyes would get back to their normal size, I was first told at 2 weeks I would notice, then 4 weeks, and now 8 wks which would be in 2 days, I saw him yesterday. My scars face downward and he said they will move upwards. How are my eyes going to get big like they were if it has already been 8 wks and he has sewn them closed at the outer corners. Can anything be done with the excess skin and will I have bigger scars? Will the scars move upwards into a straight line? When I asked him all these questions, he just said Baby, you are going to beautiful, you just have to have patience ! Will I am still waiting to see any beauty return. On top of looking ten years older, I now have dark circles that are especially pronounced in low lighting and one side looks like he took a shovel and took a chunk out. Even my girlfriends that I meet once a week for a dinner, said they have not noticed any difference in the last couple of weeks in the skin going down, or in my eyes getting big again. Once made a comment that I am suppose to look refreshed after and not old and tired. She said the scars go down and it drags me down which it does. Since my ps won`t answer any of my questions, can you? My eyes are not going to be big again are they? (they are narrow and small now, now wide and long like before) Will the excess skin go down, if there has been no improvement in the last couple of weeks, and according to my friends who see me once a week there has been none. Will the scars move upwards? I am also massaging. This ps also said I could use cheek implants and I had asked another ps and he said you have a lot of elasticity in your skin and do not need that yet! He also looked at my eyes and said, you need to see your surgeon. But my surgeon keeps insisting in time I will be beautiful. Thanks for your help.

Answer:

difficult to say without knowing exactly what he did surgically but the eyes being smaller can be caused by a canthpexy if that was done, if that is the case, as the swelling goes down it wil get somewhat better but not in all cases In small fraction of patients the canthopexy has to be undone. A canthopexy is where the lateral aspect of the lid is shortened or tightened to avoid the skin being pulled down. As the the downward cant of the scars, swelling can at times push scars downward but usually if it is due to swelling, it should have gotten better to some degree by now. If the scar is pointed down, it will fade with time but the direction likely will not reverse itself.Wish I had more to say but witout seeing the befores and after and knowing what was done surgiclaly, I cannot say more. Best of luck. JG 4.24.10

Question:

I had a lower eye lift done about 4 weeks ago and I have not been happy with the results and my surgeon does not want to answer any questions I have. He told me I have to wait until my next visit. I went to see my friends surgeon and he said he saw that my surgeon had tightened the skin on the top of the outer lid and he said he was not sure why he did that and I need to see my surgeon. (looks like part of outer upper lid is gone) Is there a reason why my surgeon did this? I find that because of it, my upper eyelid is shorter and thinner, therefore making my eye smaller. Can this be untightened, reversed or fixed? Now I am really nervous! Then the surgeon repeated that I need to see my doctor.

Answer:

hard for me to say without seeing you but if the second surgeon had not seen at least pictures of you, it is hard to say why things were done or not done. It sounds from what you are saying that a canthopexy was done to correct or prevent the lower lid form pulling down, if that is the case that can make the eye look smaller, at least while swollen. I think you need to see your surgeon and speak with him and explain your concerns. Having said that, many times the best thing to do is to give it time as many things correct themselves without intervention and more intervention when it is not needed can lead to new problems. Best of luck. JG 4.20.10

Question:

Is eyelid surgery an option to treat a Horner`s Sign ? I had a complete thoracic sympathectomy on the right side two years ago, hence the resulting Horners`. In general, when having one eye corrected to compensate for the Horner`s, is the outcome (symmetry) more likely achieved by have bilateral eyelid surgery?

Answer:

well, there are eye surgeries to improve it but they are not like a cosmetic eye surgery, but the incisions are similar. If the other eye is not involved there is no need to do both. JG 4.13.10

Question:

i had bleph years before, and then canthopexy, one eye is smaller then the other one. the bigger eye the upper eyelid goes higher then the ohter one... like u can see the white of it more... i look grose. im 29 female. what do you think is needed?i know u havent seen me but in your mind what can u predict

Answer:

well, if the larger eye shows white below your iris, it likely needs a canthopexy on that side also. At your age, the only things that can cause the scleral show, which is the white part of the eyeball showing below the iris, is a muscle paralysis, over active thyroid or excessive skin being removed at the original surgery. I am sorry to say that more surgery will likely be needed at some point. All the best. JG 4.12.10

Question:

I had a lower eye lift done about 3 and a half weeks ago. My eyes are smaller now and I was told my eyes would return to their normal size, once everything around my eyes relax. Is that true? I noticed my skin was pulled pretty tight at the outer corners of the upper lid and there is not much lid left so I am not sure how my eyes can return to their normal size. Thank-you!

Answer:

I think there likely will be some changes that occur over the next few weeks. Trying to go in and do too much too soon can cause more problems, I suggest waiting some more for now. All the best. JG 4.12.10

Question:

I had lower eye lift done 3 weeks ago. My eyes still feel incredibly tight at the outer corners where the incisions are, and the incisions face downward. I have hooding of excess skin over the top of the stitches, more toward the middle and ends and I find that ages me, the skin below the incisions is smooth. I also noticed that my upper eyelids are thinner and toward the end, the eyelid gets really narrow and is almost non existant and looks funny, especially when you look at me sideways. I am not sure if too much skin was removed and therefore the upper eyelid was pulled down to be stitched to the bottom. My eyes looked way better before and now I am regretting this surgery. I have been depressed and don`t go out anymore because I feel disfigured. My one friend saw me and she said I had the most beautiful eyes before and why would I do this. I told her when I went for botox, the doctor pointed out that I was starting to get fat pads and they should be removed and I would look so good after. They never bothered me before until he pointed it out. If I would have done my research and homework, I would never have done it! He showed me his wife that he did the procedure on and she looked fine. Now I am wondering if he really did do her. Is there anything I can do? Would a brow lift help? I am not sure about a skin graft since there is almost no upper lid left at the ends of eyes. I pointed it out to the doctor and he just glanced at me for 30 seconds and said I will look beautiful in time. I have taken a photo today and one a week ago and there is no difference in the puffiness and excess skin above the incisions. It get really bunchy and bumpy when I smile. I am so depressed and have destroyed my beautiful eyes! Please advise me what I can do. Thanks so much!

Answer:

As hard as it is, I think the best thing right now is to let the tissues soften and heal. Doing more surgery right now could make all things worse.That skin is quite thin and delicate and being too quick to try to fix or change things could make it even worse. Give it some time and then lets see where it goes. I can understand your regrets but most likely things will improve quite a bit and what might need to be done will be smaller. I wish you the best and hang in there. JG 4.11.10

Question:

Why does a bleph sometimes make people`s eyes look smaller...like w/Burt Reynolds for instance and many others. thanks!!

Answer:

that happens if the lower lid needs to be tightened with a canthopexy. That is required if the lower lid has lost muscle tone and is hanging down, it should not always happen. If the canthopexy is needed and is not performed, and skin is removed, it can lead to serious problems with corneal exposure. JG 4.7.10

Question:

Hi Dr Garcia, I`m planning for an eyelid surgery but before that I`ve been doing my research on drugs that will help to reduce my swelling. I`m currently getting stuck in between Vitamedica Arnica montana 30x and Sinecch. My question is which one is better for eyelid surgery? If i`m going for a suture eyelid method, the drugs can be taken straight after the surgery. I wrote a letter to alphine pharmaceutical and i was told not to take sinecch more than 4 days. What if i`m going for an incision eyelid method, how should the drugs be taken then? I will have to go back to the doctor 7 days later to unsew the suture. Please advise !

Answer:

I like the VitaMedica one better. Yo can take that product for a longer period of time. Taking the sutures out does not need the Arnica though as there is no bleeding from that. JG 3.20.10

Question:

Hello Doctor. I am at my wits end about what to do with my lower eyelids. Following lower blapheroplasty, I was left with severe potis and scleral show and hollowed-looking eyes. I recieved orbital rim implants which have corrected the problem somewhat medially. I also had a lateral canthopexy which has had no effect. The lateral corners still droop down unnaturally. I`m still not happy. Do you do the hard-palate graft procedure to lift the lower eyelid upwards? That, I feel, is my last hope. If you do it, how much is the ballpark cost? If you don`t do it, can you advise me of reputable surgeons who can?

Answer:

I do not perform the hard palate grafts but it sounds like that is what you need along with a probable skin graft to the outer surface to avoid external skin contracture. That procedure is done by opthalmologists. All the best. JG 3.9.10

Question:

Hello again! I wrote recently asking about botox for eyebrow/eyelid asymmetry. I forgot to report something rather amusing that you may not have heard before. When I drink wine, my eyebrows level out.And I can`t even say if one goes down and one goes up--seems to be a bit of both. Now you may be tempted to suggest the wine is affecting my vision, not the height of my eyebrows. But seriously, I have seen this time and time again over the past year. Too bad i can`t drink wine all the time LOL.

Answer:

you got me stumped! JG 2.28.10

Question:

Follow up to skin graft to lower lid, what is the healing process like? Will I be swollen again? Is there any way a filler could be used to help with the asymmetry, instead of another surgery? Thanks again Dr. Garcia.

Answer:

well, it will be weeks, 4-6 weeks before it looks presentable in most cases. It will be swollen and also red until it heals. I cannot say if a filler would be enough on its own without seeing you in person, sorry. All the best. JG 2.26.10

Question:

Greetings Dr. G: I had u/l bleph almost 2 years ago and had a hard recovery. However the results have gotten better over time, and I keep hearing how good I look especially when I run into someone I haven`t seen in a while. But one thing that has bothered me is that I still have asymmetry in amount of upper lid showing due to brow being lower on one side than the other. Would botox on one side help? Would it be injected on the lower side or the higher side? I`m not inclined to get any more eye surgery or a brow lift even if I get a facelift someday. Thanks

Answer:

it might be a good way to see if it can be improved prior to contemplating brow surgery too. I would need to see pictures of your eyes and forehead to say whether the higher or lower side would be best for the Botox. I will say that, in general, it is easier to drop the eyebrow than to lift it though. JG 2.25.10

Question:

Follow up to the skin graft to the lower eyelid w/ lid lag, do they take donor skin from upper eyelid and is it a simple procedure? How many stitches will there be? Finally, how do I find a good PS or opthomoligst who does it? Thanks Dr. Garcia.

Answer:

if there is enough skin of the upper lid, that is tte preferred site as the color match is good. It is a relatively simple procedure. As to finding a good surgeon, asking your primary care physician or calling the local county medical board is a good place ot start. JG 2.20.10

Question:

I had a lateral canthopexy approx. 2 mos. ago to correct lower lid lag from prior mini. bleph. on right eye (you`ve answered several questions of mine over the past year on this topic - cont`d thx). I think it has made some difference, but honestly, my right lower lid still pulls down a little and my right eye still looks a little bigger than left. At one point, you suggested maybe a small skin graft. I really just want symmetry. What does a skin graft entail and do all PSs do it?

Answer:

I would give it at least another 4 months and then maybe proceed with the skin graft. Any plastic surgeon should be able to perform that for you, otherwise see an opthalmologist. Best of luck. JG 2.16.10

Question:

Hi Dr. Garcia: Eleven months ago, I had lasik surgery and after three months, I had upper Blepharoplasty with the suggestion from an office staff member. The lasik surgeon sent me to a surgeon that diagnosed me with muscle/nerve damage, severely dry eyes and said I should have had a brow lift and he sent me back to the lasik surgeon for further treatment. For ten months, my vision was blurry and fluctuated daily until I was given antibiotic eye drops. (Glasses made four times since March) The eye drops were given because of diagnosed meibomian gland dysfunction after wearing bandage contacts and they immediately gave me better vision. Since the beginning, I haven`t had clear vision, my right eye didn`t close at first and now it won`t stay closed when I sleep. When I relax my eyes, the right eye pops open. I have lateral hooding with bumps at the end of my incisions. My right eyebrow is much higher than the left and my right forehead has wrinkles and the left has none. I don`t know if my eyelids are numb or if I am feeling heaviness but when I lift the outer edge of my eyebrow, the sensation is relieved. This sensation is taking a toll on my nerves. Also, I`m meeting some kind of resistance when I upgaze but when I lift the outer eyebrow, I`m able to upgaze. I use eyedrops all day, heat pads, eye scrubs, goggles when outdoors, and I sleep in goggles. Since my eyes are so dry, I had punctual plugs inserted. Recently I had a Shirmer`s test and my right eye registered a 6. I went back to see the eyelid surgeon a few months ago and he didn`t seem to be interested in my problems. He said that my eye not closing was already like that before surgery and he had no idea why I was having numb sensations. I feel so damaged and my life has changed to the point of wondering how much longer I can go on like this. Do nerves heal? Do muscles heal? I cannot have a brow lift because my eyes will not close. Is there something simple that can be done to raise my left eyebrow to match the right? It is so obvious to the point that I was sent a photograph after a 42 year high school reunion, asking me if there was something wrong with my eyes. I feel failed and shouldn`t have had the eyelid surgery since I was having problems with lasik but I didn`t know. Almost a year since lasik, eight months since eyelid surgery.....I need help! Incidentally, the lasik and eyelid surgeon worked in the same office! Thank you for any help or advice you can give.

Answer:

muscles do heal and nerves if they were cut do not, some of the loss of sensation is likely permanent, but some of the issues sound like possible levator muscle disruption of the upper lid and also some excess skin removal. I think the best is to get a new consultation by a different surgeon, in person, to see what they think is going on. At times, a fresh view brings new treatment options to light. I think you should avoid the brow lift until more of the problems improve. I will also say that the lasik alone can cause some of the vision problems, I am sorry to hear about your problems but I think an in person evaluation by a new opthamologist is very important. Best of luck. JG 1.31.10

Question:

Hi Dr. Garcia, I`m 7 weeks after lower eyelid surgery but my eyeballs and lower eyelids are still very red. Before the surgery, I was told that the recovery is only 1 or 2 weeks. Should I be concerned? What can I do to speed up recovery?

Answer:

hard to say without examining you, I suggest you see your surgeon for them to help you. JG 1.29.10

Question:

Hello Dr. Garcia. I have a question regarding canthopexy. Who is the best candidate for that kind of surgery, in case to have the best results? As for myself, i want to change the shape of my eye, to make them a bit longer and to turn them up a bit as i have very deep set eyes that are roundish and go down a bit. So is canthopexy a good option for me? As I know fat grafting is not very recommended even though i would love to have puffy eyes. Thank you for your time and considaration?

Answer:

it is best if used when the lower lid is not in its proper position due to aging or injury.Having it done to change the shape of the eye, I feel, is unreliable and difficult at times to get them even and will make the aperture of the eye smaller. It will make them shorter if anything.Best of luck. JG 1.28.10

Question:

Hi Doctor, I love your site and the way you re-assure people and be straight also when you need to be.I had lower lids done - now 7 months post op.Male 39 , fit and healthy but my eyes were terrible.I got a reputable PS but had some complications during op as I had some wasted muscles and it wasnt straightforward.I recovered fairly quicky but had bad chemosis and it took a good five months for my eyes to settle and for me to be comfortable with them even though they are still settling.I am fairly happy with the result but have some loose skin and more lines as very mild canthoplexy was done due to muscle wasteage.PS has said that the best way for him to address this if i wanted to was for him to inject fat taken from me and this would be a good way to even/plump out the skin but I would lose half of the fat injected in the first few months?I am not sure of Lasers and wonder if there is anything else you could advise on or if this is a good option (2500 GBP for the procedure....) God bless. Dan M

Answer:

well, I feel tha fat injections around the eyes are very iffy and would not suggest it, I think lasers are a better option, a light CO2 laser to help tighten the skin, I am not a believer in chemical peels helping tighten skin though. All the best and thanks for visiting.JG 1.25.10

Question:

Dr. Garcia, Thank you for your response - I was the one who wrote about filling in the hollows in the upper eyelid area. What I don`t understand, though, is that if skin is removed in the upper eyelid area and then fat is grafted to fill in the hollows, why does the skin there stil look so loose and wrinkled? You`d have to see some of these after pictures on the Web - it is really confusing. Thanks for this site, Dr. Garcia - the time you give to help us become better informed is unmeasurable.

Answer:

well, the amount of fat that it would take to fill in a hollow is quite a bit and fat injection in that area do not hold and survive well. Glad I can help. JG 1.11.10

Question:

Hi Dr. Garcia I hope you had a wonderful holiday! Recently, at my husband`s birthday party, the photographer got several photos of me smiling quite a bit and I had no idea my eyes looked so old. I am 62 and have had both lower and upper eyelid surgery years ago. But now my eyes look so hollow BUT there is also alot of loose skin - NOT in the middle of the eye but at the corners. My doctor said (I`m assuming because I already have a hollow look) he would be afraid of doing an eye lift. Isn`t there some way to excise only the skin at the corners of the eye by cutting into one of the natural creases? 1/9/10

Answer:

well the hollow can be from losing fat as you age or from the previous eye surgery if they were aggressive in the fat removal, difficult issue to improve. As to the skin, it migth require more skin removal or a laser to improve, sounds more like surgery in your case though. As long as no more fat is removed there should not be any increased hollowness. Best of luck and thanks for the kind wishes. JG 1.9.10

Question:

Hello Dr. Garcia. I had consulted with you a few years ago for a breast lift and lipo and have been saving money for the procedures. However, I think I am more interested in having my eyes (upper and lower) done along with the CO2 laser on my face. Can you tell me how long the recovery will be and the approximate cost for those procedures being done at the same time please? I`d like to schedule a consulation and have the surgery done within the next couple of months if possible.

Answer:

well, the CO2 laser wil leave you red for about three weeks and pink for about 2 months, the eyes are a little bruised for a week or so but look pretty good in a couple of weeks, fees for both the eyes and CO2 laser of the face is going ot be about $9000, I think an in person consultation would be best too see what you would benefit most from. Looking forward to seeing you again. JG 1.7.10

Question:

Dr. Garcia, I had eyelid surgery in 2007 that increased the hollows in thu upper eyelid area which only made my eyes only look older (not the result one seeks). I`ve been researching on line and see that some surgeonns are grafting fat into the upper eyelid area to fill out the hollows. However, I also noticed that the eyelids in the after photos, though filled out on top, now had extra skin on top. Isn`t there some way they can cut away this extra skin to give it a smoother appearance? What am I missing? Thanks much.

Answer:

it is hard to replace what was removed without a trade off I am afraid, you might have to choose one or the other, sorry. JG 1.6.10

Question:

It`s me again with the black eye from the tennis ball from over a year ago. I did go see someone to see if there is anything that can be done about the puffiness and bag I have under that eye. It is obvious that it is fluid, since I can actually move it from one area to another. I was told that the remedy would be to have a Blepharoplasty. What do you think? It doesn`t make sense to me since it is not a fat pad. It is like the sinuses are not draining properly on that side and it gets worse if I have a cold. Also worse when I first wake up in the morning. Would you recommend going to see a ear, nose and throat specialist. I would love to get rid of it. Thanks for your help and have a good new year.

Answer:

yes to the ear nose and throat, I agree, a blepharoplasty does not make sense, wish I could tell you what is causing it, might be a small leak through the cheek bone from the sinus causing fluid to come and go between the tissues and the sinus.Best of luck. JG 1.6.10

Question:

Hi Dr. Garcia, How long will Chemosis usually last after lower eyelid surgery? What`s the best treatment for it?

Answer:

can take 1-6 weeks, steroid drops in many cases will help too. Best of luck. JG 1.6.10

Question:

Hi Dr. Garcia, I used warm moist heat as you suggested and my bruise is almost all gone. Thanks you so much!

Answer:

you are very welcome. JG 1.4.10

Question:

Hi Dr. Garcia, I had lower eyelid and cheek lift three weeks ago. My left eye doesn`t have any bruise but the bruise under my right eye is prominent and had very little improvement. Is this longer than normal? Is there permanat bruise? Thanks.

Answer:

no, it will get better still, have to give it time, use warm moist heat and massage. JG 1.3.10

Question:

Hi there Dr....Can red veins on my eyelids a year after upper bleph be removed................ Thanks Dr.

Answer:

could try a YAG laser with eyeshields in place, but they are hard to remove. JG 1.2.10

Question:

Pre and post bleph, one of my eyebrows is a bit lower than the other. While I have nice improvement overall after u/l bleph, I have more upper lid showing on one side. My PS and I both think this has to do with the eyebrow. I did not want eyebrow lift at the time of my surgery although he said the brows were rather low. I am glad he does not push anything unwanted on me but I would have liked him to offer his opinion more strongly to educate me. Anyway I think I will have this fixed when I do facelift but, if I do brow lift as a stand alone surgery, can I expect that the assymetry can be fixed and what is the recovery time? You`re the best! Happy New Year.

Answer:

should be able to fix the asymmetry, yes. The recovery before being out in public is 10-14 days, all the best. Happy New Year. JG 12.30.09

Question:

Hello Doctor: I would like to have my eyes done, but one eyelid (droopy) is aging faster than the other. The other eyelid looks OK. Do I need to have both done at the same time or can I have just one done and the other later down the road? Happy Holidays and many thanks for all you do :)

Answer:

on rare occasiosn only one can be done. Merry Christmas, Happy Channukah and a Properous New Year. JG 12.20.09

Question:

Good Morning Dr. Garcia, I`m 25 years old, and would like to slighty change the shape of my eyes. My eyes are an almond shape for the most part, but I want the `cat-eye` look, my top lid is slightly slanted down instead of `up`. I believe a blepharoplasty would be a little extreme. Could a canthoplasty or canthopexy acheive this? Also, what is the average cost for either of these procedures? I know it does vary by location, plastic surgeon, etc...I just need an estimate. Thanks!

Answer:

a canthopexy or plasty is more invasive and difficult than a blepahroplasty and getting the two eyes to be perfectly symmetrical can be difficult. I would imagine the price range would be about $4000. Merry Christmas, Happpy Channukah and a Properous New Year. JG 12.18.09

Question:

hi doc, thanx for the reply to my twithing eye and botox. How about the filler to the left eye. I wanted to know if the left eye will look swollen and different in shape like this? or is it still the swelling? its been like 2 days or so now. (left eye filler, upper medial, ...) thnx docccc

Answer:

I would not do a filler at this point. I think you need to give things time to settle down, and by that I mean months and not weeks. JG 12.17.09

Question:

When you have an upper eyelid surgery to remove extra or loose skin, is there a lot of bleeding? Is there a lot of swelling? It just sounds so painful and awful.

Answer:

not alot of either usually. Not too painful at all. JG 12.12.09

Question:

Why would there be pressure on the eye just from having excess skin removed from the upper eyelid? Is it that painful to need pain medication? The main consultant to the plastic surgeon told me she had her upper eyelids done and drove herself there and had it done at six oclock in the afternoon and it took about twenty minutes for the actual surgery and that she drove herself back home and was home by eight oclock. Do you think that would be normal or was she exaggerating?

Answer:

the pressure is only from the swelling and excessive bleeding, not from the skin removal itself. I think the scenario the consultant is discussing is highly unusual and I would not pose my decision on her anecdotal story or sales pitch. JG 12.10.09

Question:

I have been asking you questions about having an upper eyelift. I also have been doing some on the internet about it and I have been reading that a main concern after having it done is peoples blood pressure getting up after they go home and how dangerous it is and that some people have died from the blood pressure going up. Dut to them bending over or exerting themselves. Even being constipated and it raising their blood pressure due to something frome the anethesia. Can you tell me why having your eyelids cut on would have anything to do with your blood pressure raising and is this usually a problem? Also can the dr. tell when I go to him whether or not a brow lift would be what I need instead of the skin cut off?

Answer:

I have never heard of people dying from blood presure elevation after an eyelid lift but it can certainly cause bleeding and pressure on the eye.The risk of blod presure elevation is the same after any surgery, the greater the pain, the greater the chance for blood pressure elevation. JG 12.10.09

Question:

Three weeks ago i had upper and lower blepharoplasty, rhinoplasty and a brow lift (from the upper lid incision). Healing well and happy with the results; i was warned they would be subtle as i am 31 and didn`t have much excess skin. Unfortunately though; the asymmetry of my eyes is still there. I am pretty certain it`s a result of one eye being deeper in the socket than the other. When i pull down slightly on the upper lid of the larger eye in the manner of a canthoplasty just a couple of millimetres it appears to correct the problem from all angles. Or could somebody even out the protusion of the eye`s? I don`t mind how heavy going the surgery might be. It`s the upper lid that looks more open - higher up on the iris. I would send a picture but cannot attach at present. I doubt i need to explain how important it is to me to obtain less obvious asymmetry. I am seeing someone next week regading botox injections - i thought perhaps that could help but ideally would like a permanent solution even if it does. What do you suggest?

Answer:

hard to say what you need without seeing your lids in motion, weakening the muscles can help at times, but you will see lots of changes for the fisrt 6 weeks when you have that much done at once, give it some more time. JG 12.10.09

Question:

I would like to know if you have excess skin on the upper eyelid and have the surgery to remove it, does it leave a noticible scar. If not, how long before it goes away to the point that it isnt noticible? Could I go out in public in two weeks and it not be noticed with makeup on? Is it a painful surgery?

Answer:

the scar can be seen when your eyes are cloased, and if there is a large amount of skin removed that extends into the crows feet area, that scar might be seen but typically, when your eyes are open, there is no scar able to be seen on the eyelid itself. In most cases after two weeks, the make up applied will cover the scars on the eyelid and in the crows feet area. It is not a painful surgery and most patients require pain medication only at night to help them sleep for a few days.JG 12.9.09

Question:

I wanted to know if I have the skin removed on the upper eyelids if my eyes will look like they did before I had the extra skin or will they look totally different? I know they will look different then they did before the surgery. But I want to know will it change my appearance to look different before the skin was loose or if it will make them look like they did when I was younger. What makes the skin sag in the eyes. Where did it come from and what use to be under the skin that now sags?

Answer:

well, since some fat has also dissolved over the years and that is not replaced with the surgery, they will likely look a little different. The skin sags from sun damage, gentics and fat loss. JG 12.9.09

Question:

Hi Dr I had a canthoplasty to correct a blethroplasty that left me with one round large eye & the other narrow & shallow almond shaped. The canthoplasty Dr has pulled hte upper lids too tight & sewn the sides in too close to pupils. The eyes are also uneven (one slopes up & hte other down). Its really embarrassing & at times painful due to tightness. I am in Australia but am willing to go to hte UK or US to get help. Can you recommend a Dr(s) who i can consult to have the canthoplasty undone & correct the eyelid shape & angle. THankyou

Answer:

Might suggest Dr Glenn Jelks in New Yor City or Dr McCord in Atlanta.All the best and sorry to hear about the troubles. JG 12.5.09

Question:

Hi from Germany again (transconjunctival bleph. done exactly two weeks ago). First, thanks so much for your answers and I hope you enjoyed the holiday with your folks :-). You were right, the redness disappeared and my corneas look fairly normal again. Still, my eyes feel `small . Unsure how to describe this. Tehre doesn`t appear to eb swelling, at least, I`m not seeing any. But my eyes look and feel smaller, as if I were squinting. Also, directly below my lower lash line, there are a few tiny broken capillaries that weren`t there before...odd, as the incision was from the inside. Also, there`s sometimes a tightness inside the eye, probably where the incision is. mainly I`m concerned about the small appearance of my eye...will they eventual return to normal? Also, when might I be able to resume wearing contacts? Thanks again for all your answers and help :-)

Answer:

I think you will see a sizeable change for at elast another 4 weeks and then it will continue for an additional 4 months, albeit slower. The broken caplliaries usually also go away, they have always been there, but after surgery they get dilated to absorb the fluid and swelling and as that resolves, they shrink back down. Usually we allow our patients to wear contacts after 2-3 weeks,but give it all some more time, it will get better. JG 12.4.09

Question:

hi doc, I sent you pics earlier. You suggested to have botox for one eyelid thats twitching the surgeon agreed. He just did the botox 2 days ago , where the line of the eyelash is and I think at the corner of the eyelid. Its still twitching. am I suppose to wait for longer time for it to work? and if so how much longer?

Answer:

it can take 10-14 days to work, have to be patient. JG 12.3.09

Question:

Hi doc, thaks for your reply with the email and photo questions... You said you will do fat injection to the upper eyelid medial... what point is this area of the eyes? is it just below the eyebrows? or right ontop of the eyelid of the eyes , where the eye socket is... and can fillers like juvederm be used instead fo fat injection? thanks heaps

Answer:

the inner upper eyelid, right where the fold of the upper eye is. Off the shelf fillers like Restylane can be used too, yes. JG 11.30.09

Question:

Dr. Garcia, I am beginning the process of interviewing surgeons to peform an upper and lower Blepharoplasty. Question: The first surgeon explained for the lower bleph that he makes an inicison along the outer eyelid and out into the crease (crow`s feet) where it will be less visible . I was under the impression you stop before the crow`s feet . The reason being is a friend of mine had the same procedure with cheek implants at the same time and the surgeon explained that the incision will need to go past the eyeline and into the crow`s feet in order to place the implant, otherwise without the implant, the inicision wouldn`t need to be as long. So my question is, is it necessary to continue into the creases of the corner of the eye for the lower bleph?

Answer:

it all depends on how much skin needs to be removed, it is rare that the incision stops at the lash line, in most cases it goes some distance into a crows foot line, more so if a cheek implant is being placed. JG 11.30.09

Question:

hi doc, thank you. Im sending pics with email. Don`t be scared of my face)

Answer:

will be in touch Monday. JG 11.28.09

Question:

hi doc, I have a problem with my eyes... Im 29 female. I had few surgeries, removing fat upper and lower,,, for some reason.. and then results were unsatisfactory due to haveing lots of fat removal ..my eyes looked really old and thined out with whites of my eyes showing plenty.. then I had canthopexy... it made my eyes small... then left my left eye smaller then the other.. and then Ive seen another eye speacialist, he told me I need to do hard palate graft on my left with canthopexy again , yes on the left, apparently the left needed it but it just felt like the right needed it too.. anyways.. now i look at the mirror after 8 weeks of that surgery I feel as though im crossed eyes with different eye shapes.. I don`t know what to say to the doctor when he sees me next coz he will be saying its a good result... But i know i look weird... people stare at me when Im going to places thats a big sign of weirdness... I feel like crying.. my heart sinks when i look at myself in the mirror.. I dont know what it needs to be fixed! I don`t know what to ask from the surgeon... he keeps telling me its looking good... when i look at the mirror both my eyes looks different in shape (so it seems to me aparently the surgeon can`t see it) and It feels like i really have round pupils in more on the one eye... can i send you like a video? or photo? to tell me whats wrong with my eyes? and tell me what it needs???

Answer:

the last surgery you had with the palate graft takes a long time to heal. If you desire you can send some photos to drgarcia@lvcosmeticsurgery.com and I will get back to you upon my return from seeing my family for Thanksgiving. JG 11.27.09

Question:

Hi Dr garcia, I`m the patient that had the blepharoplasty (transconjunctival) one week ago in germany. Today my left eye started bleedingly dlightly...is this normal, a week post-op? the chemosis of the right eye has slightly improved but both eyes are very tired and achy after being open/in used after five hours or so. The whites of both eyes have gone from pink to muddy. Both eyes look glaze-y and awful. How long might this continue. I went for a f/u and was told it was normal , given the chemosis factor (this was pre-bleeding). Am still on antibacterial ointment and saline solution to rinse. Would you have prescibed anything different? The Keflex I`d been taking (for 7 days post-op) are now finished. I have some other antibiotics at home, should i be taking these (amoxicilan)...any reassuring words :-)...thanks and enjoy your holiday! PS will be seeing doc tomorrow again.

Answer:

the bleeding is normal as some of the clotted blood will soften and come out. It will all get better, might want to ask for some steroid drops to help with the swelling too. Sorry I did get back to you sooner but I was with family for the holiday. JG 11.27.09

Question:

First, thanks for your speedy response on my filler issue (from Germany)...I have another question about Transconjuctival blepharoplasty which I had done this past Thurs as well. The cornea of my right eye has been and still is bright red and appears to be melting ...folding into the iris a bit. There`s no pus-like discharge and only the slightest bit of pain underneath the lower lid (am assuming there are stiches inside...?) Question: it`s day 3 after the surgery and the eye is still bright red...the cornea of the left eye is now also folding ) a little although only a slight pink and not as inflammed looking. Is this a type of corneal abrasion and, if so, is it anything alarming? The German docs place transparant adhesive pads under the eye which need to stay on for five days...also, they`ve given me Keflax and an eye ointment. I`ve also been rinsing it with saline solution without moving the lower part of my eye very much. There`s minimal itching in both eyes....though it looks like a nasty bout of conjunctivitis in the right one. Any tips as to how traumatized the cornea might be expected to look after surgery without my hitting the panic button? Thanks so much again, Dr Garcia!

Answer:

it is just blood trapped underneath the superfical layer of the eye, it is a frequent side effects, is temporary and goes away on its own with time. The technical name for it is chemosis. It looks scary but will be OK. Cold compresses and keeping yoru head elevated is all you need to do. Best of luck. JG 11.22.09

Question:

You said that I need to figure out where my eyebrows were before. How can I do that? Also I have very fine thin hair and can`t afford to have any hair loss. Is there anyway to perform a browlift and not go into the hairline?

Answer:

all you have to do is look at old photos where you had candid shots done, where you were not posing or smiling for the camera. Most people think their eyebrows were higher than they really were in earlier years. A browlift can be done right at the hairline, leaving a light scar where the forehead meets the hairline, but if you pull your hair back it can at times be seen. JG 11.18.09

Question:

How can the plastic surgeon tell if I need a brow lift or extra skin removed on my upper eyelids? I look tired and look better if I hold my forehead up, but I can tell that I have extra skin on the eyelids. Also, since I have had radiesse injected inot the cheeks for volume loss, I can see indentions in my cheeks like they have fallen more or maybe the radiesse has separated into different pieces. What is this or what can I do to make my cheeks look normal????????

Answer:

it is all able to be seen and decided by looking, you need to decide where your eyebrows were before and what you would look like if they were lifted. There are many cases where a brow lift can relieve excess eyelid skin but can leave you looking startled or surprised due to overelevation of the brows. I think what is happening in your cheeks is not so much that the Radiesse shifted, but the proces that prompted the need for the filler to begin with has continued and you need more filler in close areas. I normally use Sculptra for the cheeks in my practice. JG 11.18.09

Question:

I wrote to you several weeks ago concerning my extreme disfigurement following a poorly executed canthoplasty more than a year ago. Thanks to your kind encouragement not to give up yet, I gathered the courage to consult two different surgeons, both of whom were shocked by my situation; one confessed that he had never seen such a surgical mess in his 33 years of practice. Both surgeons agreed with your opinion that that the periorbital tissue could be dissected again to free it up for movement; so as a result of your words, Dr. Garcia, I have hope for the first time in 19 months that I might be restored to some semblance of a normal life. I am writing to thank you for that, from the bottom of my heart, and to remind you that you change lives as you sit at your computer and type into the ether. Thank you for taking your medical vocation as a healer as seriously and generously as you do. You`re treating spirits as much as bodies through your work. I am also writing to learn if a particular component one of the surgeon`s proposals sounds reasonable and possible to you. In addition to having the orbicularis muscle pulled up at approximately a 45 degree angle bilaterally, I also have 2 cm horizontal scars lateral to both eyes, which only make this horrific situation worse. It`s like having neon police tape around a crime scene. One surgeon proposed doing a z plasty to shorten the scars and to place the limbs of the incision in positions where my eyes would normally crease if they weren`t so distorted and frozen by the pull of the last surgery. Of course, he`s performed many z plasties in his career, but he`s never done one on orbital scars because he`s never been presented with this situation. My question to you is do you think this plan sounds possible, since 2 cm scars are quite small (though due to their placement next to the eyes, they appear immense)? It seems like a particularly delicate procedure because the area of dissection is so tiny and there`s no room for any margin of error. Obviously, I do not to make this situation worse than it is. Would you do this procedure on a patient who presented this kind of problem in your own practice? Thank you for your opinion, Dr. Garcia, and, more, for your humane and compassionate care for those who are unknown to you. It is not an overstatement to say that you have given me my life back.

Answer:

as to the Z plasty, yes it is possible, I have done it many times for reconstructions after cancer excisons and burns to that area. I am glad I was able to help, but all I did was to remind you of the strength of your own spirit, never lose that again and I am glad I was able to reawaken it in you. All the best. JG 11.16.09

Question:

is redeise good for the high cheeks area? I want very high cheeks from the temples & close to the eye but not right under the eye(on bone) like a J shape round eyes.

Answer:

I use Sculptra for that. JG 10.28.09

Question:

More than a year ago, I had a canthoplasty in which the surgeon elected to pick up a bit of the obicularis muscle to suspend and suture with the lateral canthal tendon on the theory that doing so would strengthen the suspension; he feared he wouldn`t be able achieve sufficient lift to correct the ectropion by tightening the tendon alone. Well, strengthen the suspension he did! I have been left not only with 1.5-2 cm scars lateral to both eyes but also with eyes that pull horrifically up and out, both statically and dynamically. In short, my face has been ruined; I have a permanently bizarre appearance which not even eyeglasses can disguise. I suspect the situation may be beyond repair. I am writing to ask 1)if you have ever heard of using the muscle in a canthoplasty in this way (I suspect my surgeon may have invented this technique on the spot to deal with the severity of my lid laxity), and 2) based on this description, do you think that the situation is indeed beyond remedy? Thank you so much for your time and expertise, Dr. Garcia. You comfort and educate thousands by this site. I hope you are regularly recognized and honored by your peers for your immense public service.

Answer:

there are times when the muscle is lifted yes, and so release of the tissue can likely be done though to help the scenario. Do not give up yet. The recognition form the people here is plenty of accolade for me though, my best to you. JG 10.28.09

Question:

ok, another question .. same person.. tarsal strip person... with the botox... where will it be injected if the twitching is happening with from the left eye and near left eye (temple) and down to the cheek? will it be injected to the cheeks area?.. and sorry to ask but approx what time will this get better? im 29 f. And if doesn`t what can i do?

Answer:

just around the corner of the eye. No way for me tell how long it will take to get better,sorry. JG 10.23.09

Question:

hello dr garcia im the one with the tarsal strip graft,,, sorry im writing again.. i told you that this procedure was performed on left eye and that its really looking different from the right. you said its from the swelling. ... i forgot to tell you that my left eye is also twitching and sometimes my left cheek twitches with it and eveN somEIMEs my lips twitch... will this heal in time too?? whats the hell is happening? can you make sense out of this? pls pls give your opinion? Im going nuts with this.. its been 3 wks after surgery..

Answer:

yes, that is all nerve irritation from pulling and tugging on the nerves, if it gets bad a low dose of Botox can help short term. It will get better on its own in time though. JG 10.22.09

Question:

I had Restylane to fill in a dent under my eye caused by Kenalog--long story but related to a leftover fat pad post bleph. The doc pressed so hard to mold it that I jumped up in pain. Afterwards I looked like I had been punched in the eye. It is really necessary to put so much pressure on the site of a Resty injection? I also had a new dent afterwards, sleeplessness and menstrual irregularities and think that, in addition to doing Restylane, he was playing around with more kenalog in the residual fat pad to avoid having to do a revision--which he said would be free. Would a doc use something and not tell you? I was laying back and could not know what all the injections were. I so trusted this man but now am not sure.

Answer:

the prsessure likely did not cause the bruise, it was the needle stick that caused bleeding and they held pressure to avoid bruising. Usually doctors tell you the plan before they start doing anything, even if they encounter something new, since you are awake, they can always tell you what is going on. JG 10.18.09

Question:

How long would it be before the scar from an upper eyelid surgery to remove extra skin is not that visible and a person is able to go out and back to work without noticible scars?

Answer:

3-6 weeks usually. JG 10.15.09

Question:

i had eye surgery exactly two weeks ago. both eyes still look different. will this still heal and change?

Answer:

depending on what was done, it can take up to 6 weeks to balance out. JG 10.14.09

Question:

hello doc garcia if i fly down to your location will you be able to me with my eye shaping.i think i have one sleepy looking eyes and then one is a different shape due to canthopexy. Im sick of surgeons telling me they look good when the other ps`s agree they actually look the way i describe it to them. and they feel sorry for me ... can you help?

Answer:

maybe send me some pictures before you fly here, take them looking straight, looking up, looking down, and also with your foreehead relaxed and elevated, please include some three quarter views too. Send them to drgarcia@lvcosmeticsurgery.com JG 10.12.09

Question:

Hi dr Garcia, my eye doc injected juverderm for upper eyelids. for about one week i was waiting for the swelling to heal and then last night i though of massaging it. So i press to it and then it vanished! it seems that the filler slipped to the back of the bony part of the upper eyelid(i think its the eye socket). IS this dangerous? and will it dissapear by its own then from the eye? I cant see it anymore but i know its behind the bone of my eye bone. should i be concerened? thanksss

Answer:

I do not think a filler can move that much after that type of injection, what you pushed must have bene all fluid or swelling. I do not think you should be concerned but you should go back to the clinic where they injected you for a check up for your peace of mind. JG 10.11.09

Question:

hello dr. my eye seems to have ptosis problem. it looks half closed, one eye is more lower then the other (upper eyelid) however i was found to have lagophthalmos problem as well. I dont understand this. If my eyes have a ptosis look how can i not close my eye during sleep? I was wondering if you heard of this or what do you think the problem can be with treatmentsurgery? thankyou

Answer:

it has ptosis while sitting or standing but when you lay back the skin of the eyelid would need to go against gravity for it to close.Hard to say 100% but surgery should help. JG 10.8.09

Question:

thank you very much I have good levator movement so he worked on the muller muscle left lid just over pupil right a little higher was going for 3 1/2 on left 1 to 1 1/2 mm on right but nothing not even 1/2 on either side he says he is going to work on muller again just so confuseing not even the slightest change and now to have to do it all over again very frustrating the time money recovery he is a board certified ophthalmic surgen

Answer:

I think you need to ask him if there is another way to do it that he might think is more reliable. JG 10.6.09

Question:

I had eyelid ptosis repair over 3 months ago. There has been no change. The Doc agress and is going to do it again. 1 why didnt it lift even a little the first time 2 why will doing same thinf work second time. 3 will it start to build up scar tissue. Thenk you very much for your time

Answer:

the sutures used in the repair might have broken or slipped is the most common cause for failure of the repair. Doing it again might require a slightly different technique to increase the chances of success. I think the degree of scar tissue build up will not be anything to worry about, all the best. JG 10.5.09

Question:

hi doc, Im the one was asking about the tarsal strip procedure. Well i had it done. I like it but the damn doctor did it only one eye... I was afraid of the shortening but it really gives a perfect look horizontially, although vertically yes as you said it will close the aperature but with that effect it looks even better! but as i said he only did it to one eye.. so i have one wide eye now! anyways.. just wanted to tell you that as i was searching for info from you earlier for this procedure.. thnx

Answer:

well, let the tissues softn and heal and then maybe the eveness will be greater so you can avoid another procedure on the other eye. JG 10.5.09

Question:

hi doc garcia, I had eye surgery 6 days ago on one eye. the upper eyelid looks thick swollen. The eye looks different in shape altogether. Is this normal at day 6? i keep applying ice, should i continue?

Answer:

all normal, and I would continue the ice for a few more days and give it some more time. JG 10.4.09

Question:

My left eye lower lid lags down and looks different from my right eye. If canthopexy is to be done will my left eye look still look different from my right or will it help it to look atleast similar?

Answer:

the attempt is to make it look similar but there is a possibility that that eye might look a litle smaller after the canthopexy. JG 9.28.09

Question:

how much is a carpoplexy - not sure I spelled it right - it is a procedure for tightening under eye skin.

Answer:

need to pick a surgeon as fees vary. JG 9.22.09

Question:

Hi DR G: What is agood procedure excess skin under the eyes. I had a lower blarpharplasty and a profractional laser but after a year my skin is no longer tight under the eyes - what can correct this?

Answer:

usually it is ski removal surgery or a laser, depends on the skin. I suggest a CO2 laser, not fractionated if you go the laser route. JG 9.22.09

Question:

Hi Dr. G - My plastic surgeon left a small fat pad behind under my right eye when I had an upper and lower blapharplasty - its been a year now - do you think my plastic surgeon should be responsible for correcting this - I broght it to his attention about 4 months after the blarpharplasty and he fluffed it off and stated he didn`t want to remove anymore and he didn`t think it was a big deal. Do you think he dhould be responsible to correct it if I am not happy - if not if I go to a different plastic surgeon - how much (ball park figure) would judt one eye lower blapharplasty cost ( to remove that samall amt of fat - that is still noticeable?

Answer:

fees vary from city to city and surgeon to surgeon, so no way to tell what it can cost. In some cases the surgeon covers a small touch up as part of goodwill, but that is an individual choice by the surgeon. JG 9.18.09

Question:

Dr.G I had an upper and lower blaphaplasty last year and my upper eyes look great. But under my right eye I still have a small fat pad that my plastic surgery did not remove completely. Its noticeable and I am not happy with this . Is another lower blapharplasty need to be performed (which I really don`t want) or is there another option that would help with this. My lower left eye is perfect.

Answer:

sorry, only surgry will remove the fat pocket. JG 9.17.09

Question:

Hi there - just posted Q on lateral canthopexy - one other question. How long does one take Arnica (sp?) prior to surgery to prevent swelling/bruising. Also, do you take it both orally and/or topically b/f surgery?

Answer:

start at least oen day befoe, we prefer 2-3 days before if possible. We use both topical and oral. JG 9.16.09

Question:

I`m planning on having a lateral canthopexy on right eye (to repair a minor lid lag after bleph). However, I just found out I got a job interview 11 days after surgery is scheduled. Can you tell me honestly if there will still be any visible swelling, bruising and/or scarring 11 days out? I may need to reschedule surgery b/c I want to look my best and not like I got punched in the face!! Thank you.

Answer:

yes, there will be swelling and likely some redness of tee eyeball itself. Sorry. JG 9.16.09

Question:

What is recommended b/f eyelid surgery to prevent swelling, bruising? I`ve heard of a supplement that begins with an A but I can`t remember the name. Thanks.

Answer:

we use Arnica Montana, both tablets and the cream. JG 9.8.09

Question:

Thanks DR, can you tell me, if I did get the veins under my eyes tied off and did get chronic swelling, would it go away? how long? and if not can you reverse the procedure? How do you know if it is a vein need? this is sooooo stressful, because I really hate the veins, they stick out. Any other ideas that might improve them. Thanks again for your time.

Answer:

no, it can be permanent, and the veins cannot be reversed.I understand the marketing aspect of offering the procedure but since there is no way to predict that the swelling will be permanent, and since the veins are there for a reason, and since the reason that the veins are more easliy seen is because the subcutaneous layer has lost fat and that is the true reason the vein is seen now and tying off the vein will not replace the fat, I suggest you not consider doing it. I woudl use a filler lIke Sculptra to thicken the skin and make the vein less visible. JG 8.6.09

Question:

Is it ok to take red yeast rice supplements (to lower cholesterol) prior to a procedure? Any problems with excess bleeding?

Answer:

should not be any problem. JG 7.28.09

Question:

Thank you Dr Garcia for answering my question on canthopexy. You mention complication rates. Are these particularly high for a standard canthopexy alone?

Answer:

about 5% on the canthopexy alone and about 15% for midfacelift with canthopexy together. JG 7.24.09

Question:

I have widening of the lateral commissure to each lower eye. I have never had lower eyelid surgery. This has led to a rather rounded appearance of the eyes with slight scleral show. I would like to restore my eyes to their previous almond appearance and an oculoplastic surgeon I visited suggested canthopexy. However a different PS I saw suggested mid facelift. I am not keen on having a facelift as apart from the eye problem I do not have any wrinkles or obvious signs of ageing (I am a 42yr old female). I have read a few horror stories about canthopexy making the eyes too small or asymmetrical and seek your opinion on whether this procedure would be a suitable procedure for my needs? Many thanks for your time.

Answer:

hard to say without seeing you in person but I would always go with the smaler procedure if it is going to take care of the problem. The PS failed to tell you that in midfacelifts, a canthopexy will also be done and the complication rate from a canthopexy alone versus a midfacelift with canthopexy favors the stand alone canthopexy. Sounds like you need to ask the eye surgeon if he thinks a midfacelift is also required. I doubt the midfacelift is required at your age although widening of the lateral eye canthus region has to be examined for its cause at your age. Best of luck. JG 7.24.09

Question:

Dr. Garcia, had upper/lower eyelid surgery 4 weeks ago for pstosis, and removal of lower lid fat, fat injection in area above eyelid/below brows, browpexy and canthopexy. I still have swelling, and also lumpy areas on outer corners. I keep reading to massage the lumpy area and the swelling. Can you describe exactly HOW to massage such a small area? Will these lumpy areas eventually go away? Thanks for your help!

Answer:

smalll circles first and then gentle strokong up towards your temple. In time the lumps will go away, they are likely from the fat injections. JG 7.19.09

Question:

Hello Dr. Garcia, Would you recommend tear trough implants or tear trough enhancement for a 24 year old Indian male (light brown skin)? Would there be complications due to my skin color? Overall, would this treatment be dangerous - specifically with the implant?

Answer:

likley would use injectables at your age. I think the implant has more risks. JG 6.21.09

Question:

I`ve asked several questions re: a lateral canthopexy to fix a lid lag on right eye - continued thanks for continued attention to this. Another question, you said that the eye getting the canthopexy would probably look a little smaller due to the way the procedure is done. My question is that my right eye currently looks larger than my left - so could it be that the canthopexy could actually make them look the same. My objective is to regain symmetry. Thanks Dr. Garcia.

Answer:

then, it might be an option, all the best. JG 7.1.09

Question:

Hi Dr. Garcia, I am thinking about getting my upper and lower eye lids done. What are the risk factors and what is the % that some of them may happen. I would also like to know what you think of collagen and fillers and how effective they are compared to a lazer treatment for wrinkles. Thank you CW

Answer:

complications are rare, less than 1-2%, the issues might be too much skin being removed and the eyelids not closing well, or an alteration in the shape of the eye. In experienced hands, the risks are low. As to fillers versus lasers, they are both relatively effective, but fillers have less downtime. All the best. JG 6.12.09

Question:

is yag laser same as ipl? would it need to be repeated ? how many times?

Answer:

no, YAG is stronger. It will need to be repeated but no way to tell how many times. JG 6.8.09

Question:

Regarding the lateral canthopexy on the right eye question, is there any way to prevent the slightly smaller opening? Or is it that it`s never going to be exact? Thanks again for your time.

Answer:

no, it is just what has to happen to correct what was done before, it is not a matter of being symmetrical to the otehr side, it is that a canthopexy has to close the aperture for it to support the lower lid. JG 6.5.09

Question:

I am going to my PS to discuss having a lateral canthopexy on right eye as a revision to a sagging lower lid about 12 mos. post op from a mini bleph. What should I be sure to ask him about? My real concern is acheiving symmetry with my left eye. Thanks for your continued support.

Answer:

just ask exactly what you just wrote, I will say that likely the eye with the canthopexy will have a slightly smaller opening. Best of luck. JG 6.5.09

Question:

How soon post upper eyelid bleph is it safe to receive Botox to crow`s feet, brows, and glabella? Thank you.

Answer:

I would wait 3-4 weeks or so. JG 6.2.09

Question:

Hi Dr. Garcia, I had a lower and upper eye bleph done a few years ago and they looked good., However I think I need both done again., Is it better to go though more surgery on one or both presedures., Or should i do a different procedure or presedures., and if so what would be the best fot me to get done, thanks you are the best.

Answer:

It is hard for me to say what would be best without at least seeing pictures. Feel free to send them to drgarcia@lvcosmeticsurgery and I wil get back to you. JG 5.24.09

Question:

Is there a surgery that tightens loose skin under the eye? I am left with crepey skin after lower bleph 3 yrs ago

Answer:

might get some improvement from a laser, likely no more surgery can be done. JG 5.23.09

Question:

Thanks, Dr. Garcia, for your answer regarding the little oblique raised lines under my lower outer eyelids. I have a few more questions for you....thank you for being so kind to answer my concerns. Can you tell me why fat grafting/injections can be problematic around the eye area and if there is any real difference between ``fat-grafting`` and ``fat injections``? I have heard of many PS`s who do fat grafting with great success, but then again, I went to the top plastic surgeon in my city (a huge city) and am not too happy with my bleph results. Can fat grafts/injections leave lumps and bumps? Resty is SO pricey and just didn`t last long enough. The Botox DID stop the bumpy lines from becoming too prominent when I smile, but I also needed the Resty to ``blend in`` the skin beneath them when my face is in repose, and it just didn`t last long enough. I was hoping that of I had fat injections it could last for many years. I`m wondering if I have some kind of peculiar under-eye muscles and that no matter WHO the surgeon was, the outcome would have been the same (?). Also, what do you think about fat grafting/injections for the tear-trough area as opposed to Resty? I could use some help in that area as well. Many thanks for your kind concern. ~ Susan

Answer:

the fat injections there can lead to lumps and the fat can be difficult to remove if it is too much. Fat graftiong and fat injections are essentially the same thing. If fat injections were so good and so reliable then the other fillers would not exist. JG 5.21.09

Question:

Hi, Dr. Garcia. Thanks for your wonderful website. I had a lower bleph done nearly three years ago to correct under-eye wrinkling. I now have little raised lines at the outer corners of my eyes which extend on a oblique angle downwards. They are really noticeable when I smile (especially when the light hits me from the sides) and seem to ``puff out`` more when I smile. I`ve been to three or four other plastic surgeons (the original one keeps saying I look ``great``, when I feel I don`t) who all say that further blephs are always risky. I`m 60 and I see all kinds of women older than myself whose under-eye work looks flawless (check out Barbara Walters who`s nearly 80!) and I can`t understand why this can`t be fixed. I`ve since tried Botox and Resty in the outer-eye are (underneath) and it really helped but seemed to be gone in just a few months and I just can`t afford that sort of thing twice a year -- or more. The little raised ``lines`` or puffs of fat make it look like the orbital area directly underneath is sunken in comparison. One of the plastic surgeons said my situation is a common occurence after a lower bleph and it doesn`t necessarily mean the original PS goofed but it could be just the way I healed. Do you think fat grafting around the area (directly underneath the raised lines) plus more Botox to stop the raised lines from moving upwards when I smile would be the best option? I`ve heard that a good fat-grafter PS can work wonders, but I`ve also heard that fat grafting sometimes doesn`t last much longer than Resty. Sorry to ramble on, but I am SO depressed about this. I`d was happier with the under-eye wrinkles -- these raised lines at the outer corners of my outer eyelids look like little Nike check-marks. Any advice would be most appreciated. Thanks. ~ Susan

Answer:

Well, as it sounds like Botox made it bettr, it appears to be a muscle issue at least partialy. If you do not want to continue the Botox then surgery is likely going to be needed to smooth the muscle out. I think fat injections around the eyes can lead to big trouble so if anything, try something shorter term. I do not think lasers will yield long term resutls, so it might come down to more surgery. I am sure the surgeons you have seen are being cautious though for fear of taking something and performing surgery and ending up with something worse. Best of luck. JG 5.20.09

Question:

How long is an incision for a lateral canthopexy. Is it just at the outer corners of the eyes? How many outside stitches does this usually entail. Thanks.

Answer:

it is in the crows feet and a little under the lashes, the length will vary, maybe a 1/4 inch, at times a little more. JG 5.15.09

Question:

I had fat transfer to undereye area to correct aggressive bleph. One eye looks pretty good, the other the fat is lower than I would like (where the cheekbone meets the undereye area), and so there is a slight bulge. It would look perfect if it were slightly higher up. Is it possible to reposition fat that has been transferred? thanks!

Answer:

sorry, but not possible. JG 4.24.09

Question:

Hi Dr. Garcia, I had a lower blepharoplasty last October. The undereye bags are gone but still have a small patch of hyperpigmented, raised skin on the top of my left cheekbone (small malar mound?). Would the DMAE and/or Retin-A help tighten the skin? If so, can they be used together? You always say the DMAE should be at least 4%. Is the DMAE that you sell 4%? If the DMAE/Retin-A won`t work, what do you suggest. Thanks.

Answer:

Retin-A woudl be good for the hyperpigmentation and either one for the fine wriknkles, although the improvement will be small. Our DMAE is 5%. If you need something stronger, then it on to lasers. JG 4.23.09

Question:

Hi, Are there any new surgical techniques to get rid of festoons under the eyes? If not, how is this issue corrected or improved? Thanks!

Answer:

nothing new besides the old ways. JG 4.8.09

Question:

I had lower blepharoplasty last January so its three months now i developed super heavy bruising and theres stil some shadow under my eyes. ithink they call this hemosiderin, tried: hydroquinone 4%, cernor, auriderm, hirudoid, glycolic peel and warm compressess. everything did not work. whats the best thing to do to speed up the recovery of my hemosiderin.

Answer:

YAG laser. JG 4.6.09

Question:

Dr.Garcia, what is better for cheek bone area: tear trough filler(which one?) or fat transfer. What will stay longer and look more natural? Thank you.

Answer:

I prefer HA fillers like Restylane as I feel they last as long as the fat does and have less chance of lumpiness. JG 3.30.09

Question:

Is there a solution to hyper-pigmented, uneven scars on upper eyelid after blepharoplasty? not enough lid for revision. make-up and coverup products do not adhere; depression creates shadows and uneven appearance. would injected fillers work in depressed areas? would `recell` bring back color. permanent makeup does not last. fraxell softened rough area slightly but did nothing for pigment issue - may have made lighter.

Answer:

can try a YAG laser to fade thm. Fiilers might help, yes. JG 3.31.09

Question:

Hi dr. Garcia, What can be done if one eye has changed in appearance and shape after lower bleph with canthopexy. One eye is smaller than the other and also more almond shape. Can the eyeshape go back to normal again? if so how, what kind of procedures can be done? It´s been 6 months since surgery. Thank u for answering.

Answer:

the canthopexy might be able to be released and then it might return to the previous appearance but if the canthopexy was done, it was likely needed to correct a problem and the smaller eye aperture from a canthopexy is a required thing then. JG 3.2.09

Question:

I was wondering if latise is safe? I read about vision issues (side effects) browning of eye skin. I already have it & am scared to use after reading about it. I know its fairly knew but if you feel ok about it maybe i should jus go for it. Im 34.

Answer:

I think if you are concerned I would not use it. JG 3.1.09

Question:

Two years ago I had under eye bag operation, the doctor who performed it made a mistake and I was left with an inch long scar under my eye. The scar is black and runched up. My dermatologist has given me several creams to apply-mederma, contractubex but none have helped. What do you suggest I do to heal my surgery scar?

Answer:

well the scar is healed at this point and I have never heard of the scar being black, hard for me to advise without seeing you, might need surgery to cut the scar out and start over again. JG 2.24.09

Question:

I heard about a non-surgical lower blepharoplasty procedure using a laser called EyeTight (laser company web site at www.lasertight.com). It is supposed to get rid of bags under the eyes. Does it work? Can it be used after a surgical lower blepharoplasty to tighten undereye skin to reduce wrinkles? Do you do it or something similar? Thanks.

Answer:

I feel it will not do what they say it will. I think lasers can be used to tighen only the skin, and we do perform that. JG 2.23.09

Question:

Hello Dr. Garcia, I had lower eyebags removed (no skin was removed) 6 months ago and although the bags are gone there is a slight amount of excess skin (a little more on one side inner fat pad area) My surgeon is top notch and he says he can do a skin pinch to remove a very minimal amout (I think 1-2 millimeters??) Please advise if it is always best to do both eyes so that they will look more symetrical...my eyes do not dseem to be as almond shaped as before and I think I would need to do both. LASTLY, How will my healing be with only slight skin pinch?? What about bruising,will it be as bad as when bags were removed?? Thank You.. Cheryl

Answer:

agree with the pinch tecnique and I think there will be some bruising and downtime, about 7-10 days or so, best of luck. JG 2.22.09

Question:

Thanks Dr. Garcia for your continuing attention on this. I`ve asked a few questions about having a lateral canthopexy on my right eye as a result of a slight lag after having a skin pinch only done on both eyes. I`ve read a lot about canthopexy and it is actually making me very nervous to do it. My PS made it seem like a pretty minor procedure, but I`m concerned about (1) whether he can get it so that it matches my left eye; and (2) the seemingly significant recovery period due to the effect on lymphatic drainage. How difficult is it to get the lid to match my other eye? What exactly is the recovery - am I going to have a black and blue and swollen eye and for how long? One other question - what else can I do in lieu of this procedure?

Answer:

well, it is challening to get even nad the greater the difference, the more difficult it is, but there are not many other choices. If one knew that is was only from too much skin being removed, then a small skin graft would be the way to go to replace it, but I cannot tell that without examining you in person. Recovery is longer than the original surgery and you will be bruised for about one week and swollen for a little longer than that. All the best. JG 2.19.09

Question:

I had my eyes done about 1 1/2 years ago. There was a ptosis in one eye that was repaired. As a result I have a much bigger eyelid on one eye. My surgeon removed more skin from the smaller eyelid and while it is a little better it is still uneven. He suggested that I put juvederm in the bigger eye`s upper lid because he said when the ptosis was fixed some fat was removed and my eye has a sunken look. Is that a good idea, is it safe? I think it will balance out my eyelids because it will fill in the bigger one. He is doing this free of charge.

Answer:

well, generally it is safe, but am not sure as to blaming fat removal during the ptosis repair, if the fat was not in excess, that did not have to be done. I do think the filler might make it look more even for awhile though. JG 2.19.09

Question:

Hi Dr. Garcia, Thanks for answering so promptly. I`m the 55 year old with the 6 months post lower-blepharoplasty malar mound and some new asymmetry and wrinkles. If there are no non-surgical options and a chemical peel won`t help, is it possible to get revision surgery? If so, what kind & how long do I have to wait? Also, some of your posts mention IPL? What does that stand for? Thanks.

Answer:

well, it really is not revision surgery as a lower blepharoplasty alone will never fix a festoon, in most cases the festoon can be seen before the eyelid surgery and then the patient counseled about its options. I think excising the festoon is the most predictable, it leaves a small scar, but that is easier to hide than the festoon itself. I think that can be performed at any time since the eyelid incision will not be invovled. Attemtpting to fix a festoon through an eyelid incision I have found to be not possible. IPL stands ofr Intense Pulsed Light, a baby laser so to speak. JG 2.19.09

Question:

Hi, I`m 55 and 3 months post lower blepharoplasty. I now realize that the lower eyebag that I was hoping to correct is a malar mound or festoon. It is still there, and I now have some asymmetry (left eye appears bigger) and wrinkles under both eyes that I never had before. My PS does not want to do any revision (to at least make eye symmetrical). He is recommending a chemical peel to smoothe out the malar mound. I am very disappointed and skeptical. I didn`t expect perfection, but I did expect some improvement. Are there any non-surgical options for malar mounds or festoons?

Answer:

I am afraid the non-surgical optiosn will not work, especially chemical peels. JG 2.19.09

Question:

Hi Dr. Garcia, My under eye bags are driving me crazy. I am 37 years old, and heredity doesn`t seem to be a factor. I have a fat deposit that causes very hollow bags under my eyes. I have heard good things about restalyne, but I am also hearing something about Aluma. Any info on the product? Can that fat be melted ? Thanks, and hi from the chilly and snowy Midwest.

Answer:

skip the Aluma, especially in that area, but the Restylane or Juvederm might be a good idea. Stay warm! JG 2.19.09

Question:

Hello Dr. Garcia- I want to fill hollow eyelids I have as a result of an aggressive lower bleph. The area I am concerned about is the area, eyelid, right under the lash lines, especially toward the outer eye, it is so hollow that it is concave. it also more hollow in one eye and slightly pulls down at the lash line. . Can this are be filled with restylane, juviderm, fat grafting or injections?? Which do you recommend ?

Answer:

I am sorry but I have no good options and fillers in the area you mention are very difficult to get right and leave no lumps. JG 2.19.09

Question:

i have swelling on the right cheek bone.2 years ago i had under eye surgery to remove fat,an skin.can a steriod cream take down the swelling?i have heard of a steriod injection but my consultant will not do this.

Answer:

I have never heard of eyelid surgery or steroids causing that, you might have a festoon though that would never be helped with the eyelid surgery or the steroid cream, it might require surgery to remove it if it is a festoon. JG 2.16.09

Question:

Hi there again Doctor.......Will a (hypertrophic or keloid) scar start forming on an incision six weeks after surgery. It seemed like it was doing just fine and all of a sudden within the last few days it feels tight and tender. Or is this just a part of the healing process.

Answer:

usually keloids and thicker scars cannot start to form until about 6 weeks because there is not enough collagen until then, it might flatten out in time though as thicker scars do mature with time. JG 2.14.09

Question:

I`ve asked a couple questions recently and you suggested a lateral canthopexy (thanks for continued help). I`m seriously considering this b/c I`m almost 8 mos. post op from a lower lid skin pinch that left one lid a little lax. What is the healing process of this? Does it involve an incision at the outer corner of eye to do the internal stitch? How bad can I expect to look right afterwards? Thanks again!

Answer:

healing will be a little more than the original and there will be some more swelling and some discomfort that will be more than the first time. It does normally involve an external incision and the opening of your eye will appear smaller when done. You will look a little oriental for a week or so. Best of luck. JG 2.12.09

Question:

Thank you so much for your prompt responses!! I have two other questions re: the lateral canthopexy, how does the PS make sure that it will match my other eye? And, why is the recovery worse - is it b/c it`s a second procedure?

Answer:

they normally look at both eyes to compare how tight to make it while doing the surgery. The recovery is worse because the lymphatics that drain swelling are normally kinked off for awhile and that produces more swelling. JG 2.12.09

Question:

I posted questions yesterday regarding side effects from lower bleph, upper levator muscle repair and bilateral canthopexy 27 days ago. Yesterday, I had an eye examination. I`ve never had one before because I thought my vision was perfect. I was told that I have some dryness of the cornea on one side and to use drops, so I started that. I was told that I have 20/20 vision, but that I have minor astigmatism. One of the lenses made letters considerably clearer. I filled a prescription for glasses to use at work. Then I thought: is it possible that this astigmatism is temporary from the eye surgery, from pressure on the cornea from the lid changes? Or was it likely always there. I cannot tell, because maybe I`m hypersensitized to all things relating to my eyes right now.

Answer:

swewllig due to dryness can make the astigmatism a little worse but does not cases it outright. JG 2.10.09

Question:

Is it normal for there to be a sensation of tightness in the upper lids and eye corners (a pulling sensation) 4 weeks after a lower bleph, upper levator repair and canthopexy? It may be a stupid question... I had the canthopexy released on one side because of asymmetry a week after surgery, and the tightness is greater on this side, so I suspect it`s related to swelling rather than any sutures. How long does such tight continue, in your experience (a broad range)?

Answer:

very common actually. Might take 8 weeks to get feeling looser. Best of luck. JG 2.9.09

Question:

Re: blood vessels...Hi there Doctor Garcia.....Can broken blood vessels on the eyelids after upper bleph be removed somehow. I`ve had them done with laser on my chin and cheeks before but I wondered if it`s possible on the lids.

Answer:

can try the lasers there, it is a litle ncomfortable but will work. JG 2.8.09

Question:

Is it just normal to have this blood shot eye- eye hemorrhage on my right eye. I`m still heavily bruised on my right side and still have this eye hemorrhage. The left eye healed quick and looks good.. Im 2 weeks post op from lower blepharoplasty tomorrow. The eye hemmorhage looks bad. I just developed this 4 days after the surgery. The bruises also went up to my upper eyelid, thoughts on this?

Answer:

not common, but not unusual either. Might want to see the surgeon to see if they can give you some steroid drops to see if it is going to help. JG 2.4.09

Question:

You previously suggested I may need an incomplete canthopexy . I have very minor laxity on one lower lid 7 mos. post op. Could you tell me what this or a lateral canthopexy entails as far as how many stitches, will they be external, can it be done from inside eyelid? I had just a skin pinch and I bruised up and swelled pretty bad. I`m hoping not to have that again. Thanks.

Answer:

well, I guess a better choice of words would be a canthopexy and not a canthoplasty. The pexy involves no cutting of the ligament itself, only a tightening of the existing ligaments of the lower lid, where the canthoplasty involves cutting it in its entirety and then re-attaching it at a higher position. All sutures are internal. It cannot be done from the inside though. JG 2.4.09

Question:

what helps get rid of malar bags? i seem to have more than two on each cheek and im only 19. and also, aluma claims that it can lighten the look of dark circles because it contstrics blood vessels and at the same time treats fat pads under the eyes?? please tell me if its even worth going into before i waste my money, thanks.

Answer:

I have never seen a laser or other surface treatment that will help them on a reliable basis. At times if it is due to swelling, then diuretics might help. In severe cases about all that can be done is to cut them out and leave a scar. I think the claims for Aluma are likely not going to hold up. I would save your money. JG 1.28.09

Question:

I had lower eyelid surgery (a skin pinch only, i.e. no fat removed) 7 mos. ago. My right lower lid is slightly maybe a millimeter) lower than my left. PS says he cut out the same exact amount of skin on both sides. I`ve massaged it for quite some time but have not seen much of an improvement. My question is this: assuming my right side didn`t need as much skin taken out as the left (which I guess may be the reason for asymetry), how is it fixed? My PS said he can fix it w/ a couple of stitches, but I`m not sure what he intends to do?

Answer:

might need a tacking up of the muslce to a higher point to lift the lid into better position, it would essentially be an incomplete canthopexy but should help. JG 1.26.09

Question:

Hi Dr. garcia, How many upper eye blephs, lifts are safe to have, thanks your the best.

Answer:

well, as long as the problem that exists can be corrected with a surgery, it is OK to repeat. JG 1.24.09

Question:

I asked you what I should do for crepiness under the eyes and you said do a light laser peel. What lazer do you recommend?

Answer:

light CO2 laser or a Rhytec Portrait Plasma. JG 1.24.09

Question:

I asked you what I should do for crepiness under the eyes and you said do a light laser peel. What lazer do you recommend?

Answer:

a light CO2 laser or a Rhytec Portrait Plasma. JG 1.24.09

Question:

hello me again... but im worried. im only 28 and with this canthopexy im going crazyy.. my eye doc. appointment is a month later this time coz docs on holidays... my left eye twitches and as i have stated before... will it get worse or will it remain the same? or will it even get better in time? and if its indone can correct cahtopexy be done? how bad will the shape look after removing the sutures? please please answer all..... pleaseeeeeee.... i am so upsetttt.. im always wearing sunglasses to hide that eye... please help....... and will it make me blind???? what are the possibilitesss of these thingsss...

Answer:

It wil likley get better with time and not worse, might stay the same though. Reversal of the canthopexy can be done in most cases. I cannot predict how it will look after the relase but it should go back pretty close to the way it was if no skin was removed. JG 1.24.09

Question:

hi doc, you said i wont have the owl look if the canthopexy is undone and no skin was taken out.. my ps said there was no skin removed but he still said i will have the owl look. Well i have twitching hapening at times during the day.. so somthing needs to happen.. do you think if the canthopexy is undone the twitching will still happen and if the canthpexy is not undone will botox to the nerve on the eyelid do the treat to stop the twitching? and why would the ps say i will have a owl look if no skin is removed? and can they loosen the canthopexy?..im waiting to read your answers... thankyou.

Answer:

I am not sure how he can say that unless you had the owl look before the surgery.The twitching us usually due to muscle or nerve irritation and there is no guarnatee that releasing the canthopexy will alleviate that. Botox might help, yes. Best of luck. JG 1.24.09

Question:

Good Morning Doc, I`m having U/B Tomorrow. I have been taking arnica. Can I also take Bromalain with it before surgery> Also should I use obagi exfoderm or exfoderm forte after I`m also gettting a 20 percent tca peel. I`m 50 yrs old.. Warmest Regards Debra

Answer:

yes on the bromelain and as to the exfoderm, I would wait at least a couple of weeks or more. Best of luck. JG 1.22.09

Question:

Hi i was punched in the eye years ago and this left my lower eye bag muscle to show, now you can see some of the muscle and doesnt look as smooth. It looks like when people have fat in their lower eye bags, but its not fat its part of the muscle fibre. i was wondering is there any way of making the lower eye muscle to not show and to make it look smooth, note that you can see the strand of muscle fibre which sticks out, is there any way of smoothing the eye bag area aout, im 28 years old, thanks

Answer:

hard for me to say without seeing you in person in order to feel the tissues I am afraid. JG 1.20.09

Question:

I am 60 years old and wish to tighten the creapiness under my eyes. Ten years ago I did have a lower eye lift so I cannot do that again, but the skin is crepy and wrinkly.What do you suggest.

Answer:

light laser peel. JG 1.20.09

Question:

i just had my eyes tatoo`ed for eyeliner. the lady gave me cornea abrasions in both eyes. can that give have long lasting effects on my eyes? what should i be doing to prevent severe damage. i did go to the emergency hospital and the eye specialist and have been doing drops for lubrication.

Answer:

that is about all you can do for now, and then in 6 weeks see the eye doctor again to make sure all is healing well. I would also report it to the state agency. JG 1.19.09

Question:

If you have had too much fat grafted into the tear trough, can it be removed? Would it be done the same way a loer bleph would be done to remove fat?

Answer:

hard to say becasue it depends where the fat was placed, if it is above the muscle it will be more difficult to remove than if placed below the muscle. JG 1.19.09

Question:

i had a lower blepharoplasty in 2006 with good results,but about 6 months after i noticed the left eye still had a small bag compared to the right,over time it has got worse an i now have festoons ,which i did not have before the operation.my consultant is reluctant to re do the blepharoplasty,but said he will,but probably there will be no improvement to the bag,and could make the festoons worse.what is the procedure for festoons an could it be done effectively as it would be a revision of the eye.

Answer:

a lower bleph will not correct festoons I am afraid, they might need to be cut out with a resultant scar. JG 1.18.09

Question:

I am almost 4 weeks from upper/lower bleph. My left eye still wasnt closing all the way, getting there, but not quite. Suddenly yesterday morning after using some different drops and lubricants for moisturizing eyes, i woke uo with that eye red, puffy, tearing, and burning. Called the PS and he prescribed steroid drops 4x a day for 5 days. He siad it could have been a reaction to an ingredient, but since that eye has been problematic from the beginning, he is treating it as dry eye, tho i am not positive it has ever been true dry eye, but borderline. It does feel better today, after using drops 4 times, but its still red and the lower lid is a little pulled away from my eye ball. Do you agree with this course of treatment?

Answer:

yes, for now, and also some light massage pushing the skin up and out, starting at the nasal area and going up and out toward the temple. JG 1.18.09

Question:

HI Dr. garcia, I was just wondering how long does an upper eye bleph lift last, thanks your the best.

Answer:

it depends but I would say 5-10 years or so. JG 1.18.09

Question:

What do you think about using Lumigan as an eye lash stimulant? I know some one whos eye doc gave her samples, said it wouldnt harm healthy eyes, to apply it as an eye liner? What about these products after upper/lower bleph? how soon after can use? I have LiLash but havent used since surgery almost 4 weeks ago.

Answer:

it has not been approved for that, it would be off label for it and I think if you are going to risk it you should check with your eye specialist first. JG 1.16.09

Question:

I had several facial procedures 3 1/2 weeks ago, including upper/lower bleph. Wondering how long before all is normal, approximately? I know everyone is different but i still have numbness around eyes, risied spots in outer corners that are still tender to touch, where internal stitch is supposedly holding everything together. was told it will disolve and flatten out. One eye still not closing all the way. Of all the lubes i have to put in eyes at nite, my favorite and most soothing is called Paralube. Do you know if this is a perscription? I was given some after surgery and bought some at drugstore that were recommended. Thats why i dont know if this one i like is a script. Some of them sting a little at first and this one doesnt at all. Any recommendations for night use? Thanks ps, my eyes seem more irritated after wearing my contacts, which i only do occasionally(soft) out of necessity. was hoping by now for regular wear.

Answer:

should look markedly better in another 2-3 weeks, and then subtle changes will continue for 3-6 months or so. I do not believe Paralube is a prsecription. I think that eye drop or using Bausch and Lomb wetting solution for hard contacts at night works well too. Best of luck. JG 1.15.09

Question:

Good Day Doctor........Does steroid injection for hypotrophic scars work right away or can it still be working for weeks after and does the excess that did not go into the scar just sit inside the skin forever or does it disolve in time.

Answer:

no, it does not work right away, it takes weeks and most of the time multiple injections to see an improvement. The material is absorbed by the body over time. JG 1.14.09

Question:

Hi Dr Garcia, I was told to massage one of my eyes that is still not closing all the way from upper/lower bleph. I am 2 weeks and 2 days post op. When PS demonstrated on me, he basically just rubbed my eyeball around with eye closed(duh) I cant imagine putting bpressure on the eye ball like that can be good. I have been experimenting with various techniques, my fav seems to be just lubricating upper lid with eye goop that i sleep with, and stroking downward on my lid. I was just told to start yesterday at my appointment. Any suggestions on technique? btw, today seems to be a better day, not sure if its the cortisone shots, massage, time or combo of all, but ridges on face from lower f/l SEEM tiny bit better. and i am looking just a tad more like the old me. if you still have that email with my pic site, i added pics taken yesterday. JR

Answer:

I would avoid the pressure on the globe and massage from the nose outward, with gentle pressure to get the swelling to improve. I am glad the other areas are getting better too, hang in there. JG 1.7.09

Question:

Hi it´s me again. i just want to add I´m a woman who just turned 40 and I have had beautiful prominent eyes before surgery, lower bleph. I do not have anything wrong with my thyroid. Thanks

Answer:

Hang in there.JG 1.5.09

Question:

what can be done to soften raised scar bumps in outer corner of one eye from upper/lower bleph? i am 2 weeks and a day post op.

Answer:

massage and mayeb ScarGuard or Mederma for now is about all. JG 1.5.09

Question:

Hi Dr. Garcia. I have done a lower bleph with canthopexy. My right eye is ok bur my left eye hurts behind the edge of the upper eyelid and I also feel pain in my left temple. It really hurts and I´ve felt the pain every day except for the two first weeks after surgery. I also have an ectropion on my left lower eyelid and the tissue in the lower eyelid is a bit numb. Since I had the surgery there has ben a small lump inside the lefte lower eyelid and to me the eyelid looks a bit broken. Too much fat has been removed from my left lower lid. Is there anytging that can be done about all this? what? I´m scared to death that my eye will hurt for the rest of my luf + not hug the eyeball properly+ My eye doesn´t look like my eye, it looks pulled and the left eye looks smaller. Help! I live in Sweden and I´ve been to my local eyedoctor andhe just says that there is nothing wrong and that my eyepressure is ok.

Answer:

sounds like an overly tight canthopexy and the bump is likely the knot from the suture used to make the canthopexy, might be a good idea to have the suture cut to allow the tissues to relax. JG 1.6.09

Question:

Hi Dr. Garcia. I am a 35 year old woman who has hooding of one upper eyelid. Are there any options for me other than surgery? I really value your advice!

Answer:

I am afraid surgery is likely the best, although in a small percentage of cases some Botox might help a bit. JG 1.4.09

Question:

what eye drops do you recommend to your u/l bleph patients? I am 9 days post and the itchiness drives me nuts, i cant obviously rub them. I use Refresh plus and Genteal. and of course the goop at night. One still doesnt close all the way, am assuming it is more swollen. scars in corners are kind of raised, anything to soften these? thanks

Answer:

nothing I would put on the scars rigth now, yo can look for Panatol eyedrops or use Bausch and Lomb wetting solution for hard contacts. Best of luck. JG 12.31.08

Question:

hello dr. hope you had nice holiday. I am on my 5th day post u/l bleph, and so far best seeing day, though inconsistant. my left eye was swollen shut for almost first 24 hrs. rt one no probs from beginning. had a little white head looking thing before that ps said he would remove on lower left rim. am wondering if this is why that eye seems to be taking longer to clear up? i now find that it doesnt close all the way. i am still def swollen and hv been religious about putting gunk in eyes at night, and lots of drops during the day to prevent dry eye.If dry eye synrome is going to happen, when would it be? when will swelling be gone and vision cleared up? i hv my 1 week stitch removal monday.

Answer:

way too early to be worrying about all of that, have to give it time, all of what you are seeing and feeling will likely go away and is all within the normal post-operative healing. The hollow eyes and dry eye would not likely start to show up as problems for 6 weeks. Got to be patient. Merry Christmas and Happy New Year. JG 12.27.08

Question:

It`s just me again.......regarding the steroid coagulating under the skin at the injection site. You said that it may need a small needle hole in the skin and the material push out......could I do that on my own or should I let the surgeon take care of it. I don`t want to risk any infection and turning to scars...since that was the whole reason for the steroid injections in the first place....scars. Thanks again Doctor Garcia!

Answer:

I think you should let the surgeon do it, without a doubt do not try it yourself. Best of luck. JG 12.22.08

Question:

Thankyou.So dou you believe there could be a link between the two, a blood shot eye(possible infection) and the puffiness? Is it likely that the assymmetry will be permanant? Merry christmas

Answer:

could be a link,hard ot say though, seriously doubt there will be anything permanent. Best of the Holiday Season to you too. JG 12.22.08

Question:

Hi Dr, thanks for your very prompt response. I forgot to mention that I have had 3 blood shots in the same eye over the last 3 weeks in exactly the same area. Could there be a link between this and the puffiness? an infection maybe? I was advised to massage around my eye, I have a feeling it may be irritating the contour and and slightly discolouring it is there anything else you could reccommend and should I stop the massage?

Answer:

well, take a few days off on the massage and see how it looks a few days from now, best of luck. JG 12.22.08

Question:

Love you website! I had upper & lower blephaplasty 19 days ago. After the first week everything looked like it was coming along very well. I started using my Obagi product line and makeup. I noticed a hard bump on the corner of my lower part of my left eye, soon after my upper and lower suture line became inflamed with irregular shaped raised spots. I went to my PS and he said that was experiencing a violent reaction to the products that i was using. He prescribed to me a pack of steriods (MethyIPrednisolone), Ibuprofen & Betamethansone Dipropionate (topical ointment). I have noticed no difference. Have you experienced any of this in your profession? Any ideas of how this can be overcome and how long it will take? I can hide it pretty well with makeup but my PS says not to wear makeup.

Answer:

no I have not but we do not allow our patients to use those types of products for one month, I think in time it will get better though, just make sure you get the make up off every night. Best of luck. JG 12.22.08

Question:

Hi there, I am 8 weeks post transconjuntival bleph. The swelling went down in less than 8 days and there was a significant improvement directly under my eyes but lower down where the crease meets the cheek is still puffy,especially on my right eye. I am assured it will heal in time and it may take up to 6 months. The surgery was performed by a highly respected surgeon but I still have my doubts. Is it possible to take this long despite seeing no difference in over 6 weeks?

Answer:

It is normal, eveyone is different, just give it time. JG 12.20.08

Question:

Happy Holiday.....Doctor...have you ever heard of steroid from injections coagulating under the skin around injection site. It almost looks like pus colour and very ugly on the eyelid. You did say earlier that it might disappear on it`s own in time....but is there any other way to correct this a little quicker. I can`t go out in public like this. I`ve been in hiding ever since.

Answer:

well, I will say that the steroid injection medication itself, if caught superficially in the skin, will almost look like pus, actually more like yellow sebum, like in a pimple, and sometimes it is hard granules. It might dissolve on its own in time, but not always. It might need to have a small needle hole made and the material pushed out. Best of luck. JG 12.18.08

Question:

Well Surprise....NO Questions......Just a Big Thankyou for answering all of our questions so honestly throughout the past year..even if sometimes it was not what we wanted to hear....You have been so kind for helping us all get through our traumas (so to speak). You are very much appreciated. Happy Holidays and A Safe One for yourself and your family.

Answer:

thanks for all the good wishes and I wish the same to you, glad I was able to help at least a little. JG 12.18.08

Question:

Merry Christmas Doctor Garcia! I am now 7 weeks post upper eyelid bleph. Unfortuneatly I developed hypertrophic scars which I hear is very uncommon. I was devastated but my surgeon injected steroid into them which has miraculously, after only one week, have softened and have almost disappeared. I still have to go back for more in three weeks if the scars haven`t totally disappeared by then but I do have a problem with it. It looks like the steroid leaked out under the skin near the injection site when he was pulling the needle out and now there is an ugly yellowish patch near the injection site. He told me this would go away within a week or two but after a week it hasn`t even begun to disappear. My question is ...Will it ever go away? I`m so discouraged because it seems like I just get one problem cleared up and another happens. Please let me know if there`s anything I can do to help it go away...like massage or whatever. And can I put a Scar Gel on top of it while I`m putting it on the rest of the scar? Thank You for all of your help during the past year.

Answer:

I think it will go away in time, yes. Massage and warm moist heat will likely help too. You can also use ScarGuard but do not get it into the eye. Best of luck and glad I could help even if just a little. JG 12.16.08

Question:

I was told today that transferring fat to the tear trough (as part of a lower bleph) would not last but about 1 to 1.5 years, and then the fat would reabsorb. Is it worth doing this extra step if it has such a short life? Or is it still better than removing fat because of the danger of under-eye hollowness?

Answer:

personally I do not think it will even last that long and I do not suggest it being done. Maybe they should reposition the fat instead of removing it. JG 12.16.08

Question:

Dr. Garcia, I`m considering a lower bleph - could you please tell what the worst case scenarios might be? I would like to know what the effect would be as well, e.g. too much fat removal = hollowness, etc. Thank you, C

Answer:

the worst case scenario is loss of muscle tone and resultant scleral show or ectropion. Fat removel to an excess can also happen and that would leave hollowness that cannot be repaired too. JG 12.7.08

Question:

Hiya Doctor...what kind of scar is one that has formed do to infection from a stitch that ripped through the skin. It is raised, round, white and bubblely looking when looked at through a magnifying glass with a tiny whole in the center, and hard. And will it eventually disappear or has the skin been damaged to the point of no recovery.

Answer:

it is killed a hypertrophic scar and in many cases will get better in time with nothing done, kenalog injections can help at times too. JG 12.7.08

Question:

Hi Dr. .....I was told that Scarguard ..because it contains Hydrocortisone....is very harmful to the skin ...especially on the eyelids..and it causes irreversible skin thinning. Is this the truth.

Answer:

I think the amount is so small it likely will not have any long lasting negative effects. JG 12.4.08

Question:

Regarding upper bleph.....Hi Dr. Garcia....I am 6 weeks post upper bleph and my scars are raised...and don`t seem to be going down at all...I think they look more prominent...especially the white bump where the stitch ripped out on the first week. Is this unusual and should I be concerned? Should I contact my doctor? Thank You

Answer:

it is not common and I think seeing your surgeon is a good idea, they might be able to suggest somethng after they see you in person, best of luck. JG 12.3.08

Question:

for a lower bleph, when it is just skin to be tightened, how low on the face under the eyes is tightened? I have little wrinkles that smooth out all the way down to my lower orbital rim when i pull on it like i am hoping will be what the PS is going for. Since it is just skin, no fat pads, i am assuming he will go from the outside. I am getting uppers done too. What kind of laser can be done if at all, under eyes during surgery if PS goes that route? I am going to see him Wednesday for last minute questions. Surgery is the 22nd. Thank you. hope you had a restful Thanksgiving, your first as a married man :-)

Answer:

the skin to the edge of the orbital bone is improved, but the further from the incision at the lash line, the lesser the degree of improvement. I would likely use a light CO2 laser for a Rhytec Portrait for the resurfacing, and thank you for the kind wises, I had a wonderful time. JG 12.1.08

Question:

I`ve been in a car accident 4 years ago, recieving multiple injuries; including a blown eye w/ my eye-lid being injured to where it diesn`t open all the way and is puffy. I don`t know if my lid is puffy from my surgery to correct it or just the injury it recieved because they had opened it too much that i couldn`t close it all the way & they had to put me back out to correct it. So, my question is- is there any surgery to correct my PUFFY eye-lid somehow?

Answer:

almost impossible for me to tell without seeing you in person but I will say that in many cases, similar to what you describe, there cannot be anying further done to lessen the swelling. JG 12.1.08

Question:

Hi Dr. Pierce .......I`m now 5 weeks post upper eyelid bleph which I`ve now gone through 3 times for revisions. I was so hoping this will be the last. I looked up at the ceiling and felt instant pain about two days after surgery. With careful examination with a magnifying glass I was horrified to see that I had actually ripped a few of the stitches right through the skin. I did get infection on the one eyelid and the doctor put me on an antibiotic and it finally went away within a week. But now there is a bump with a slight hole in the middle from where the skin ripped. The skin around it looks bubbled up and white if looked at closely. I`m using Scarguard to try and get it to flatten but someone told me that the hydrocortisone in it is not safe to use on the skin. Is this true and what should I do.

Answer:

hard for me to say but hydrocortisone is something you should avoid until the entire surface is closed. I think seeing your surgeon again is a must. Best of luck. JG 11.30.08

Question:

Dr. Garcia I know everyone heals at a different pace but in your opinion, if all things go smoothly, what is the length of time you suggest for patients who have upper and lower bleph wait to get permanent eyeliner?

Answer:

I would say 6 weeks should be a very safe time period. JG 11.24.08

Question:

hello i am 28 and had bleph. done upper and lower eyelids years before. big mistake. My upper and lower eyelids are really hollow...... my concern is upper the most. Can anything be done to fix the problem. I look so much older with the deep hollows upper eyes. theres is no pading. will eyebrow lift fix it... or fillers?? anything??? please advice?

Answer:

Might be able to help with fillers such as Restylane in experienced hands. Tough problem though. JG 11.24.08

Question:

I had an upper bleph 6 weeks ago. My eyelids are still very tight and do not completely close unless I really squeeze them. When I close my eyes in a relaxed fashion, about 1 to 2 mm of sclera shows. In addition, my eyelids are opening now when I sleep. I went back to my ps, and he told me that this is normal and that my eyelids will eventually close. He seemed very nonchalent about the whole thing. Meanwhile, I have had to get punctal plugs and am suffering from severe dry eye (I registered 1 ml of tear production on a Schirmer test). Is it truly normal for the eyelids to still not close this long after an upper bleph? I’m worried that my ps took too much skin and that I will need to get skin grafts. If I do need to get the problem fixed, are there other procedures that might help my eyes to shut properly? Thanks so much!

Answer:

it is not normal but it still might get better in time, if it does not then something surgical will need to be done, yes. I think massaging and taping your eyes as closd as you can might help though.JG 11.22.08

Question:

Dr. G: Help! I had a erbium laser w/ profraction under my eyes last month and I am noticing under my right eye - there is some wrinkling. Would it be wise to have another one done and is there an erbium laser without profraction - what would be my best option (i am afraid of pigmentation with the Co2)

Answer:

I would not repeat it for 3-6 months and if the eyelids are the only areas, the risk of pigmentation changes with the CO2 is almost unheard of. JG 11.22.08

Question:

Hello Dr. 2 questions. Do the protective lenses put on eyeball make eyes sore after surgery? and how do you know, since you are asleep, that the PS you pay big bucks to do the surgery, actually does it all, and not some surgical nurse or some resident? and what do PS s leave, generally, for these assistants to do?

Answer:

the protective lenses at times can cause some irritation but in general it should get better in a couple of days, in my practice, on the rare occasion they are used I am the one who places them and removes them, no way to know in your case without asking them though. JG 11.22.08

Question:

Greetings. Any idea why, 5 months after lower bleph,I have a triangular depression on one cheek? It`s right under bone at lower lid, more towards inner corner. I would not say my lower lid area is hollow above that and I may have had some of this before. However I don`t see it when I look at my before pictures. Also, I lost over 30 lbs in past year and wonder if that could make it worse too. Thank you and Happy Thanksgiving.

Answer:

if it was on the lid area itself it can happen at times if too much fat was removed but where you describe it it is much more likely due to the facial fat loss. Best of the holidays to you. JG 11.21.08

Question:

It okay to have wine right after surgery on your face, along with a chemical peel? Thank you

Answer:

I would wait a few days at least. JG 11.20.08

Question:

Dr. G: I have a small knot in the corners of my upper eyes from upper blaphr(sp?). What are these and will they go away?

Answer:

could be a little scar tissue or a suture tha was placed below the skin, they usually go away on their own or the surgeon can pop them out with a needle at times, JG 11.20.08

Question:

Which method do you prefer for lower bleph where there is a minimum of loose skin to fix, and virtually no fat pad to remove? going inside the lid or outside? i am also having uppers done.

Answer:

well it sounds like there is no fat to be removed so if surgery is what has been decided, then it would be a skin removal from the outside. JG 11.14.08

Question:

I have had two endoscopic brow lifts. Neither gave me the desired result of having any eyelid show. I asked about fat removal on the upper and lower lids (lower lids are a little puffy) and my PS said I wouldn`t see any difference. So he did a third brow lift, where he made an incision from ear to ear and peeled my brow down and lifted up and he also injected some fat in my tear troughs. Six months later, I still have no eyelids and my lower lids are still puffy. I cannot tell a difference. Why is this? What do you suggest? I have deep set eyes and I just want to see some lid!

Answer:

very difficult for me to advise as to what has occured without seeing your before and after pictures and knowing what exactly was done during the procedures. JG 11.12.08

Question:

Hello Dr. I`ve now had my third surgery for upper eyelid bleph. There is obviously some scar tissue. After using Scarguard...it only spread the scar out flat which caused the scar to show even more....and whiter in appearance to the rest of the skin around it. (I`m so sorry that I used that product). My question is.....The new surgeon had to stitch over this scar and one of the stitches pulled out , ripping the skin when I looked up toward the ceiling at a bee, then it became infected...and inflamed. Since all of this I`ve now got most of the inflamation down with antibiotics and Polysporin but it just doesn`t seem to want to heal. I think I have it and then it starts to itch and burn again. What can I do? Should I go back to show the doctor and have it restitched or just keep applying the Polysporin. I`m afraid if I do this the little hole that it left will just heal open and show forever or not ever heal at all. The doctor is a 4 hour drive but I`m willing to go if you think he should look at it. Thank you

Answer:

I think most likley the scar would have gotten to look that way without the product, it just got there faster is all. There might not be enough skin to re-cut it so I think allowing it to heal for now might be the safest thing. JG 11.3.08

Question:

hi doc, several years back i had fat removed upper and lower eyelid. i wasnt happy with the shape of my eyes. They changed from almond to round circles with whites showing alot. Later they did canthopexy saying it will help but THEY CHANGED MY EYES TO BEING SMALLER IN WIDTH, didnt even correct the problem!- my upper lids have scars on both from the fat removal procedure...along these scars my eyelids fall down extremely... so i have this problem now too... my question is this---- will a temple lift extend the outer parts of my eyes, giving back some width back to my eyes? or is there another procedure for this work? my ps said temple and eyebrow lift will be ok to perform but will this give me the effect normally? i dont want small suprised looking eyes nowww! i want the almond slanty eyes with a lift... anything you can offer??? pls do if you can.. im 28 yrs old.. dont ask me why i got these procedures done.. I made a mistake and no-one really warned me and im stuck with probsss...

Answer:

I do not think a temple lift wil accomplish what you desire I am afraid. I am not sure there is anything that can make it better I am afraid. Might be able to tell more if a saw some pictures, you can send them to drgarcia@lvcosmeticsurgery.com JG 11.2.08

Question:

Hallo Dr. Garcia. I have two questions. I have made for the next week an appointment for a lip lift. and now i become scared of the scar after the sugery. Is it visible? Can i correct a scar with laser to make it lightener maybe? 2. Ia it possible to change the eye shape? maybe with canthoplexy method? but i want the lower lid upper. but not the end of the corners . i want the opposite ,the beginning from the lower lid up. is that possible? Thank you so much rebecca

Answer:

the scar usually heals quite well and if red it can be faded with a laser at times. A medial canthopexy is a much more risky and difficult operation and I do not suggest it be done for cosmetic reasons. Best of luck. JG 11.2.08

Question:

how long before you can were contacts after upper/lower bleph?

Answer:

usually two weeks. JG 10.30.08

Question:

Hello and thanks for your always quick replies. I had u/l bleph 4 months ago and one upper eyelid is more prominent than the other. This was the case before surgery except that I had NO eyelid showing on the side that now shows a bit less. I had thought perhaps this would resolve with time but it doesn`t seem to be changing. In general, I look better than before surgery,having two visible eyelids and all. The eyebrow over the smaller lid is a bit lower than the other,however, and I am wondering if that is the cause. It always was lower and, while both are a bit low,I made decision to NOT do browlift as the low brows were never a concern to me. Would something like botox help raise the one that is a bit lower so more eyelid shows? Short of that being a solution, I may consider brow lift, at least on that side, if/when I do face lift. Can a lift be done just on one side if change needed is small to just expose a bit more lid? I see my doctor in 2 weeks again but thought i could ask more targeted questions if I had your opinion.

Answer:

Botox could help lift the brow if properly injected and I think most likely the appearance you have now is due to the asymmetry of the brows that was not appreciated pre-operatively to be as much as it is now. Brow lifts can be done on just one side if needed, yes. JG 10.20.08

Question:

I posted about skin pinch and eye questions below. I am not 100% sure i need lowers done, but wonder why the PS would say i do? He is a friend and neighbor and i believe he would be honest, but he is also a perfectionist. I will probably see him again before surgery(dec22) since i will have to pay 2 weeks before, and i will ask him again. I know my DH will want me to get it all done at once, and i tend to agree, since i am do not want to go thru anything else after this. Do you think CO2 laser would be the answer? I can pinch skin there for sure, but when i tighten it, i really dont see much difference. Does lower lid add any significant down time, in the scheme of things, since i am getting nose, lower face lift, and upper bleph, having 2 full weeks to recover(hide)? JR

Answer:

I will be brutally honest, the fact that you have asked so many questions about this issue, if you were my patient and had come in to see me about a procedure, I would postpone it. If a patient wants soemthing done and I feel it is a legitimate thing to do and explain the risks and they agree, then I will proceed, but this surgery is elective, it is not needed, it can be postponed indefinitely. The simple fact that you have asked this many times would concern me and I would not do it myself. All plastic surgoens are perfectionists, so that explaination does not cut mustard. Doing something because you are being threatened to do it all at once is as bad as having someone telling you that you need cosmetic surgery when you do not want it, who`s body and appearance is it? I see very little to no reasons for you to have a CO2 laser too. I re-iterate, if you cannot clearly see the reasons to do the eyelid or anthing else, then either you do not need it or the surgeon has not done his job of explaining it to you and you should hold off on having it done.JG 10.20.08

Question:

What is a skin pinch for eyes? Does it have to do with lower lids? and how is the lower bleph done when gone in thru inside of lid? do the stitches in there irritate the eye ball? Does it depend on how much improvement is needed whether PS goes from outside or inside? I am second guessing myself about getting my lowers done, as you said by my pics that i could skip it. Is there a risk of changing eye shape by doing both, especially if there is not alot to work with on lowers? Thanks. JR

Answer:

it is a method used to estimate how much skin is to be removed and can be used on the lower lids. The incision on the inside of the lids is done through the lining and usually does not get sutures placed but is allowed to heal on its own. The location of the incision is usually made upon what is need to be done in each case. Eye shape can be altered the more that is done, especially when an outside incision is done. I will tell you that I never do surgery on a patient unless they are totally sure of the surgery, it can always be done later, if you are not 100% sure, do not do it now, do it later if needed.JG 10.20.08

Question:

Hi Dr. Garcia...I had an upper bleph in April 2008 & am very happy with the results, however, 2 small keloids have developed on my lids. The MD recently used a light peel on the lids & injected them with cortisone (not 100% positive that this is what she used). Anyway, the keloids are still present. Any suggestions on how to eradicate them completely? Thanks so much for all the valuable suggestions you offer on this site!

Answer:

I must say that keloids are very rare on the eyelids, it might need a series of injections and I think lasers will likely not help much, in some cases the scar needs to be cut out and sutured closed again. JG 10.19.08

Question:

Hi Dr. Garcia. I sent you some pics via email yesterday to get your opinion on my nose bump, affirming that it will be done without breaking(they were the digitally enhanced afters). If you still have those, what do you think about the need for upper and lower bleph? I know i need the upper but was surprised at PS saying i needed lower as well. He has me look down and could see the shadowing. It is more expensive than price of the uppers and seemingly less work needed. Is there some benefit to the PS doing both? And how is a lower done? As you can see, i have no fat pads. Wondering how horrific i will look after. If you dont hv the pics, i can send them again. Thanks so much. JR

Answer:

I would pass on the lower lid at the present time. The lower lid can be done through an incision outside on the skin or one inside, but I think the change would be small and I think you can wait on it. JG 10.19.08

Question:

hey doc, i had canthopexy done now its been a while like 2 years after. im only 33 yrs old. when i look at people while they are talking (say for about 30min) my eyes lose focus and it has a burning feeling. My eyes also also get watery and red at times and i feel as though i blink more then i should, maybe i dont but thats how it feels like. This is serious isnt it? what do you think it is? do you think it will be cured?

Answer:

not sure if the canthopexy is related, I suggest seeing an eye specialist for a full work up. Best of luck. JG 10.18.08

Question:

i have had upper and lower eyelid surgery. i am very unhappy with the results. my eyes do not match. the left eye is smaller and rounded. my ps says they look fine. i have consulted other plastic surgeons and the clearly identify the problem but do not want to fix it. i am so unhappy with the way my eyes look.. the left lid is lower than the right. the left eye is smaller. is there help for me.

Answer:

it sounds like there could be some things done to improve it but perfect symmetry will likely not be able to be acheived, I am afraid that it is not uncommon for other surgeons not wanting to take over when there have been probelms with the previois surgery though. Best of luck. JG 10.9.08

Question:

Hey Doc! im a 19 year old student from South africa.. I recently had upper blephs perfromed due to alot of excess skin, blocking my peripheral vision.. but im 5 weeks post op, and the right eye is dropping alot, yet my left eye looks great.. could it be swelling on the right side? but none on the left?

Answer:

sounds more like a case of eyelid ptosis, I suggest you go back and see the surgeon for a check up. Best of luck. JG 10.7.08

Question:

Hi Dr Garcia, I had the corner of my right eye lifted several years ago along with cheek implants. The corner of my right eye opened a little bit over the years and the dr reclosed it again a month ago. My eye kept filling up with a clear yellow fluid in the outside corner and the dr kept draining it. He decided last week to go back into my eye and reclose to solve the draining. He did the surgery on Monday and it seemed to work. My eye started filling with fluid again yesterday in the outside corner and I went to see my doctor. He chose not to drain it and feels the fluid will go away over the next few weeks. Have you ever heard of this problem. I am a little frightened.

Answer:

unusual, hard for me to say what could have happened without knowing the details of the surgery though. JG 10.4.08

Question:

I wrote to you previously about a palpable and visable lump beneath my left lower lid. It is now large and unsightly. I saw the Dr. and he thought it was a hematoma. My question for you is isn`t it late (3.5 weeks post surgery) to develop a hematoma?

Answer:

yes, I agree, they usualy develop in the first few days. If they put sutures to hold the lower lid fat over the rim it could be a cyst from the sutures there. JG 10.3.08

Question:

Three weeks post upper and lower eyelid surgery. There is a palpable lump under my lower left eyelid slightly visable on the surface. Any idea as to what this might be?

Answer:

likely a cyst where one of the old sutures was, warm packs and time should let it go down as it opens and drains. JG 10.2.08

Question:

For a change I don`t have a question about me :o) I am dealing with healing after 4 months and it will be what it will be. I have issues but doubt I`ll want revisions at any point; it might turn out ok in the end. What I`d like to ask if there is an organization that does pro bono reconstructive surgery to which I can make a contribution to in some way thank you for all you do for us. Smile train for example? Let me know.

Answer:

I apprecaite it and I am sure Smile Train would be happy to receive anything from you and they are a good organization. You are most kind and thank you. JG 9.27.08

Question:

Hi Doctor Garcia, I had lower eye bleph (tranconjuctal?) about 3/2 wks ago by a board cert. very well respected plastic surgeon..Also had upper done. My upper are great and scars almost nonexistant. of course the initial bruising and swelling is gone but on top of cheeck bone area and maybe where interior incision was placed the my skin color isn`t right yet and I think it still needs to heal. Under eye seems a little darker (getting better) where the inside incision probably was and my left lower eye seems like the natural fat he left is a tiny bit more than the other side, at 2 1/2 weeks doctor said it it isn`t excess fat but was my muscle and that I am healing ahead of the game. I go back on Oct. 8th and if its not even I will tell him I think it is a tiny bit fat because when i press it with finger it goes away...Will they even out and coukld it still be more swollen on that side because that side had more bags...Help.. Thanks

Answer:

well, fat does not go away with pressure but swelling does. I think giving it some time is key right now. JG 9.22.08

Question:

Thank you for your answer to my last question (right below this one). Are you suggesting that the chemosis is due to my lid being too low and my eye getting irritated? or is the lid drooping slightly because the chemosis is pushing it out ? I actually don`t think it`s bad enough to warrant more surgery. it`s just slightly off and I am only one that seems to notice unless I point it out. Thanks again

Answer:

chemosis will not cause the lid to lag, that is either a muscle issue or a skin issue. JG 9.22.08

Question:

hello again! I am now 3 months post u/l bleph (lower was transcutaneous). I woke up yesterday with noticeable bags under my eyes after only having a tiny one for a few weeks. Went down a tiny bit during the day but not much. They are there today. Where did they come from after all this time? Does this mean there`s a revision in my future? ugh. If so, can it be done transconjunctival method? And final question, will there be a risk of eyelid pulling down if that is done? I already have slight drooping at outer corners but hoping this is just due to the lingering chemosis, and I know this may sound nuts but I kind of like it because it makes my eyes look bigger. Sorry for all the questions at once. thanks so much.

Answer:

well, if they are changing in size throughut the day, then it is swelling, can be allergies or the position you slept in or large salt intake. Swelling cannot be treated through surgery, no matter what the cause so I do not think a revision is in the offing. Sounds like your lower lid is too far down, many causes for that and some surgery could be done to correct that, in some cases at least. JG 9.22.08

Question:

Hi Dr. Garcia, do you know of the success rate of pearl fat grafting or orbital fat grafting for hollowed out upper eyelids due to aggressive bleph surgery? As I mentioned in my last question, fat by injection didn`t work for me. Can I email you photos of my eyes so you can take a look and make a recommendation? It`s so hard to find info online about this. The only doctor`s website that keeps coming up is dr. meronk, but I`m hesitant to go to him because I only know of 1 woman who used him and she had a bad experience. Do you know of any satisfied patients that went to any particular surgeons that could help me? I do not want to go through the rest of my life like this. Thank you again.

Answer:

it will last no better than the fat injections, in fact it has a higher rate of cyst formation. I am afraid you do not find alot of sites showing remedies because there are no reliable ones, sorry. You can send the photos to drgarcia@lvcosmeticsurgery.com if you wish. 9.20.08

Question:

Where are the scars positioned when a lazy t is done on the lower lids and are they hidden pretty much, so as not to be noticeable? Thanks you.

Answer:

at the lash line and corner of the eye with a small downward leg at the corner, they usually fade pretty well with time. 9.20.08

Question:

What is a canthopexy regarding lower lids.

Answer:

a repositioning of the ligament on the outer part of the lid to elevate and or tigthen the lower lid when not in its correct position. JG 9.19.08

Question:

I`m 36 and i had upper eyelid bleph surgery back in january 08. Too much fat was removed from my eyes and don`t look like mine anymore. the crease is too high especially in the inner corners making me look tired, drawn out and weird. they are hollowed out now (more so in my left eye) and I`m disturbed by this everyday. I`ve tried fat transfer by injection twice and I didn`t retain the fat. What are your thoughts on the best way to correct this and do you know if dr. toriumi in chicago has ever done this surgery? I don`t want to go to meronk since I know a woman who had a terrible outcome. Thank you in advance.

Answer:

I am not sure if Dr Toriumi has done that type of corrective surgery and you can try other fillers such as Restylane but they will likely react like the fat did. Wish I had more to offer. JG 9.18.08

Question:

Hi, I have posted a few questions here. Anyways, does a lazy t procedure on lower lids leave noticeable scars, and will it change the shape of the lids?

Answer:

no way to predict how noticeable the scars will be, but there are scars, yes. It will change the shape of the eye if too much skin is removed too. JG 9.18.08

Question:

My lower eyelid use to feel snug against the actual eye area, if that makes sense. It now feels like just skin there with no attachement to the actual inner muscle eye area, if that makes sense. lol sorry. It feels like loose skin, and just empty space inside. Can this be fixed and why does it feel this way? Had lower bleph there a few years back.

Answer:

might be able to be improved with a canthopexy. JG 9.18.08

Question:

I had a lower transconjunctival bleph done about 3 years ago. After poking the heck out of my lower lids and relaxing all layers of muscle, which I thought were gonna stay tight forever. Didn`t know it would loosen like that. Now basically I have thin skin there and no muscle tone at all. It doesn`t look droopy really, but it just feels like loose skin there. Anyways, I was told to come back into my surgeon and they would see about maybe doing a Lazy t. What is that? What does it do. Does the surgeon retighten the muscles with it. Thank you.

Answer:

it is just a skin removal technique, transconjunctival blepharoplasties never tighten the skin on their own. JG 9.17.08

Question:

hi

Answer:

hello. JG 9.16.08

Question:

HI

Answer:

hello to you too. JG 9.16.08

Question:

i m still swollen from surgery done 11 wks ago i had transconjuctivial lower bleph w/ skin pinch also skin under eyes looks crepey and wrinkly on one eye what can i do

Answer:

I would go see your surgeon as what you are seeing is not common, the fine wrinkles might benefit from some Retin-A though. JG 9.16.08

Question:

i had lower bleph transconjuctivial with a skin pinch 11 wks ago.. my eyes still has some swelling and the skin under looks creepy and wrinkly is this normal..

Answer:

it can be normal in some patients, should be getting better slowly though, best of luck. JG 9.17.08

Question:

Last October I had an upper and lower bleph. Both eyes were left a little droopy in the corners so I went by in February to have the corners lifted. (can`t remember what`s its called when the stitch the corners up inside). Anyway, my right eye looks great, but the left eye still needs more work. It`s much wider and more open that the other. I`m scared of having a third surgery done. What will that due to me in later years if I keep messing with my eyes. You do your homework thinking you found the best doctor, and this happens to you. What do you recommend? A 3rd operation, a different doctor?, What?

Answer:

well, properly done, the surgery should not negatively affect your eyes long term, and waiting more time will likely not make them look closer in appearance. I think a consultation with a dfferent doctor is warranted to allay your fears though. JG 9.15.08

Question:

Is the trend going away from browlifts. I have heard that lifting the brow can actually age you and that a younger/natural look is not to lift. Also, what do you think of the Fraxel Repair? thanks!

Answer:

I think there are less browlifts being done due to the use of Botox. I do not feel that brow lifts will acccelerate the aging process though. As to Fraxel Repair, I am not a fan. JG 9.10.08

Question:

Have I used up my question limit? I should have mentioned when I said I was 11 weeks post bleph and still bruised. I had a lot of swelling 2 weeks ago when I saw doc and was given steroid injection in each lower eyelid area. It helped swelling a lot but made the bruising worse again--so in that regard, I am kind of starting over. Am trying to hang in there. They tell me bruising ALWAYs goes away at some point...in the event there`s some melasma there, we are treating that too!

Answer:

oooh, OK, now I see, the bruising is from the steroid injections, well, that is unusual too, but I have done it on a few occasions. If it helped, then it is swelling and not fat though. To prevent the melasma I suggest sunblock and using hydroquinone 4% topically until gone. All the best. JG 9.9.08

Question:

Hi. How can you tell if what seems to be a bag (11 weeks after surgery) is fat or just leftover swelling? If it stays put when you move the skin around over it, is it fat or swelling? I still have bruising too so, with me, everything just seems to take a long time! you`ve been very helpful by the way.

Answer:

if it changes throughout the day it is swelling, if not it is likely fat. Bruising this far out is very unsual I must say. Hang in there for a bit more. JG 9.9.08

Question:

Will co2 laser help malar bags? If not do you cut them out or do you know of anyone who does as they are extrememly puffy and look like someone punched me inthe eye. Also once the eye is corrected from a sugical causing ectropion and the eye is small can the eye ever be made to be a tad bit larger again after cantholplexies? Thank you

Answer:

I do not think the CO2 will help, sorry. In most cases they are cut out if they are as bad as you say. In cases where a canthopexy was required to improve an ectropion, there is no reliable way to enlarge the aperature again, sorry. JG 9.8.08

Question:

Hi Doc. How long after u/l bleph can one consider laser for fixing skin texture under eyes? and what type of laser treatment do you normally recommend? thank you again!

Answer:

surgery does not improve texture so I suggest 3 moths to let th eswelling go down,I usually use a Rhytec Portrait or a CO2 laser. Best of luck. JG 9.8.08

Question:

Dr. Garcia: Two years ago, I had upper bleth. Both eyelids were hollowed out and especially the left upper eyelid. A yar later, I had orbital fat strip grafting where fat from the pubic area was placed behind the orbital septum and two fat pearls added to the inside corner of my upper eyelid. I had swelling for almost 5 months. A year later, I have ptosis in the eyelid and narrowing of the palpebral fissure in the inner corner. I want to get the fat graft removed. I have been to several doctors in my area and several oculoplastic surgeons and they have never heard of the type of fat grafting I had done. Therefore, they do not feel confident in removing the graft.. Could you please give me the name of a doctor(s)who would understand and deal with this complicated issue? Thank you.

Answer:

well, the technique used is not common but not uncommon, unfortunately though, removing the graft is most likely not going to help, I think most of what was grafted has absorbed and most of what is going on now is scar tissue. I would guess that due to the difficulty in correcting your problem, they are hesitant to get involved with something that might not be able to correct to any significant degree. I would suggest going to a University type opthalmology program and get an evaluation. All the best. JG 9.4.08

Question:

Hello Dr. Garcia: I had heard, If you have a severe case of Dry Eye Syndrome, (I am on restasis) that it may be dangerouse to have the upper/lower bleph done. Is this true?

Answer:

you can have prolonged dryness of the eyes even without that to start with, so if done, it has to be very conservatively performed. JG 9.4.08

Question:

I am considering an upper/lower bleph. will that also help with the hollows that are under the lower eye above the cheek which I assume comes w/age? If not what would you suggest to fill that out.

Answer:

typically a lower blepharoplasty will not correct hollows of the lids themselves, those are usually due to fat loss and is very difficuult to correct. If you are speaking of hollows of the upper cheek, those will also not be improved with a lower blepharoplasty either but can be improved with fillers such as Restylane. JG 9.2.08

Question:

I am 36 years old and having lower bletholasty due to a large fat pocket in one eye. I have a very small one in the other. My question is, is it to early to have this done, & can the fat pockets come back. Also, my Dr. told me all swelling & bruising will be gone in 7-9 days. Is that possiible? I have to return to work 8 days after. Thank you so much for your help!!

Answer:

it might be too early, no way for me to tell without seeing you in person, as to the pockets coming back, the fat is removed permanently but not all of the fat is removed so whatever was left can pooch out as time goes on. I think the bruising can be gone in that amount of time but I think the swelling will be better by then but not 100% gone for 3-6 months, you will be presentable in public in 8 days though. JG 8.29.08

Question:

What do you think of Tri-Luma for discoloration under eyes?

Answer:

for brown spots, it works, but that is all. JG 8.28.08

Question:

Hi again. I want to use something to expedite scar healing after blepharoplasty. Scarguard is fine to use at night but unsightly to put on during day and looks weird with makeup over it. Would it make any sense to use Scarguard at night and Mederma during the day since it has sunscreen in it? Thank you.

Answer:

sure, that is fine and it does not have sunscreen in it., JG 8.25.08

Question:

Dr. Garcia, I have a `surgery gone wrong` question. A couple of years ago I had surgery on my lower lids for wrinkles. This Dr. cut outside underneath my lashes. He did nerve damage under one eye and I was left with `tatooing` (like smudged eyeliner)under both eyes. They also removed the stitches too soon leaving gaping resulting in depressed scars. to add insult to injury, he used a laser right after the scars started to close to try to `fix` his mess. The result today are the dark tatoo like marks right under my lashes and then white scars under these that can`t be covered well with make-up. I should have been more informed, as I am now,but at the time I trusted that he knew what he was doing. What can I do now to help with both problems. Also, the eye without the nerve damage was overdone (not to the point of not being able to close my eye, but my lid turns out). Is there anything that can be done for this as well?

Answer:

sounds like you need more surgery to correct the everted lid, in doing that it might require a skin graft and that will remove the dark spots sand the light spots but the trade is off for an area of skin that is not exactly the same color, hard to say more without seeing you in person. JG 8.23.08

Question:

My plastic surgeon took my lower lids with his fingers and basically rubbed the skin together throughout the lower lids. Before he did this my lower lids were not puffy, but now I actually have bags now and they feel hollow and light. What did he do? I was complaining about the lids pulling. They sure don`t now. I might as well have another bleph done now.

Answer:

I am not sure what was done or what is going on to casue it, sorry. JG 8.19.08

Question:

What do you recommend for squint lines under the eyes?

Answer:

Retin-A or my eye booster cream. JG 8.18.08

Question:

Hi, what is the best filler for the lower eyelids and does it give a tighter feeling to those lids, if they feel droopy.

Answer:

I typically use Restylane and it will not change any droopyness. JG 8.14.08

Question:

I had blepharoplasty on 7/28/08. Stitches were removed at one week post op. I seem to have a section where a cut was made, but it wasn`t stiched back together. It looks like a plain open cut that wasn`t sutured. Should I go back and ask the Dr. what the heck happened? Is he going to give me some b.s. answer about how it will look better over time? I`m scared - It looks like I have a gash over my eye. It certainly didn`t make me look younger or prettier.

Answer:

not use as to what occured, there might have been sutures there initially that broke and fell out while sleeping or became stuck to a pice of gauze, as long as the edges are touching it will heal well though. JG 8.14.08

Question:

Hi, my lower transconjunctival bleph (I am 47 years old) seems to have relaxed in the tear trough area, if that makes sense. It feels like its hollow in those areas, near the bridge of the nose on both lids. I can`t stand it. Is there anything I can do about this. Can the muscles in that area be pulled out (if that makes sense) Thank you.

Answer:

it might be a better plan to inject a filler as tighter muscles will likely not change anything. JG 8.13.08

Question:

Thank you for answering my question yesterday about u/l bleph and my various little complications, especially chemosis! Don`t know how you find time to do this but am grateful for it. It may seem odd, but I actually don`t know if I had canthal tightening or canthopexy and will ask PS when I go back for checkup. I had some very tight stitching in outer corner where lids meet and have distinct scars there. Could that indicate that maybe one of those procedurues was done? Also, did not want brow lift so scars do extend out from eyes (someone else was asking about this); they are neat and will fade. Thanks again.

Answer:

could be, yes. I think the lateral scars should look better in time too. JG 8.12.08

Question:

Hi. I am 53 and 6 weeks post u/l bleph. I would not advise anyone that you will look ok to go back to work in 2 weeks. I supposedly had an unusual amount of swelling. My experience anyway is that you still look like heck till about week 4 and even then, remaining bruising is very hard to cover discreetly with makeup. Thankfully, things are beginning to clear up for me although chemosis persists which pulls my outer lids down a bit--they`re red but it`s not awful and fortunately no scleral show under iris. Upper lids seem slightly asymmetrical but over time might be ok; nothing I can`t live with. I do have a noticeable hard round cyst on suture line under one eye which doc called a pimple and said that it would go away on its own. I think after 4 weeks being there it should be lanced. What do you think? Also, I`ve heard chemosis can go on for months. Is it safe to use FML every other week until it clears up? Is it normal for one person to have all these normal minor complications ? My PS is very well regarded in a major metro area and my friends who`ve used him have had outstanding results.

Answer:

the pimple if not responding can be lanced yes, and there are more agressive methods to resolve the chemosis, patching the eye and applying pressure at night wil also help, and at times more aggressive options after that. Using the FML is certainly OK though. Your story is not the common thing though, unless a canthal tightening or canthopexy was done, in that case the swelling and chemosis are more common and you could have expected it. Best of luck. JG 8.12.08

Question:

Hi Doctor Garcia, My daughter has treacher collins syndrome and she has had 13 surgerys., Five which were eye surgerys, mostly under the eyes.Now she wears sunglasses all the time because people can see into under her eye sockets and the scar tissure under her eyes are thick., I hurt so bad for her., Is there anything that can be done to correct her eyes, thank you.

Answer:

very difficult for me to say wihtout seeing you in person but I will say that if there have been so many surgeries already, it might be difficult. JG 8.10.08

Question:

Hi, I had a lower transconjunctival bleph about 3 years ago. I believe I loosened the muscle from that procedure and it feels like the skin is hanging now on my lower lids. It doesn`t look that way really, maybe a little. It feels like it is though. Anways, I was told to get CO2 laser on it to tighten it. I just wanted to get the lower lids done but I`m told I have to do the whole face and neck or I could have a discoloration in the eye are from the rest of the face. Is this true? And how tight can the laser make the lids? I`m kind of afraid of scarring too. A dermatologist is going to do it.

Answer:

it depends on how deep you have the laser done, in some cases the area around the eyes can be done without leaving a line of demarcation. JG 8.10.08

Question:

Hi Dr Garcia. In January 2007 I received a severe reflection sunburn from a metal roof I was working on. Two months later I saw a Dr as my facial skin was still red. He suggested a Gemini Laser to reduce the redness, during the second treatment he placed the Laser near the corners of both eyes resulting in swelling of both upper and lower eyelids which also resulted in tightening of the skin of the orbital area.The eyes have been very sore and the eyelids have shrunken resulting in the eyes appearing smaller. Is there any creams,peels etc you can suggest that may assist as I have been told surgery to correct over tightening of skin is difficult. Thanks for your time.

Answer:

I think there is no surgery or laser that will help, I think most likely it wil get better as the burned tissue heals, might want to try some copper peptide creams and avoid using anything with glycolic or alpha hydroxy acids or retinols in the creams, best of luck. JG 8.4.08

Question:

I am scheduled to have upper and lower eye bleph aug. 26th Is it ok to have power peel or microdermabrasion prior to surgery (no glycolic, salacylic or retin a)I just want to freshen my skin. How long following surgery do I need to wait to get botox for crows feet?? Help..Thanks...

Answer:

yes, should be OK to do as long as it is a few days before. I think waiting a couple of weeks for the swelling to go down will be enough to wait for the Botox. One more thing about Botox. It has come out that the education that injectors were given since the beginning of Botox release was incorrect. The bottle is to be used for a single patient. That means that a bottle should not be shared between multiple patients. The company that makes Botox has known about this but has never issued an alert to doctors or patients. The risk is that of the bottle becoming contaminated and passing a communicable disease like HIV or hepatitis from one patient to another. There are no known reports of disease transmission in the use of Botox, but it has not bee looked at yet in order to determine that issue. For that reason I strongly urge you to demand that a new bottle be used when you are treated and then observe the injector destroy the remainder of the bottle. If that is not done I urge you to contact the local board of health for the violation. Ask to look at the box it comes in and you will see the single patient, single use wording. JG 8.2.08

Question:

have you ever heard of the need for skin graft when performing a lateral canthoplexy is there a danger of an ectropion with this procedure? thanks

Answer:

it depends on why the canthopexy is being done for, but that is not commonly done. As to ectropion, there can be many casues for that I am afraid, no way to tell in your case without an in-person exam. JG 7.31.08

Question:

Hi Dr Garcia Thankyou for your prompt reply regarding my question of puckering scars after blepharoplasty, you mention that a light laser might help, can you tell me what this laser would be called as confused to all the different types. Thankyou

Answer:

I would do a very light CO2 laser or preferably a medium depth Rhytec Portrait Plasma. JG 7.31.08

Question:

Hi Dr Garcia I had a blepharoplasty (uppers and lowers) in April 2006. It got rid of the rather large bag I had under the left eye which was making my life a misery as I am only 43 now. My question is regarding the scars, the lowers are liveable, i notice them without makeup but other than that they are ok, its the uppers especially on my left eye, both are above the crease line and very white, I have been applying some false tan to make them less noticeable. Now the one on my left eye has started to pucker and seems to be thicker than it was a couple of months ago, I can now see where the sutres were, and it creases into the corner of my eye (nose side), it looks like a wrinkle. Can you please tell me if this is a normal occurance because the surgeon I used is a very good and well known one. Many thanks.

Answer:

not a normal occurence but cna certainly happen, I think a light laser might help those issues as I think cutting and re-suturing them will likely not correct it all.JG 7.30.08

Question:

Hello - 2 weeks ago i had a lateral canthoplasty to improve lagophthalmus. It all went well. The only problem i have is severe pain on my right eye upper orbital bone area(below eyebrow), which is almost constant and even worse when i sneeze, squint or blink hard. I have numbness stretching from that area down round the corner of the eye (past the incision)to half way along the top of the upper cheek area. the surgery went well and there is a definite improvement and healing is excellent. In fact i can sleep without ointment in my eyes for the first time in over 15 years. However if i sleep without it in my right eye the pain is worse and i think this is because of the drying/stretching effect. It is like a pulling sensation. Are there any nerves that could have been cut during the surgery. Will this go away - it is very debilitating and constant. I am living on brufen. The swelling is slightly more in the right eye and it is still showing some bruising on the cheek area. My surgeon is on one month vacation, so i can`t go back and ask him! Have you ever had this complaint before after a lateral canthoplasty procedure. THANK YOU.

Answer:

I think the pain is due to the tisseus being tightened and not from any nerves that were cut, if nerves were cut it would more likely be numb. In most cases, with time, the pain gets better as the tissues relax a bit. It is not uncommon for patients to complain of that afetr the procedure. Best of luck and give it some time.JG 7.30.08

Question:

Good morning I am trying to find out what you know about Ketoprofen 20% cream- I have emailed you before re: having laser resurfacing done three times under my eyes. The puffiness that I developed after the procedure is on my upper cheeks below my eyes. The last resurfacing was done 2 years ago. I have been told the puffiness/swelling can last that long. Will teh cream help reducing swelling, in your opinion? I have been told there is a 50% chance that a cantopexy procedure will work but that is not a good enough change to do the procedure. What are your thoughts on the cream and the procedure? Thank you. SLT

Answer:

I think acute swelling might be helped with ketoprofen topically but in your case it is too far out I feel. I cannot say whether a canthopexy will help your condition without seeing you in person, sorry. JG 7.29.08

Question:

How many weeks or months should you apply scarguard or neosporin after eyelid surgery to the scars in the eyelid and the corners of the eye?

Answer:

once sutures are out there is no need for neosporin, as to the ScarGuard, up to one year. JG 7.27.08

Question:

Thank you for your quick response stating it was normal to have raised scars, but is it normal to have half inch scars extending out the corner of both eyes after an eyelid lift? I thought the scars would just be in the crease in the curve of the eye.

Answer:

not common, but if there was a large amount of hooding on the eyelid and one was not getting a forehed lift to correct that part, it could be a longer scar. JG 7.27.08

Question:

I had upper eyelid surgery 3 weeks ago and have raised scars of about half an inch long coming from the outer corner of each eye. Is this normal?

Answer:

they can be a little raised at the begiing but typically flatten out in time with light massage. JG 7.26.08

Question:

How long after an eyelid lift should you apply neosporin, scarguard, or dermatix to the scar on the crease of the eye and outer eye? Which is best?

Answer:

once the sutures are out, wait another day or two and then you can apply the ScarGuard. JG 7.26.08

Question:

what do you think of the mentioned surgery for under eye circles and arcus deformity? arcus release and fat grafting, and pigment on the upper cheek skin just below the arcus deformity which could be removed witht the IPL or 2940 laser. also with regard to fillers..i am not pregnant but nursing. i want to do jevederm, should i wait?

Answer:

well, I think fat or other fillers like Restylane for the arcus are options, I do think the arcus marginalis needs to be released before fat grafting where the off the shelf fillers do not, as to the laser for the pigment, if it brown is will work, if not, it will likely not do much. I think you should wait on all of it until you are done breast feeding, although the laser is likely OK to do now. JG 7.22.08

Question:

Hi Doc. i had under eye surgery 10 weeks ago. I got an abscess under my eye which finally cleared up 3 weeks ago after having it drained. However i have a large red mark under my eye ... like lots of tiny veins. Can you tell me how to get rid of them? shall I wait longer before doing anything? how long and what should I do if they don`t go way? What`s the best treatment? thanks

Answer:

the veins can be imporved with some IPL treatments or a YAG laser series of treatments. I think 2-3 months after the infection has subsided would be enough time to wait. JG 7.19.08

Question:

In doing under eye procedures, would the shape of the eye change? I ask because I notice that with certain surgeries the eyes look more cat like. A family trait is recessed lower pockets that seem to be getting more noticed and I`m considering getting them adjusted. Would you inject something in or do incisions to pull the skin tighter? If so, what is the approximate cost and down time for this procedure?

Answer:

it should not change unlesss that is needed or desired. If the fat is dissolving on the lower lids, then pulling the skin will not make it look any better I am afraid, fillers there are fraught with problems too. JG 7.18.08

Question:

I`m a 43 year old Male Model who is considering having my upper/lower eyelids done. Is there a consultation fee to come into your office to discuss the options?

Answer:

yes, the fee is $50. It would be applied towards the surgical procedure if scheduled within 6 months. JG 7.17.08

Question:

I had eyelid surgery 7 months ago and recently I noticed a white lump along the scar line. My dermatologist tried to remove this with electro coagulation and then with a needle just a couple of days ago. I am noticing a lump again. Could this just be a reaction to the treatment or did he perhaps not remove the whole thing. Thank for your answer

Answer:

it is likley a cyst form where the sutures were and at times, lancing will be enough, in some cases the cyst wall needs to be cut out and that means a suture or two, can be done under local anesthesia. JG 7.16.08

Question:

I had an eye injury back in April of 2008, a severe black right eye, it took over two months for the bruising to heal, but I now have a small amount of bruising and swelling, which looks like someone who has severe undereye bags. There is still some pain and twitching of the eye. Will this swelling ever go away or will I need to have it surgically removed.

Answer:

in most cases it will go away but it can take months in severe trauma cases, there is no surgery required in those cases. JG 7.15.08

Question:

I know you advise copper after resurfacing, but have you ever advised using copper for upper bleph scar healing? Would copper serum hurt the healing process for the scars in any way? And while I know you don`t carry this product, what do you think about using SkinBiology`s copper serum on the scars nine days post op?

Answer:

there might be a small improvement on the scar itself. I think the SkinBiology is OK to use. JG 7.10.08

Question:

Thank you in advance, Dr. Garcia. I had an upper bleph one week ago today. The stitches came out yesterday - they were a running prolene stitch. Just yesterday morning I noticed a hard slightly raised area along one of the stitches at the outside end - about 3/8 of an inch long and maybe 1/8 of an inch wide, and traveling along and just every so slightly above the incisions/suture site. I was hopeful that it was due to the suture, but today it`s still there. Will this go away in time? Should I be massaging it or putting ice/heat on it? Other than that, my eyes look great.

Answer:

just normal wound edge swelling as it lays down new collagen, will flatten out over the next few weeks. Warm is good and light massage is OK in a few days. JG 7.8.08

Question:

Thank you for your reply regarging my lower eyelids. What is the difference between a cathopexy and a hard palate graft, if thats what i need? I also read somewhere that fat injections could also lift my lower lid slightly, when i squint a little i look normal, please help im all confused.

Answer:

the hard palate graft is needed at times if there is a shrinkage of the internal lining of the eyelid, it is not always required, just in severe cases where the tissues, once released, are not adequate to close the the wounds. I think the fat injections only help in a very small number of cases and I do not think it is worth trying it. JG 6.27.08

Question:

Hi Dr Garcia, Its been 6 months since my upper and lower blephoplaty, and my eyes are showing a lot of white still on the bottom, and very round. I am scared of revision because i dont want cat eyes. I just want my lower lids to be lifted slightly, what do you suggest?

Answer:

well you will likely need more surgeyr, it might be able to be done conservativley in order to avoid the cat eye look but it will certainly look like that for a period of time though. JG 6.26.08

Question:

Hi Dr. Garcia......I`ve been using Scarguard now for 2 1/2 months for my scars after having upper eyelid surgery. How much longer should I use it or when does it stop working? My scars still show even though they are much better ....I`m not sure when I should quit. Also....my eyelids are still a bit swollen....after 2 months and 3 wks. post op. Is that normal? I was told that it could be up to 6 mos. to a year before I see the final results. Is this true? Thanks for your help!

Answer:

it reaches about its max at 6 months or so. As to the sewlling, it varies, depending on what was done, give it some time. I agree with the time for the final results too. JG 6.25.08

Question:

Will extended blepharoplasty help with festoons? What about skin tightening? I have read that aluma may help diminish the appearance. Thank you for your time... M

Answer:

not in my experience. I do not think Aluma is worth the money. Festoons at times need to be directly cut out leaving a scar right over that area. JG 6.11.08

Question:

I had upper and lower eyelid surgery two weeks ago, with the laser treatment on the lower lids. Also had fat injections for the merionette lines. The fat injections look great and the upper lids are healing fine too. The redness from the lser is going away but 8 days post up I got what looks like bags of fluid under my eyes. they are along the eye socket near the bridge of my nose. They are mushey and almost seem fluid filled. THey dont hurt but are really ugly. Any ideas what could be going on? Other then that....my healing has been great.

Answer:

I think that is all normal swelling that has migrated downward due to gravity and will get better soon. JG 6.10.08

Question:

Hello Dr. Garcia Is it possible to improve deep tear troughs permanently? If not, is the maximum time the injection will last dependent on the patient? Note: I am of asian descent with brown skin.

Answer:

no, sorry, it is not possible. JG 6.5.08

Question:

PS: is there anything I can apply to the swelling and redness to help reduce it faster?. thanks again

Answer:

warm moist heat. JG 6.1.08

Question:

Hi Doc. Further update to my questions regarding under eye infection after lower eye and mid face op. Well I am on day 4 of taking antibiotics and the redness and swelling under my eye has got bigger and redder. However it doesn`t feel so sort. It started with a small lump just on the bone below the eye, below the inner corner of my eye. Anyway now i have a small lump with a tiny red patch under my other eye. it is not sore, but can you tell me why I would get a lump in exactly the same place under my other eye? Could there be an internal stitch there that I have reacted to? Also Is it normal for the redness and swelling to get worse when taking antibiotics. When should I notice it going down? What do you think I should do next. The doc who did the op is not in the same country as me so I can`t see him. Please you advise is really needed. thank you.

Answer:

might be infected stitches. The redness and soreness can get worse if the antibiotic does not cover the organism that has caused the infection. I think you need to see a doctor in person, even if not the one who did your surgery. JG 6.1.08

Question:

Hello! I have a home ultrasound kit. Is this safe to use to help eliminate blepharoplasty scrs?

Answer:

sorry but it will not help the scars. JG 6.1.08

Question:

I am 54 and had uper and lower eyelids surgery 10 weeks ago now as the swealling is going down nearly gone the expression lines are more marked and I look as if I have aged! is there anything I can do, is it normal? what do you suggest I should do to diminished those lines thank you very much in advance for your reply

Answer:

fine lines are never helped by a blepharoplasty, that is quality of skin and surgery only fixes excess quantity of skin, might need a laser or at least some Retin-A for the texture. JG 5.31.08

Question:

Hi Doc. Thanks for your advise. If the 56 staphlex does not work for the infection under my eye, what antibiotic should I ask for. What do you think is best? What could have caused the infection? Do you think it could get worse and require surgery?

Answer:

hard to say what caused it and I am not familiar with the antibiotics available in your location so you will need to discuss that with your doctor, if an abcess forms then lancing the abcess might be needed, let`s hope it does not get to that. JG 5.30.08

Question:

Hi Doc Well I went to my doc and he gave me 56 staphlex for an infection under my eye. It`s been 3 weeks since my surgery. I`m a little worried. When should I notice an improvement? What happens if the staphlex doesn`t clear the infection? What are the causes of infection after surgery. Is this normal?

Answer:

not normal, might need a different stronger antibiotic. JG 5.29.08

Question:

I`ve had a fatty decompression and two wall bone decompression on my right eye for Graves Eye Disease. My upper and lower lids now look a bit hollow compared to my left normal side. Is there anything that can be done to plump them up a bit and make them look more symetrical?

Answer:

very difficult if not impossible to do I am afraid. JG 5.27.08

Question:

Is it save for a person who is 35 to do Bilateral lower lid blepharoplasty. One of the surgeon said it might make my eyes droop a little, is that true? And if in later age do the blepharoplasty again may get even worse. Is that true?

Answer:

safe, yes, neeed, that is another question. Drooping should not be a problem if properly done. As one ages, if too much fat had bene removed, there can be a worse appearance. JG 5.27.08

Question:

Thanks for your quick response. Just one more thing regarding my lower eye and mid face lift surgery. There is also now a mild burning feeling as well as the tenderness and redness. Am I silly? How long do you think it will take before this goes away?

Answer:

I think that is due to the eye not closing and the cornea getting dried out, might need some eye drops for a while unitl it gets better. JG 5.27.08

Question:

Hi Doc I had under my eyes done just about 3 weeks ago as well as a mid lift. Under my right eye is a little tender and red looking. It seems to be more swollen then my left side. Is it too early to worry about this tenderness? could it mean an infection? will it right itself.... am I worrying about nothing.

Answer:

I think at this point it is all within normal for what you had done. I do not think you have an infection but seeing your surgeon is the safest thing to do. JG 5.26.08

Question:

Hello Dr. Garcia. Will you perform an upper eyelid surgery with use of local only? Can you tell me what the approximate cost would be? Thank you in advance!

Answer:

I do it under general anesthesia or local with intravenous sedation, never under straight local anesthesia, fees are about $2700. JG 5.25.08

Question:

Thank you for your response reagrding my eye procedure. You provide a wonderful service. I have another question. I am 10 days post op from my tca,restalyne and botox procedure. My eyes peeled and look great but the restalyne that was put under my eyes looks uneven. It looks like my right under eye is filled in more and cheek lifted. I love the look and want the other eye to be the same. I just paid $3600 for this procedure and don`t want to have to pay more to have my face even. I saw my doctor and he said he put 1 tube in each eye and I would have to pay for another tube of $500 to fill out right eye. Is that normal to have to pay or is that something my doctor should fix without charging me? Thanks. Andrea(San Diego)

Answer:

well, every doctor is different, in most cases if the uneveness did not exist before, one can expect that if both sides are injected with the same amount, that they should be even, so I think it should be covered with the previuous fee in most cases, if for no other reason than good will. JG 5.21.08

Question:

Hello Dr. Garcia. I am 2 years post op fat grafting surgery by Coleman. I have horrible lumps and bumps under and above my eyes. I realize that this could be fat encased in scar tissue so it cannot be cut out. Before I try Kenalog, which frightens me a bit, do you think daily ultra sound treatments will help to break up the scar tissue? If so, do you have any suggestions for the settings and duration of treatment time. Many thanks for your help. Truly, Casey

Answer:

I think ultrasound might help, and I also think a small nick with a blade and trying to push the oil out might help to smooth it out some. I think the setting should start low and increase as tolerated until it is at the maximum, best of luck. JG 5.20.08

Question:

Dr. Garcia, I am scheduled for upper and lower eyelid surgery after a bad field of vision test. Now I am scared to death after researching online. Seems there arent many positive outcomes from the surgery. Also the risks of impaired vision terrify me. Do you know what the percentages are for these risks, and are there any alternatives for the eyes, other then surgery. Thank you

Answer:

I think you get a jaded view on the internet and people that are happy are not on here talking about the success. I think overall the complication rate is 1-2% in most cases. I will say that I do not see how the insurance is going to cover your lower eyelid surgery though for vision loss as that cannot happen, only with the uppers. JG 5.20.08

Question:

I had upper and lower blep. and a brow lift done 25 days ago. One of my eyes is open more than the other. Is it possible that there is still more swelling in the brow area and it is keeping one eye open more? How long does this recovery usually take?

Answer:

it is possible since there was so much done around the eye, yes. It usually gets better in 6 weeks, might want to use eyedrops and try to tape your eye closed at night to avoid injuring the cornea by exposing it to the dry air. JG 5.17.08

Question:

Good morning! :) If I am going to have IPL laser for acne, botox for my eyes and upper eye lid skin removed, should I have it all done the same time or in any certain order etc? Thank you :)

Answer:

Botox before the surgery, the IPL will not matter as you will need many treatments so starting before is fine. JG 5.16.08

Question:

I had a lower eyelid bleph six months ago. One of my eyes turned out fine, the other still has a visible, puffy piece of fat. The doctor did incisions inside my eyelid on the first surgery. To correct my problem, he has offered to do an incision on my lower lash line. I am concerned that my eyes make look different because of the two different types of incisions. Do I have anything to worry about. Thanks a million for your time and expertise!

Answer:

I think it is OK to proceed with the outside incision, they should not affect the healing as long as no skin is removed from the one eye during the touch up.Best of luck. JG 5.14.08

Question:

Hi, im 32 years old and considering upper lid sugery for skin removal only. Will in 10 years from now how will my eyes age? Considering that i take care of my skin and diet and excercise. Will i have to do it again? Or is it best to wait when im 42? Basically how do the eyes age with age. I dont have fat baggy eyes just little extra skin.

Answer:

In time most likely the skin will continue to sag but it will require much less to be done than the first time. JG 5.11.08

Question:

I have a followup question if you would. Cheek lift through old canthopexy inc. How much swelling and bruising should I expect and how much change in contour of face. Surgeon said lifting the top of cheek pad for the outer corner of lower scleral show and asymmetry. Any other suggestions for the very minimal surgery required for this result? Thank You for your opinion.

Answer:

the swelling will be considerable due to the tissue being released from the bones of the cheek. I think in some cases a canthopexy with or without skin grafts or flaps can correct the issue without lifting the cheek, but it is hard for me to tell without seeing you in person. I wil say that minimal surgey might not be possible to fix the problem. JG 5.10.08

Question:

I had a bil lower bleph with canthopexy 16 months ago. I have asymmetry and scleral show. I`ve gone to an oculoplastic surgeon who is suggesting a cheek lift with canthopexy for correction. The incision would be just lateral eye over the old incisions but would extend out a little further. What is your opinion on this? Thank You.

Answer:

hard to say whether that is what you need without seeing you in person but if there is a need for more skin, the cheeklift can help with that and the incision will likely need to be made a little longer to gain access and repeat the canthopexy in such a way to avoid the scleral show. Might be the only way to go, but I cannto say without a physical examination. JG 5.7.08

Question:

Dr. Garcia, I had upper and lower blephaproplasty done 2 weeks ago. I have red broken capularies at the bottom of each eye and on the top lid of one eye. Is this normal and will this fade? My concern is that I have broken capularies on my nose and I have fair and sensitive skin.

Answer:

all normal from the surgery and should get better, but slowly. JG 5.6.08

Question:

Hi Doctor.......will Scarguard make the little pimples that appear on the incisions of an upper bleph away or will anything or will they just disappear on their own. I`ve just developed a couple after 4 wks post op. Thanks again for your answers.

Answer:

they will go away on their own, I do not think the ScarGuard will take the bumps away. Warm moist heat will help though. JG 5.5.08

Question:

Hi Dr Garcia I just wanted to thank you so much for your guidance about endosopic lifts etc. I`m the one who had a SOOF kift that was redone and devopeled bumpiness and indentation under one eye. One dr wanted to do the endoscopic midface and break up scar tissue. After reading your comments I went to another dr who injected the area with a strong steroid injection and did a strong tca peel. After 2 weeks of bright red the area is flat!!!That`s the first time in 2 yrs! Others have done injections but there wasn`t any difference. How come this worked this time? The least invasive way sometimes is better. Your thought?

Answer:

might have been the dose injected, or the level at where it was injected, or both, glad all is better. JG 5.4.08

Question:

Hello Dr........I was just wondering why...when you`re considering getting an upper Bleph why they ask you if you have Hypothyroidism.

Answer:

low or high thyroid can affect the bulging of eyes and also the amount of tears you make. JG 4.29.08

Question:

I am sorry...This was a rim fracture not involving the floor. so its like i have no bag left under that eye(flat tire effect) understand? orbital RIM fracture recessed or sunken bottom eyelid....... Thanks

Answer:

well, you can certainly try the Alloderm, I do not think it will last, but I think the mechanism of the defect is loss of fat from the old trauma, I would likely go with something else, but it wil be hard to replace what has been lost, no matter what you choose to use. JG 4.28.08

Question:

Hello Dr. Garcia, I am 4 months post upper Bleph. I have developed 2 cyst like bumps on one of my eye lids. Are these a direct result of the surgery and can they be removed? Also, how extensive is the scaring if the Bleph has to be re-done? My MD is going to remove more of the upper eyelid skin. Thank you for your help as always.

Answer:

most likey they are cysts where the sutures were and the small holes now have a little plug in them, warm moist heat many times gets them to go away, otherwise they can be opened by your doctor with a small needle. The scarring should not be any more extensive than after the first one in most cases. Best of luck. JG 4.28.08

Question:

I have wrinkles under eyes horizontally and some going vertically all the way to cheek in the medial portion of one eye. I am not a candidate for lateral canthoplexy unless i do graft and not willing to do that. I have had a lower lid bleph ages ago and have tear troughs as well. Do you think any type of laser, thermage, etc would help. I have graves disease withlower lid retraction in one lid and cannot risk any further retraction so have to be careful. I would also do a filler but am nervous about lumpiness.Any suggestions or at least what would you try first?? THANKS!!! thanks

Answer:

I think a deep Rhytec Portrait should help those, or a light CO2 laser. JG 4.28.08

Question:

Thanks so much. I have never heard of using silica sheeting for my orbital rim blowout(flat tire deformity . Who uses this? I can not find anyone.I have consulted with Yaremchuk,kawamoto...ect and no one has ever mentioned it. I have been offered implants,alloderm,pulling my face off and re doing the bones(not an option)...I am interested in this for sure. I would like to see some results or consult with some docs that do this type of procedure( in the orbital rim area)....I can not find anyone. Can you help with some names? You can email me if you like at getdishsat@yahoo.com Personal Regards, Mike

Answer:

the usual way to initially correct an orbitla blow out fracture is to place a silicone sheet in the floor of the orbiit to support the fat and the eyeball. Once time has passed it might not be as effective, I cannot see how alloderm will help as for it to last it needs a well vascularized area and that does nto exist next to bone.I really don`t have much more to offer. JG 4.27.08

Question:

well, i HAD AN ORBITAL RIM FRACTURE 5 YAERS AGO. IT IS SUNKEN IN UNDER THAT EYE. DR HARVEY COLE IN ATLANTA WANTS TO USE ALLODERM IN IT.WHAT OTHER CHOICES DO I HAVE TO BRING BACK THE VOLUME UNDER THAT EYE?

Answer:

I think using a silastic sheet to buld up the orbital floor and elevate the remaining fat is a good option. JG 4.26.08

Question:

Hi there Dr. Garcia.......I`m not here to ask any questions tonight but just to thank you so much for your expertise and suggestion of using Scarguard for my upper Bleph incisions. I thought I was doomed (so to speak) because on my revision surgery this time both eyes had a lot of bumps and some of the scars left from the first surgery. On using this product...and for only 10 days so far....it`s like a miracle. All the bumps are almost gone and the redness is fading fast. WOW! What a product. And also....a little suggestion of my own to anyone else using this product....I`ve learned a quick, painless and easy method for removing the old to put on fresh twice a day.....SCOTCH TAPE. It`s works like a charm. So Thanks ...once again.

Answer:

thnaks for the suggestion and glad things are better, all the best. JG 4.26.08

Question:

Hi , thank you for your response earlier to my question about my upper/bleh. Im still a little confused about your answer. My ps said he actually wants to remove the muscle and you said wants to use the muscle to support my lid. Is any bleh procedure really safe for long term. Im not looking for quick fix and then later deal with problems and looking for reconstructive surgery. thank you

Answer:

I think blephs are safe procedure but I see no reason to do that for someone your age. I think he is being too aggressive. JG 4.26.08

Question:

hello, im 32 yrs old considering upper/bleh. I saw a ps last week and he said he would remove a muscle to anchor my eyelid. I only have little hooding and lax skin. Removing muscle really concerns me in the long term as i age. Why would he suggest something like this? And i asked him if this would weaken my muscle and eye structure and he said he had never heard of this. Well sorry but that answer was not good enough for me. I made another appointment with a opthamologist to get second opinion. Wouldnt tissue sparing be a better approach? Considering i am still young. i want to look like myself but better. Came across Dr. Meronk website and he said it is not nescessary to remove and fats or muscle from younger patients. Is this true. Thank you

Answer:

I think he is likely trying to support the lid with the strip of muscle so the end result will not pull down on the lid and expose your eye too much. I will say that it is rare for a person youe age to get a significant improvement from a properly done blepharoplasty. In most cases the amount that can be safely removed will likely not yield much difference and what look you are trying to acheive might not be the result you get. JG 4.25.08

Question:

Hi there Dr. Garcia......I`m a bit confused with the instructions for SCARGUARD....Do you have to remove it every time you add more. If I put fresh on every morning...can I just add to it at night or vice versa. I also find it difficult to remove completely. Is there a trick to it. I don`t want to rub or pull on my lids too much for fear of stretching the skin. Thanks for your help! I sure hope it works because I have a few very noticeable little bumps on my incisions on both eyes.

Answer:

yes, remove the old and reapply. Try soaking a moist wwrm towel on the area first. JG 4.22.08

Question:

Hi there Dr. Garcia, When is it OK to start using Scarguard on the incision after upper Bleph? It`s been two weeks post surgery...and on one incision I did feel a tiny sting on a part of it. It just says don`t use on an open wound. And also is it unusual for one eyelid to be more swollen and for longer than the other. Thanks for your wonderful support during our recoveries. You`ve been a Godsend.

Answer:

a few days after the sutures are out is OK to start, so you can begin whenever you wish. It is very common for one eyelid to be more swollen than the other. Best of luck. JG 4.19.08

Question:

thank you again for your quick and honest answer, this is what I feared, I am very disappointed in my results. Is it commen to end up with this result, more fat on one eye, is it something my PS should/can correct?

Answer:

not common, but it does happen. I think the PS should try to make it better, yes, unless he told you before that it was going to happen and you decided to proceed even with that warning. JG 4.15.08

Question:

HI Dr. Garcia, Thank you so much. I posted before about a tarns conjunct lower belph, what about having volume/fat in one eye 5 months post op , could this be swelling or different amount of fat from each eye?

Answer:

likely different amounts of fat removed, the swelling should be about gone by now. JG 4.15.08

Question:

thank you for your quick reply. after a lower tranconjunct lower bleph would a skin pinch would have a cut/scar on the outside of eye below lashes the inside of the eye to the outer edge? it was not what I was expecting.

Answer:

it all varies, depending on how much skin there was to remove, the skin removal is what likely rounded the eye out. JG 4.15.08

Question:

Hi Dr. Garcia - I am a 35 yr old female who had a transconjunctival lower bleph w/ fat removal a skin pinch 5 months ago to relieve the bags under my eyes. Now, instead of the puffy bags I seem to have half moon shadows above my cheekbones. It is much worse on the Lefty eye. Its seems that that the left eye has less volume and fat than the right eye. It seems that my eye socket bone is protruding. On the right eye I have more volume or fat around the eyeball, but the eye is slightly rounded, this plus the volume is creating and asymmetric look. I saw my PS yesterday, He said the right eye is still swollen and i should tape it and milk it, is this possible? He also said the shadow/valley I am seeing were always there, just more pronounced after taking the bags out. Is this correct or did he take to much fat? He wants to fill the valleys with juvederm, he already put restylane in what he said where the remaining fat pockets. Do you suggest this? will my eye shape go back to normal? I this difference in volume/fat fixable and how will it age? Thank you!

Answer:

the eye shape issue might need surgery to repair but I would wait one full year, as to the dark line, when the fat was removed it likely made it more visible and fillers might be the only way to improve it. JG 4.15.08

Question:

HI DOC, Since my endosopic lift didn`t treat my muscles correctly and I still need botox. Can an upper bleph treat the muscle that create the horizontal lines on the forehead and the frown lines between the eyes. It seems the muscle that has all the action is right above my eye. Sorry, I notice I posted a guestion 2 times about a forehead lift. Thanks for all your help

Answer:

the musces can be accessed through that incision but with the previous surgey, it might be difficult to see what needs to be done, I suggest a regular open forehead lift. That will also fix the sagging of the lateral brow at the same time. JG 4.15.08

Question:

Hi there Dr. Garcia I`ve just had my revision upper bleph 10 days ago. Can`t believe how fast it`s healing this time. Bruising and most of the swelling was gone in about 6 days. The last time I still had swelling and very red incisions 3 months later. However as good as it looks....all of a sudden a very dark spot appeared right inside the incision. I sat and iced it thinking because I put my head upside down for a couple of minutes to dry my hair that maybe some blood rushed to that spot. I hope it`s nothing serious and will disappear as quickly as it appeared and that nothing else more serious is happening. That eyelid still does have some swelling. It`s just a small spot but I`m hoping it`s not going to get larger. Is icing it a good idea and also could you tell me what this might be? Thanks so much! I was feeling so comfortable and good about this surgery because all was going so well and looking good.

Answer:

ice is good and I do not think it is anythng to worry about long term. Best of luck. JG 4.14.08

Question:

HI Dr Garcia, I had upper and lower blephoplasty and also rhinoplasty done 11 weeks ago, I still have scleral show on my lower lids is this still quite normal, or should it be back to normal by now.

Answer:

should be better by now, I think you need to see your surgeon. JG 4.13.08

Question:

i had upper and lower eye lid surgery 2 yrs ago i have not been the same since.. my eyes are slightly rounded which makes me hate the way i look i use to have gorgeous eyes .. eyes are the window to our soul.. i have been very depressed what can help this... i heard about canthoplexy .. what do you think

Answer:

canthopexy can make the eye look less round but the opening will end up being smaller too. JG 4.6.08

Question:

I have been unable to close my left eye enough to keep out water since eyelid surgery 10 weeks ago. The lower lid lifts on the inside much more than the outside, and the loser lid droops a bit toward the outside. Any idea what the underlying problem is? I`m nervous about revision at this point until I really understand what`s srong. Thank you.

Answer:

hard for me to say without seeing you, could be to much skin was removed, I think you need to see your surgoen to see what can and should be done. JG 4.2.08

Question:

I went to American Laser Center for a consultation - I have a tentative appointment for 5 refirme treatments for puffiness under the eyes. I notice that you do not support the procedure. Do you know anything about Therma-lift? What is the difference? Thank you SLT

Answer:

that will be a waste of time and money also. JG 4.1.08

Question:

I had my eyebags taken out 2 yrs ago but it look like they are starting to come back it that possible? What cause eyebags to develop again?

Answer:

it is not that they come back, but what is done is mininmal amounts are removed in order to improve the appearance but not leave one looking hollow. As time goes on, the fat that was left can pooch out and require further surgery. JG 4.1.08

Question:

hello doctor. I had lower eyebag removal done about 6.5 months ago. There is still some reddish/pinkish coloration in the middle of the incisions done on the lower eyelids of both eyes. How long does it tak before the scar turns white and loses the pinkish coloration? Does that take longer than 6 months?

Answer:

might take up to one year in some patients. JG 3.30.08

Question:

Would you do an upper blepheroplasty and Rhytec during the same visit? If not, which would do first and how long a wait until the other procedure? I have used Retin-A, peptides, vitamin C, and DMAE since last October and the undereyes are okay; the upper eye area is still crepy, though.

Answer:

yes, it is just that I would not do the Rhytec over the skin on the eyelid treated with surgery. JG 3.30.08

Question:

thank you for your website and possible help with my problem. I had a lower lid blephroplasty and what I think is a canthopexy with temp. sutures. When looking up or opening my eye much it drags the rest of the lt side of my face with it. My rt eye is now feeling like it is becoming loose in the corner and pulling away a little from my eye. My eyes are constantly irritated and anyting i put in them or any creams i use to moisturize irritate them and they, especially the rt waters and runs down my face. My surgeon said maybe she cut a little too much skin from my rt eye and to stretch it. Also everyone likes to say give it time. So, in your opinion is it to soon to say I have a problem and if so how long until opps, there is too much skin gone! and it needs help. I feel like I don`t have much of a lower eyelid any more, between the lower rim of my orbit and my eyelashes there is not even a index fingers worth. I have always felt much better if I shove my cheeks up towards my eyes and I thought it was due to the pulling of the canthopexy. Also I don`t understand why if a canthopexy is suposto hold your eyes up I felt as if the corners of my eyes were pinched in a downward hood over my eyes. My son kept telling me I looked asian. I am panicked that I have ruined my eyes. Please tell me what could help. Thank you very much.

Answer:

well, things do stretch out over a few months, the urgency in repeat surgery would be if there are any problems that could potentially affect your eye itself and from what you have described you are not at that point. If there was too much skin removed you will likely need a skin graft to replace it, and I think 3 months after the original surgery should be more than enough to determine that, best of luck. JG 3.28.08

Question:

Hi Dr. Garcia-thanks for responding previously-I did get a smas face lift w/neck lift and got a great result on the neck and jowls but I chickened out on the lower bleph w/midface that he wanted to also do(because of the possible complications). And now 6 months post op I have the tired eyes and flat midface- what do you recommend for lifting mid face and tightening lower lid skin instead of the trans lowerbleph/mid face? I am so far away from you otherwise I`d come in to see you-Thanks

Answer:

your mid face, if the SMAS is done properly should be elevated, there is no need for a seperate procedure. It might be because you have lost fat there and there was nothing to lift, maybe some Sculptra injections will reclaim some of the fulness in that area that you have lost over the years. The lower lids might benefit from a laser or a Rhytec Portarit resurfacing. Best of luck. JG 3.23.08

Question:

Hi again Dr.........I`m now almost 4 months after upper eyelid surgery....I have problems with bad wrinkling on the inside corners. Finally went to see my surgeon after he told me to wait at least 3 months to get a better idea after swelling went down and he is now (April 4th.) going to do some cosmetic surgery on them.(the first time was just to remove excess skin to better my vision)....he said he is going to remove some of the fat and a tiny bit more skin as I still have a bit to play with...so he said....I`m hoping this will take care of the problem. I asked him if it will look worse and he said no. Do you think this is a good idea? He told me that when surgery is done to just remove skin....that`s all that`s done since the cost was covered by gov. health insurance..with no cosmetics involved and they can only do the best they can to make it look as natural as possible. He is however charging me only $1000 for this upcoming surgery. He is supposed to be the best in our city and I`ve seen some of his cosmetic work and it looks really good so I`m trusting him. What else can we do but that since we don`t have the knowledge of a surgeon. Please let me know what you think. Thanks for being there for us!

Answer:

I think you should move forward, best of luck. JG 3.19.08

Question:

I have a slight amount of fat under eyes, which will be removed during a blephaoplasty. One dr. said he would make the incision inside the eye, the other said outside the eye, under lashes. (I am 66 yrs. old.) The Dr. who said he`d incise inside the eye said he was doing that because he did`t want to remove any of the skin under the eye. I know I`m sight unseen, but, in general, which incision location do you think you`d choose? Thank you so much. J

Answer:

in someone your age there is usually loose skin that needs to be removed so I would do it from the outside since there would need to be an incision there already for the skin removal. If there is no skin excess, then the inside incision is a better choice as it is hidden and there will be no sutures placed. JG 3.19.08

Question:

Hi dr. Garcia. What is the best way to redmove excess skin in the upper eyelids and puffiness under eyes.It is not bad enough where it may require surgery but I was thinking about some form of laser.

Answer:

don`t think lasers will do all of that, maybe a little for the upper lids. JG 3.10.08

Question:

I have heard of a lot of horror stories in this forum about a stange look (upturned in the outside corner) from a lateral canthopexy. My question is would`t a surgeon when stitching be able to see how much to tighten the stitches and loosen them on the spot if necessary? Or does this happen because of the excessive removal of skin and then having to overtighten as to not have ectopion? Thanks

Answer:

yes, there is some relaxation in some cases though, so some surgeons will overcorrect, expecting a relaxation effect and sometimes it does not relax. JG 3.8.08

Question:

hello dr garcia. i underwent transconjunctival 5 weeks back. i still have slightly bloodshot and dry eyes. can eye drops help and which can you recommend? also, my right eye seems to have a dark circle where the left doesn`t. may this be due to blood under the eye, or something else? if so, what can you advise to heal? Best regards

Answer:

all of that should get better soon, I might suggest Panatol eye drops. JG 3.8.08

Question:

I am now 15 mos post op from bil lower bleph with canthopexy. I am still having lt eye edema and lt periorbital swelling sometimes going as far as the cheek. I`ve been told I have dry eye. Rt eye has never given me any trouble. Could there have been injury to lacrimal duct? What other possibility would cause such swelling and discomfort. I use moisturizing eye drops in lt eye but does not help at all.

Answer:

not likely, but the canthopexy can actually pull on the duct so that it does not function well, don`t know what else it could be. The swelling can be from the canthopexy kinking off the lymphatics at the corner and that can cause prolonged swelling. JG 3.5.08

Question:

Hi Dr Garcia, I had transconjunctival blepharoplsty (lower) 4 weeks ago. My left eye looks perfect (and did after 2 weeks), whereas my right eye still looks dark underneath and looks like a black eye in certain lights (which was the reason i opted for surgery). Might the surgeon have not taken sufficient fat out of the right eye or will it look like the left eye over time? If not, and more fat is to be removed from the right eye, when can I realistically have the 2nd operation? Best regards, D (29 yrs old)

Answer:

too early to tell I think, if anything it is more of a too much fat removed rather than not enough in most cases though. I would not do a repeat surgery for at least 6 months. JG 3.3.08

Question:

Hi Dr.Garcia. A month ago I had my corrugator removed via eyelid incision. I`m happy with no complaints. I was just surprised to find the indentions along the middle third of my brow and a small indention right before the middle of my brow. They don`t bother me it`s just I thought the muscle was between the eyebrows not along them. Is this common place to remove muscles. My surgeon said he removes muscles that most don`t feel comfortable doing. Thanks again for you time. Have a great weekend!

Answer:

well, the muscles do lie there and althugh it is not an everyday procedure, it has become increasingly more commonly done due to the interest in Botox, prior to Botox it was not frequently done. Might need a fller to be placed to smooth things out. JG 3.1.08

Question:

Dr. Thank you again for your prompt response. There is a light bluish tinge to the affected area under both eyes.WHAT IS A ULTRASOUND MASSAGE? And where would i be able to get it done? Thanks again.

Answer:

it is done with an ultrasound machine, seen at physical therapist`s offices. JG 2.28.08

Question:

How can you tell if you need a browlift, upper eyelid lift, or both? I have a lot of corrugator actvity i believe and a permanent vertical line in btwn brows which makes me look confused or angry. My brows are still over the bone however and there is a lot of looseness in the upper eye lids. My eyes look smaller, more deep set, and somehow closer together. Any recommendations?

Answer:

the easiest way is to look at a picture of yourself as a teenager and then a picture of yourself now without actively raising your brows, if the brow position has changed, then a brow lift migth be beneficial. JG 2.25.08

Question:

Dr. Garcia -- Thank you for your prompt response regarding my canthopexy. You remarked that I should have the sutures cut `soon` before the scar tissue becomes too formed. Can you please clarify the timing of `soon`? Do you mean immediately? Do you think that this office procedure under local anesthesia would be sufficient enough to change the shape of the eyes to look less almond shaped?(like they were before) Thank you. A.M. 2/25/08

Answer:

less than 3 months or so. Office procedure might be possible, yes, an the shape should go back if it is due to the sutures and not anything else. JG 2.25.08

Question:

For hollowness under eyes, do you recommend fat transfers via graft OR via injections. Thanks

Answer:

filler injections. JG 2.24.08

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

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

Question:

Hi Dr Garcia... its me again... about the round balls under the eyelid from canthopexy... they used dissolvable stitches... you said they will maybe fix itself up.. does that happen with the dissolvable stitches too? and what if it doesnt go away... its right under my stitches.. and its big.. can they cut it out? or will warm water help? is 2weeks too early for it all to fix.... one eyelid looks like its beeing pulled down from the bump.... i cant go anywhere ..i will look weird...

Answer:

dissolvable sutures will tend to flatten better than permanent sutures, yes. Warm moist heat and time are the best for now. Hnag in there. JG 2.4.08

Question:

Dr. Garcia, My mother needs to have a lid lift as she can no longer see from the lid sagging. She is Oriental and tends to form keloids. Although she has been told that one does not form keloids on the lid, she is unusual and and cut forms keloids. Is there any new procedure that she can have this done without an incusion? Any new lasers? Thank you.

Answer:

I have not seen keloids form on the eyelids in orientals even if they form keloids elsewhere. I am afraid that lasers will not help nor any other surgery. Sorry. JG 2.4.08

Question:

hello Dr Garcia... I had canthopexy.. 2nd week now.. now I have bumps under my eyelids just under the scar.. scars closed up but I can feel like a knot or a bumpy something.. will they go away? when I touch it, it feels like rubber marbles.. what am i suppose to do with this problem?? Please say something positive..let it be the truth though

Answer:

could be the permanent or long term sutures the doctor used to perform the canthopexy, they are underneath the skin and can at times leave small lumps that in most cases get better with time. Hang in there for a bit. JG 2.4.08

Question:

hello dr Garcia... i just want to know... with canthopexy does it involve stitching the outer corners of the eyelids from the inside... sounds weird but... in other words does the width of the eye shortern...? because i thought it just involved pulling the bottom lid up... the ps didnt cut any skin off... but it feels like my eyes are smaller...with width.. i can see stitches on the outer corner... im panicing its my 9th day..... what do you think? and if so .. can this be undone? and howwww!

Answer:

in almost all cases the opening of the eye or eye width does become smaller, yes. It can be undone but cutting the internal suutures to release te tissues but at this point you are likely still quite swollen. JG 2.4.08

Question:

hello Its yasemin... with my canthopexy.. one eye is swollen (top eyelid)... i just saw my ps and he said to take distaph.... i asked if it has infection.. he just kept quiet... its only my first week away from the surgery... he pulled the stitched area apart using tweezers... it started to bleed... i think he looked to see how bad is the infection. he later said..not that bad.. but he left the stitch open... it was bleeding... he said touch it up with salty water... does all this sound like a normal way of handling the matter??? will the area still look normal when it heals on its own although he pulled it apart?? because he just left it like that.. and my eyelids are still swollen he was suprised ..but the one eye that had the infected eyelid is so droopy... not looking good.. do you think it will be okay?? im 27... so dont have old skin but i still think the area needed coverage or a stitch back...

Answer:

it can be as infections are rare and if they happen they are usually superficial. In time it should look OK, even if there is a small seperation as that area heals well in general. If there is an infection you need to let it heal on its own as putting in a stitch again would get re-infected. JG 1.30.08

Question:

hello its my 7th day after canthopexy... the stich for one of my eyelid (upper) is still swollen and now i just saw that it has fluid... when i touched it with a eye bad I saw little blood. that eye is also still swollen.. the other eye is not as much... infection? what do you think? and what can i do about it??? will it get better??? and in what time??

Answer:

probabaly just the normal swelling. I suggest apllying warm packs and seeing your doctor in a couple of days for follow up. JG 1.30.08

Question:

how does the eyelids relax after you have canthopexy? and what does it mean relax ? does is mean that it will gradually open? and how long does it take for it to `relax` normally.. because i have about half a cm of my eyes closed up from the outer lids of my eyes.... is this permenant?

Answer:

yes, they will, to some extent relax. The angle will widen at the outer corner of your eye.The amount of time it takes varies from patient to patient and from type of canthopexy to another, no way to tell I am afraid. That degree of closure will likely not be permanent. JG 1.29.08

Question:

i want to undo the canthopexy... i just wanted to take away the whites at the bottom of my eyes but it seems like the doc gave me a totally new shape... i hardly have any of my eyes showing.. my eyes appear so small! whats the difference between skin pinch and canthopexy? i had sutures put in and pulled up without a cut under my eyes and i have a scar at the out corners of my eyes and just below my eyebrows... did i get cantho or skin pinch??? anyways... its just been 1 week after the surgery.. if i undo the procedure and get filler in the tear trough area will it make my eyes look almost lifted without cantho? because this is really making me worried and upset.. im 27 years old... my ps said because im still young my eyes will look great with this procedure but i hate it...tell me... how do i explain this to my ps without getting our wires crossed? i dont want to get him hating me because he will have to undo the procedure... that will be scarey if hes going to hold a knife in his hand to operate on me, while holding negative thoughts of me! maybe you know him.. his name is Dr. Norman A. Olbourne from sydney(australia) im actually getting really irritated by him because when we first spoke (consultation) he was seeming normal later that, and during the procedure he kind of kept distant, almost as though he was trying to avoid me... when was leaving he didnt say goodbye...he took off without explaining much... is this guy supppose to be a normal ..and a good ps , if you ever heard of him???? because he seems to be in his own world..

Answer:

I would give it at least 6 weeks before undoing it. A skin pinch is a method of doing an eyelid surgery and removing minimal skin excess, it is totally different than a canthopexy. Sounds like you got a canthopexy. I cannot say without examining you whether the filler will be an option for you, sorry. I just think you need to give it some time and then be frank and honest and explain your concerns. I do not know him personally and I am surprised at your age that a canthopexy was required. Best of luck. JG 1.29.08

Question:

Hello. My name is Yasemin. I had canthopexy done. My outer eyelids seem to be bonded together making my eyes appear small in width. People like my friend, says that its normal and that my eyelids will open up as everything relaxes because its only been my first week (7 days today)... is this true? will it get better? the doc said that he will make it tighter then usual so that when my eyelids relax it will look much more attractive .. but he said it will relax ..... bottom line.. are my eyes going to open up or according to your professional judgement do you think my eyelids are made smaller in width to stay like that... he said also that he didnt cut anything out... so can he undo this procedure if its going to have a bad result? im really worried... and please tell me how long does it normally take to see the eye shape as a whole to get an idea how its going to look like because at the moment im really scared to look at the mirror... please help!!!

Answer:

it is true that at this point there is still lots of swelling and things will relax quite a bit in most scenarios. It can be undone by cutting the sutures placed below the skin if it is not to your liking. It might take a couple of months to look significantly better though in some people and final results at times take 6 months or more. JG 1.29.08

Question:

hello i had canthopexy done only 6 days ago... and both my eyes look smaller then what they used to look... i can see that the outer ends of my eyelids are squashed together ..almost like glued.. my friend says that they will seperate and open up as my eyes relax abit in time.. will this happen in time?

Answer:

it will loosen and look better in time but part of the canthopexy effects, if it works, is that the eye will look smaller. JG 1.29.08

Question:

Hello again Dr.........I am considering a revision on my upper eyelid surgery.......I`s totally a flop. The incisions were made totally different on each eye and they so don`t match. And there is a tremendous amount of wrinkling going on above the incision on the one which was cut going down into the inside corner of my eye where the other is higher and straighter in the corner of the eye. Even that one has a pouch of skin already starting to fall into my eyelashes. I`m so disappointed especially after looking at success story pictures of others on the net. I could just cry every time I look in the mirror. Although the problem of vision and burning and heaviness of the lid due to very heavy hooding has been taken care of....I look terrible. My question is .....should I tell the surgeon how I would like to see it done this time or should I leave it in his hands once again. I don`t want insult him or make him angry since he will be the one holding the knife.....again. I am so worried that this revision could make my problem worse than it already is. I feel that more skin should be removed and the incisions be made identical and going more in the direction of the natural crease in the inside corners. Even the outside corners where the wings were made...one is going down more creating a heavy wrinkle. I really need to approach him just right in order to have it be a success this time. And also ...will I have heavy scaring the second time around? It is now 2 mos. and my incisions are still pink and heavier scaring in some spots. Please help!

Answer:

I think being honest and tell him what it is that bothers you is the first step, if you then feel that he undersands and is willing to proceed, then stay with him. If, on the other hand, he dismisses your complaints and concerns, then go seek care elsewhere. I do not think the scarring will be any worse the second time around. I will say though that waiting 6 months if possible or longer will make the tissues softer and easier for them to be modified during any second surgery. Best of luck. JG 1.26.08

Question:

Hello Dr. Garcia, I am 2 weeks post upper bleph. There are still quite a few hard bumps around the scar lines. Especially at the lower corner of my eye. (seems to get larger with massage) I also still have some loose skin that hangs (hood) over the scar line. Are these things normal and will fade with time? Thank you so much for your time and your expertise. Susan

Answer:

yes, all normal and it should get better in the next two weeks, gotta hang in there. JG 1.19.08

Question:

I have a fastoon just below my right eye. Has been cut directly over it 2xs, still there. Next recomendation is to recut and repostion fat with 2 stitches underneath on each side, to pull up and flaten area. I really do not see any fat, just a fluid pocket to me, but skin is a little loose in area. Question? What is your thought on this procedure? Any recommendation on a solution to my problem?

Answer:

sounds like you just need more excision, no sense in putting more tissue into an area where there is already a bulge. JG 1.18.08

Question:

Hi Dr.Garcia this site appears to be full of horror stories around fat injections to the lower eyelids. Do they really have such a high failure rate or do we only hear about the poor outcomes on this site? Are there ever any successes with the procedure?

Answer:

I think the results are, at best, short lived and I feel that the probelms that can arise compared to the success stories make it not a viable option, certainly when off the shelf fillers are easier and have less risk and last about as long. JG 1.14.08

Question:

Dr. Garcia, Do you recommend Erchonia laser treatment after upper and lower eye surgery. My Chiropractor said it would heal me faster. Can you respond ASAP as the surgery is happening 1/13/07 Thank you very much

Answer:

I do not think it will do much for you, sorry. JG 1.10.08

Question:

Dr. Garcia: REgarding question about Erchhonia Laser treatment I just posted............the upper lid and low eye surgery is 1/13/08 (not 07) sorry for the typo

Answer:

I figured, takes a few weeks to get the change set. JG 1.11.08

Question:

will burn it off leave a scar, like a burn scar is it like pus wanting to come out like a pimple?

Answer:

yes, but it usually heals in a couple of days. JG 1.8.08

Question:

what is this pimple-like, and how will the ps remove it?

Answer:

most likely will burn it off or remove it with a small scalpel. JG 1.8.08

Question:

I had upper eyelid surgery 16 days ago now and the swelling of the lid is still apparent. The corner of my eyes feel slightly sore at times and the lid feels sticky too. Is this normal and will it go away in time? Is there anything I could apply in the meantime?

Answer:

all normal I am afraid and it will take another couple of weeks for it to get better. Ice in the meantime, and a little massage. JG 1.8.07

Question:

I have hypothiroidism and i take synthiroid everyday..the question is i would really like to do blepharoplasty in my upper eyes they are saggy and it dont look at all..what are the problems that i can have if i do this operation ? thnks for answer

Answer:

as long as the thyroid problem is balanced there is no reason not to go forward. JG 1.6.08

Question:

Please help...if one long suture was put in for upper eyelid surgery and I pulled on it too tight thinking I was removing a piece of stitch....it left a wrinkled look on the incision and is now pulling the crease line up in that spot.........will it settle on it`s own or have I created a big problem and can it be fixed. It looks like a bit of the skin between the wrinkles is forming a couple of little bumps as well. I`m just frantic.

Answer:

yes, it will settle down, if the suture was totally removed. All the best. JG 12.31.07

Question:

years ago my husband had a bad case of bells palsey and now at 59 his eyes are droopy, BUT his left eye is very hooded as a result. one doctor wanted to do a `basic` brow lift that he said will leave visible scars over the eyebrow. We asked for a 2nd opinion and that was to have a browlift with a blef as well and ther would be no scars? have u any information about correcting eyelid drop made bad by bells palsey and worsened with age? thanks so much. kathy

Answer:

I think a browlift done through an incision in hair is possible and a upper lid blepaharoplasty at times is also helpful at the same time. All depends on the severity of the muscle weakness. I think a direct lift with a scar right above the eyebrow is easy but also will leave a visible scar. JG 12.29.07

Question:

First, I`d like to thank you doctor for being there for us . It`s so comforting to know that there`s someone out there to help with our concerns. A few questions........5 weeks post upper eyelid surgery.....my right eye looks beautiful....however my left eye doesn`t match it. The inside corner still has loose skin and the crease raises higher than the left eye does on the inside. Will this level out.....There are also two little bumps on the incision on the raised spot. Will they just disappear or will something have to be done to get rid of them? I had one long stitch, what are the bumps caused from? Is there anything that can be done for this?.......and does the incision create a new crease on the eyelid or will the actual crease still be there after the incision fades. Thanks so much!

Answer:

the differences after an eyelid surgery, since that area is affected so easily with minimal amounts of swelling, will get better but it might take 3 months or more for a final result. The little bumps are usually due to the sutures and with time they open up and flatten out on their own. You can try applying warm moist heat packs and that helps many times. As to the incision, ideally it is placed in the crease so it should heal in the same place where it was before JG 12.29.07

Question:

hello doctor and thank you for answering my previous questions. i have had stitches out of lower eyelid for 2 days and have noticed little white bumps where they were. is this normal? at times they itch. will they go away on there own?

Answer:

all normal, warm moist heat will speed their going away and the itching is part of the healing process and will get better in time also. JG 12.29.07

Question:

If you have a lower bleph with skin pinch and fat repositionsing, does this mean you won`t get a hollow look because fat isn`t removed just repositioned? Do you think repositioning fat is a good procedure with good outcomes?

Answer:

the likelihood is much less, correct. I think repositioning fat is a good procedure if it stays but it can be unreliable at times. JG 12.28.07

Question:

Dr. Garcia, i had my stitches out of lower eyes after a skin removal and now the line is dark, will it fade? it has only been 9 days since surgery, also my insicion is sticking out more on one eye, is that normal? and will it flatten out and color of insicion get lighter? THANKS

Answer:

all normal and will get better slowly with time, nothing to worry about though. JG 12.28.07

Question:

DR. Garcia, My PS said the milia I have are not the kind that you can just open up with a needle. They are more like clusters and do not have heads or what ever. I have been looking on the computer and wonder if what I have is syringoma. I had a few of them before lower bleph but now they look a lot worse . Do you have any ideas how to treat them? The PS said to leave them alone but I wonder if Retin A or chemical peel may help.Thank You for your very speedy responce and time.

Answer:

syringomas have to be treated with hyfercation or a laser to burn them, but they grow back. I do not think Retin-A or a chemical peel will help them. Surgery should not make them any worse though. Sorry. JG 12.26.07

Question:

Dr. Garcia, I had a upper/lower bleph 7weeks ago . I have a lot of bumps under my eys and also the wrinkling under eyes is a lot worse.There are more lines and they are much deeper.I am sick about this. I went to the plastic surgeon today and he said he thinks wrinkles are worse because I still have some swelling. He said the bumps are milia but not easy ones to remove. He said they may take a long time. My under eyes look so much older. What do you think/ He says I am a slow healer , to give it more time but I don`t see how any of this can or will improve. He said if wrinkles are still bad ,after 6 months, he can pull skin up a bit. Is this all common or am I just one of the unlucky ones. I`d appreciate any info you can share with me. Thank You, KIm

Answer:

well, assuming you did not have any laser to the lower eyelids, it is unusual, yes. The acute swelling from cutting surgery can make wrinkles look a little worse for a few weeks but that usually gets better after about one month. At times if absorbable sutures are used for the lower lids, they can leave milia where the sutures were and they need to be opened with a small needle to let the oil out, warm compresses might also help that too. Hard for me to say much more without seeing before and after pictures and more details about what was done, sorry. JG 12.26.07

Question:

Hi, Dr Garcia I had upper blep and had patosis corrected, it has been 5 days now, one lid is higher than the other making one eye look bigger than the other. I will not see the doc till 010908. Can that be fixed with touchup if it does not correct by itself. Thanks.

Answer:

I think it will correct itself, not uncommon for that to look that way in the healing phase. JG 12.24.07

Question:

dr.garcia. i had lower bleph 5 days ago with just skin removal,my stitches extend into crows feet area and my upper lids are pulled down on the ends like a rocky look is this normal?

Answer:

normal, due to swelling at this point. JG 12.24.07

Question:

Hello there Good Doctor I`ve been told about so many different products to put on my eyelid surgery incisions to help them heal and prevent scarring and I`m so confused. The latest is a product called CICAPLAST by La Roche-Posay which sounds good and feels good by relieving the dryness, and my sister told me to use just Vaseline because it is supposed to be the best healant on the market......could you please tell me what the best product to use would be. I`m one month post surgery now. Thanks for being there for us!

Answer:

we ue Mederma or ScarGuard for our patients. JG 12.23.07

Question:

I had juverderm injected near the the eye are because I had the sunken eye look which was in August of 07. I don`t know what happened but I now have puffiness in the corners of my eyes to me it looks like fluid build up. I know it can`t be fat because that`s the reason I had them injected in the first place there was not enough volume to begin with. Is there anything that can be done for this, would this entail having lower eyelid surgery to fix the problem? Thank you, Gina

Answer:

could have the doctor inject hyaluronidase to dissolve the Juvederm. JG 12.20.07

Question:

Hello there Dr........I just wondered how long it should take for the incision for my upper eyelid surgery to fade. Mine is still quite red and I`m going on my 4th. week. It`s also tender to the touch.....I have dissolving stitches...would that make a difference? Thank you for your time!

Answer:

the redness will take 6-8 weeks or more and the final result will be at least 6 months. Best of the season. JG 12.18.07

Question:

Dr. Garcia, I had transcutaneous lower lid bleph. in 1990 which resulted in no visible improvement. Then I recently had transconjunctival lower bleph. with a chemical peel in late April 07. The results were slightly better but the Dr. said he will need to go in again on one of the eyes that has too much fat left in lateral aspect. I told the Dr. that even if he does it again I still have more bags and lax skin than the average person and he agreed that I would need skin removed in order to resolve the lax skin (which is not that bad). I am afraid to go through this another time. Would you recommend that I ask him to remove the fat through the conjuctiva again and then do a separate skin pinch procedure as opposed to the transcutaneous approach for both? I have read such negative things about the cutaneous method and am concerned because this is my 3rd attempt. Please advise if you would do this type of procedure. Thanks

Answer:

I think tranconjunctival fat and a skin pinch is certainly safe. That is what I usually do in that scenario, all the best. JG 12.14.07

Question:

I am 6 weeks post upper and lower blepharoplasty from a cutaneous approach(through the front). The surgeon also put a suspension suture to tighten the muscle and support the lower eyelid. My eyes now are still swollen, especially at the edges, with a slight upward tilt. They also seem smaller and narrow. My surgeon believes this will settle down to my normal eye shape. My question is, if this does not go back to my normal eye shape,1) will it be safe to remove the suture, 2)does scarring and retraction of the lower lid have a time span,and 3) do patients have this suture removed? thank you very much.

Answer:

if it does not go back to he normal shape the only way to get it there is to remove the canthopexy suture, and that is not dangerous to do. Scarring and retraction of the lid, if they are going to happen usually are seen within the first 6 months after surgery. There are patients that have to have the suture removed if it is pulled too tight at the time of surgery. JG 12.13.07

Question:

Hi Dr, What is the cause of purple eyelid color? I don`t mean a tear trough deformity or hollow eyes, but a permanet purple/bluish color around the eyelid. In my case it goes all around my upper eyelids and down to the corner of my lower eyelid. At times it appears darker than others but it is always there in some form. What causes this? and is there a surgical solution?Thank you

Answer:

due it the skin being thin and the blood vessels in the skin being seen as there is no fat to reflect the light off. No surigical, laser or cream solution, sorry. JG 12.12.07

Question:

Thanks for your swift answer regarding purple eyelid color! One more question on that point, you said there is no fat to reflect the ligh off of, does that mean that possibly fat grafting could help? I`m planning to have fat grafting done regardless due to my severely hollow eyes, recommended by a well regarded surgeon in my locale, could there be a side benefit of reduced purple coloring?

Answer:

the problems is the fat needs to be placed between the surface of the skin and the muscle and fat injections there can be lumpy and do not survive well so it is not a good option. Best of luck. JG 12.12.07

Question:

You`re so helpful in our quest for answers. I had asked you about the tingling in my lower lid and also asked about getting a cortizone shot where he extracted some skin on my chin. It was actually his nurse who suggested the shot, but when I got to the office yesterday, he didn`t wanted to give the shot and as far as the tinglies, he said they would all subside, tinglies and bumps on chin, within anothe 4 weeks. That puts me at just over 3 months. It was just nice to know that what you said matched what my doctor said. So, thanks! Now if I could only get me derm to be that way. Going to see a new one the 20th.

Answer:

hang in there. JG 12.12.07

Question:

Hello Again Dr...........you`ve been so helpful during this healing time. A question about swelling. How long is normal for the swelling to go down completely. One of my eyes still looks swollen on the inside corner......a bit more than 2 1/2 weeks post surgery. Thanks for your expertise!

Answer:

in 4-6 wees syou get about half the swelling down and the remainder takes another 3-4 months, so hang in there. JG 12.11.07

Question:

Hello there Dr. Garcia...........I had upper eyelid surgery about 2 1/2 weeks ago now. The doctor put in one long dissolving stitch in eacn eyelid. They don`t dissolve on the outside of the skin so he told me to go home and soak with warm water on a wash cloth and that would dissolve them and they should just wipe away and that was on my fifth day post check up. I did what he said but some would just not dissolve so I pulled the remainder all but a couple out and I think I might have caused a bit of pulling and it left a few wrinkles in that part of the incision. Now at 2 1/2 weeks post surgery there is a few hard bumps in that spot amongst the wrinkling. Will this take care of itself or should I go back and see the doctor. It is on the inside corner of my eye and shows a lot. It doesn`t look smooth like the other eye at all. I`m really worried! Could you please help me out. I`m afraid if I wait too long it will be too late to fix it and it will heal that way if it hasn`t already.

Answer:

give it some time, it will get better, I have had that happen but it will improve in time. JG 12.10.07

Question:

Good Morning.......I have a few hard bumps on the incision line of my upper eyelid surgery. The doctor used one long dissolving stitche and I think where I put warm compresses and wiped the dried blood away the stitches may have been pulled and caused the skin to pull and now the skin is wrinkled in that spot. Will I have to have them cut out and will the wrinkles stay.

Answer:

I think they will heal well in time and you will likely not need any surgery to correct it. JG 12.11.07

Question:

Good evening Dr.....I had upper eyelid surgery 16 days ago. My right eye looks great but with a little hard bump at the outside end of the incision.........and the left eye is has more loose skin in the inside corner and about three little hard bumps right on the inside corner incision line. Will these hard bumps on both eyes disappear or do I have to have them removed by the surgeon. Is there something I should be doing to get rid of them myself. And the looser skin on the inside corner of my left eye...can it be fixed to match the other eye. I am a bit concerned and hoping that I haven`t made a mistake by having this procedure done. This upper eyelid surgery was performed to remove excess skin to correct my periphial vision but I don`t feel because of that.......that I should have my eyes not look nice. Please help!

Answer:

the hard lumps are where the sutures were placed and that will all get better in time. I think the looser skin will also look better in time too. A little too early to worry yet. JG 12.9.07

Question:

Hi Dr. Garcia. Pls. allow me one more question regarding scarred muscles after repeat lower eyelid surgery: If scarred tissue allows more swelling to form and is also a cause for slower resolution (as you wrote to a patient in 2nd December) there should also be a way to `smoothen` the scarred tissue of the muscle? How would you do it? Would you also perform a canthopexy in this connection as a precautionary measure to prevent an ectropian? Thanks for your patience and your time.

Answer:

scar is scar, no way to remove it. When doing eyelid revison it is very common to do a canthopexy to avoid ectropion, correct. JG 12.9.07

Question:

Dr. Garcia, almost 2 years ago, on 2/14/06, I had bilateral lower bleph. I had asymmetrical results, the left eye came out rounder than the right. The PS performed a quick revision (20 minutes) where he made two incisions on the outer corner of my left eye in an attempt to extend the lid but I had more scar tissue and a smaller eyehole. The outer corners of both eyes have also healed upwards giving my eyes the slanted look. I want to revisit this procedure and make my eye corners rotate outwards and extend. The left lid has to stretch out more so my eye extensions are the same. Can this revision be done now? What is the risk of having the eyeholes become even smaller as a result of the revision? Will the scars be very visible and difficult to hide? Will the risks outweigh the good outcome with eyelid revision? Thanks for your time and response.

Answer:

I think enough time has passed that a revision is OK to attmept but I really cannot speak to what it would take to correect the problem without seeing you in person and evaluating the tissues. The scars will be permanent but should fade in time. I cannot judge without seeing you whether it would be worth it. JG 12.8.07

Question:

Hi Dr.G. Had repeat lower bleph 22 months ago. Still suffer from swelling in the morning and when the swelling has subseded from wrinkled skin. In addition to that there is also a clear demarcation line at the area where the skin was undermined (after swelling has gone down). I was diagnosed with a scarred orbicularis (and protruding) muscle as a result of the 2nd surgery. I was suggested to have a revision done to thin out or strip out the scarred muscle (or release the trapped muscle ) combined with a canthopexy, but I was also warned that the result could be more swelling and another prolonged healing process. My question is twofold: Is the proposed procedure for the revision appropriate and how would you consider the relation of risk/benefit of this 3rd surgery. Would it be too risky to go for it, could I end up with an even worse result? Thanks a lot in advance.

Answer:

from what you are describing I do not think further surgery will help. If you did have scarred muscle it would not get better as the day goes on, and the crepey skin comes from the swelling going down and then the skin looking the way it normally does, it is just that the swelling hides it in the morning. I will say that morning swelling from the position youy sleep in or allergies or a number of other causes will never be helped by surgery. As to the line of demarcation, that migth be helped with injections of a filler like Restylane of Juvederm.Fixing the crepey skin is difficult, can be done with laser, but lasts only a few years. Best of luck. JG 12.8.07

Question:

is the webbing or moon shaped divit in the corners of theinner eye after the upper bleph a result of too little skin being taken off, or the way in which it was done. If I pull up and out on the skin between my eyebrows it disappears. Thanks!!

Answer:

possibly. JG 12.7.07

Question:

I recently asked a question regarding the bumps at the corners of my eyes and the co2 laser, you thought a small revision might be better? Is this also for the inner corner flap of skin and the divit or webbing also? and also, would the co2 laser cause a pulled appearance by chance? Thanks!

Answer:

yes,for all of that, and as to the CO2 laser causing a pulled look, if it is done deeply it can result in that and will for sure look like that while swollen. JG 12.6.07

Question:

I had an upper and lower bleph 2 years ago. I have two little scars at the outer corners of each eye where the sutures are, and when I smile, this slightly has a crease, however, in the inner corner of each eye on the top eyelid, I have a small flap of skin that comes down and on the left eye, it looks like webbing or a divit kind of. Is their a procedure to correct this webbing look, and I had a doc say that the co2 laser would tighten the place where the stitches were, but won`t you still see the lump? Thanks

Answer:

I think revising it with a little surgery might be better than with the CO2 laser. JG 12.6.07

Question:

Good evening Dr. I am now 12 days into my post upper eyelid surgery. One side is healing very well but the other side is very tender and red close to the inside corner of my eye. The incision does not seem as tightly closed as the other........I have Triple Polysporin Ointment. Will that help in case it is getting infected and wait a few days before calling the doctor. It also says on the label that it moisturizes to help minimize the appearance of scars. And it supposed to be Vitamin E enriched and a Heal Fast formula. Who knows just how true this all is. Could I please get your opinion. Thanks for your help.

Answer:

I think that is OK to start using but I would not wait too long to see the surgoen in case you need oral antibiotics too. JG 12.4.07

Question:

Hi Dr. Garcia, thanks for ur advise. I already have two reviews after my surgery, the 1st month everything was already set & obvious that my lid is not balance one thicker den another & cos my eyes is small wen i open my eyes, the depth of the lid is not obvious is like only a slightly seen line across my eyes is it that it was not tighten enough or? i request to redo but the dr says at least must need 3 months to let my eyes set then can touch up or redo is that true? What will u reccomend, should i redo the whole thing or just touch up? What kind of touch up can be done? By adding another stitch & tightening will it help? pls list all the possible touch up it can be done. If i will to redo for all what will u advise the points we should take note on to prevent unsatisfied surgery again?

Answer:

I do suggest waiting at least 6 months from the original surgery before a revision and actually prefer one year if possibel to let the tissues soften. The touch up will likely be very similar to the first surgery, most of it will need to be done again. I think the end result will be in the surgeon`s hands and also how you take care of it after surgery so make sure you follow all instrcutions. JG 12.4.07

Question:

Hi Dr. Garcia, i just had a double eyelid surgery 2 months ago de surgery was done by cut & stitch, 2 stitches on each eye. it was say that de stitch were not be taken out & will let it heal with de tissue itself as to keep it permanent the stitch is not dissolvent is juz a normal stitch, is that true there is such procedure? after this 2 month one of my eyes has heal & the scar is not obvious but the other eyes the swelling has gone but i think the stitches knot was tie slightly thicker that`s y it take a longer time to heal but the knot has form my outer layer skin to look like a pimple & is abit harden wen i touches it. I did apply dr prescription cream like how i apply another eye but it seem no difference. Will the pimple heal & go eventually? around how long does it take to heal if it can be heal or it`ll stay harden 4 a very long time? beside applying medication, massaging with ice bag with cloth is there any other way to let de pimple gone? i`m worried pls advise. thank you.

Answer:

there is such a procedure, there are actually many variations of the procedure and many of them work well. The side with the stitch might need to have it removed and at times the surgery might need a small revision to even it out. I would cut the stitch out to lessen the chances of scarring. JG 12.3.07

Question:

Hi Dr. Will Aloe Vera juice directly from the plant help with the healing and fading of surgical scars from upper eyelid surgery. I am from Canada and Scarguard or Mederma is not sold over here. Which is better for this......Real Aloe Vera juice or 800 ui of Vitamin E oil. I am only 11 days post surgery. I`m still swelling ...especially in the morning when I wake and one of my incisions is more straight than the other....will this make a difference after I`m healed...and how long will it take. Thanks so much!

Answer:

it wil help burns or abrasions but I do not think it will fade the scars anymore than just time would. Between the two choices you are giving me I suggest the Aloe Vera as a moisturizer, the Vitamin E can plug pores at times. JG 12.3.07

Question:

Hello Good Doctor - I have researched your archives thoroughly but can not find an anser to my dilema. It was exactly 4 weeks ago that I had a lower eyelid revision. This is the 3rd time for this eye in 2 years. The first 2 times there was no improvement or change and I healed up within one week with minimal bruising. This time my incision has healed but the eye is still very puffy (not bruised though) and much worse when I first wake up- almost like edema that doesn`t go away. I do not have this problem with the other eye. I have read that bruising can last up to one month and since this time is now up I am starting to get concerned. Would this be because of all the revision surgergies and subsequent scar tissue that has built up under this eyelid? Will it improve or do I now have anothe problem I didn`t have before. My PS saw me one week ago and didn`t seem concerned. Thank you so much for your time.

Answer:

you are correct, multiple surgeries, especially in thin skinned areas like the eyelids, can result in scar tissue that allows more swelling to form and also for slower resolution of the swelling as the scar tissue impedes the absorption. I would give it time and let it go away on its own, the human body has an amazing capacity to heal itself, give it a chance. JG 12.2.07

Question:

Hi Doc, I had upper/lower trans bleph with a little CO2 lasering just under the eyes 6 months ago. Wondering: 1). How many years does upper bleph (to remove excess skin/creping) last before reappearing? 2). what about the fat pads they removed with the lower trans bleph, will they come back? How about CO2 lasering to keep the wrinkles around the eyes from returning? 3). I recently have noticed some slight scaly redness on my upper eyelids that extend out a little at the corners of my eyes. The texture is slightly red, scaly and a little like psorisis, even though I`ve never had problems with it before. Could the irritation be from the upper bleph from 6 months ago? or maybe from the Jan Marini eyelash growth conditioner? any thoughts? any suggestions to treat it? moisturizer hasn`t seemed to help much. Thanks, Doctor.

Answer:

the eyelid surgery in terms of excess skin usually would last 5-10 years and in some cases more. The fat pads removed are not totally removed and as you age and the muscle weaken, more fat might need to be removed, better to take more out later than to take too much out as it will look hollow and it is hard to correct. The CO2 laser effects might last a few years, 2-3 and not much more I am afraid. The irritation of the eyelids could be from the Jan Marini eyelash product, or a dermatitis. All the best. JG 12.2.07

Question:

Hi Dr. Garcia, I am a 42 year old male and am considering lower eye lid surgery due to the excessive amount of skin under my eyes when I smile. I am a bit afraid of undergoing this procedure due to the possible outcome. My question is twofold. Is it important to select a surgeon who has done this specific procedure on a large # of male patients? I don`t want a stretched look. Is the lower eye lid surgery less complicated than the upper eye lid surgery? Thank you for your help.

Answer:

I think experience is important and I do think the lower lids are more complicated than an upper lid surgery. I will say that the amount of skin to be removced is that skin in excess in the relaxed position, if you remove the skin in excess when squinting the removal will be too agressive and have problems. Skin removal is not the answer for thin poor quality skin, it is for skin quantity. JG 11.28.07

Question:

Hi it Linda again What Kind of touch up are we talking about? will it correct the white showing so much.or will it make it worse

Answer:

it is a touch up to lessen the rounded appearance and the move the lid up so the white does not show excessively. JG 11.28.07

Question:

Hi I had upper and lower eye lid surgery 2 months ago. My eyes are still red and the corners of my eyes are rounded. I can see alot of the white of my eye on the bottom ,and the corners are sore to the touch My doctor said he put a internal stitch in the corner, the doctor states this will heal in time and my eye shape will come back..Is this true, is there a exercise I can do to make the bottom lid go back up.I am really scared it will stay down. Thank you, Linda Griffin

Answer:

the redness is likely due to the lid being pulled down and the eyeball gets dried out. I do not think the rounded appearance will change much in the future from what you are describing, sounds like you will need a touch up possibly. JG 11.28.07

Question:

I had surgery about 3 months ago. I was wondering about the technique my doctor used. I think he used a surgical glue for the incision closure , but then i had a long suture that was knotted at the outside corner of my eye and then sewn thru to the inside corner of my eye and then the loose end was taped to my forehead. I did not have a lot of individual stitches along the incision. What purpose does that long suture play? why this method over others that I have seen?

Answer:

the long suture is used below the top layer of the skin to keep everything well approximated and then it can be pulled out and removed after it is no longer needed usually one week. It is a personal preference of the surgeon, not any better than other methods. JG 11.25.07

Question:

Dr.Garcia- What can you suggest for dark under eye circles- I have glycolic acid cream 6 %, Retina A cream 0.5 , hydroquinone 4% and Retina A micro .01? I have very daggy circles under my eyes and i am only 30!

Answer:

sorry but nothing will likely help, nothing reliable. JG 11.23.07

Question:

I asked you a few days ago about a face lift, eyes, etc and what the usual rate would be. In answer to your questions re eyes; upper/lower? Probably both. Thanks

Answer:

that would be about $13,000, all inclusive with a one night stay at the hospital and all other charges. JG 11.21.07

Question:

Hello Dr. Garcia, I had a sub-periosteal mid facelift two months ago, and unfortunately, I was unaware that my eye shape would change as a result. According to my surgeon, the change I am seeing was caused by his narrowing the palpebral fissure (I`m sure you know what this means but, essentially, my lower eyelids were pulled/tightened). When I expressed my concerns, he just replied that this narrowing was a necessary part of the mid facelift. Though I believe I should have been informed of this prior to surgery, I`m embarrassed to pursue the subject any further with him. While I realize I am still healing, it would ease my mind to know whether or not there is anything that can be done to round out my lower eyelid - should I still feel the same dissatisfaction 6-12 months down the road. FYI - I am 36 years old, so it was not a matter of tightening any loose/sagging or exceess skin. Thank you for any information you can provide. Kayla

Answer:

well, I have to say that I have not heard of palepbral narrowing being a necessary part of a subperiosteal lift, it is due to the amount or aggressiveness of the lift, and initially it can be due to swelling but you are way past the swelling stage. Hard for me to say what can be done to correct it without examining you. JG 11.17.07

Question:

Hello Good Doctor. 10 days ago I had one lower eyelid revision surgery since the first time there was no improvement. The doctor took a little more skin off the lower eyelid free of charge. Although I am still slightly swollen I do notice that a bit more of the white of this eyeball now showing than on the other non-revised side. My question is this - as time passes will this distortion and eyelid retraction become worse or will the lower eyelid skin tighten on its own and the retraction improve? I read all your archives on this but couldn`t determine the answer on my own. Thank you so much for your time.

Answer:

at this point in time it is likely due to swelling and some temporary weakness of the muscle and I feel that it will likely regain its normal position in time. JG 11.14.07

Question:

Regarding my question about laser upper eyelid resurfacing. You answered it effects could last up to 3 years. Doe sthat mean the creases in upperlid are permanent or that you would get more damage as you are in sun each year? I thought maybe the laser resurfacing could permanently get rid of crease if I stay out of sun? I don`t know if crease caused by sun or closing my eyes. Which laser do you recommend for this?

Answer:

the damage will continue to worsen, faster if you are in the sun, but even without the sun they will get worse. Nothing will permanently remove or prevent them. I would consider either a light CO2 laser or a Rhytec Portrait. JG 11.13.07

Question:

Thanks again in advance Dr. Garcia for your time. I had fat grafting (lipostructure Coleman procedure) in upper eyelids and lower. In the uppereyelids after 8 months I still have very noticable canulatracks and they don`t disappear. In the lower I have a chain of little fatpearls. Is there anything I can do to get rid of these pearls and the canulatracks. My PC suggested filling them out with microfatgrafting ?!

Answer:

well, more grafting might leave more problems, might want to consider a small nick in the skin over the pearl and have the fat pushed out. JG 11.13.07

Question:

Thanks again in advance Dr. Garcia for your time. I had fat grafting (lipostructure Coleman procedure) in upper eyelids and lower. In the uppereyelids after 8 months I still have very noticable canulatracks and they don`t disappear. In the lower I have a chain of little fatpearls which look like a scar. Is there anything I can do to get rid of these pearls and the canulatracks. My PC suggested filling them out with microfatgrafting ?!

Answer:

might consider a small nick in the skin and then try to push the pearls out. I think more grafting might make it look worse. JG 11.13.07

Question:

Hi Dr. Garcia, I was wondering if you have any idea how long an upper bleph will last using the endotines inserted into the upper brows. I know it`s a relatively new procedure.

Answer:

well the endotine is for a brow lift,not for an eyelid lift or a blpeharoplasty so they are different things, I think the endotine brow lift done through the eyelid incision might last 3-7 years or so. JG 11.13.07

Question:

I use rethin-a on eyelids for the creases. It seems to work except closer to corner of eye which I see deeper creases. Do you think laser resurfacing would be effective than retin-a? And how long would effects of laser resurfacing on eyelids last?

Answer:

I think it would be more efective and likely last 1-3 years. JG 11.13.07

Question:

I am 4 1/2 weeks post-op after having an upper and lower bleph. The upper lids look great and am very pleased. Scars hardly even noticeable even when closed. My concern in my left lower eye. It looks nothing like my right eye. There is a bulge, which the doctor says is muscle. The right eye looks great and is so smooth and pretty. I just hate my eyes look so different. I am very embarassed by it and don`t want to go out in public. Extremely depressed. My doctor is very cooperative and understanding and says he will not leave me with results that I will be unhappy with,I just need to wait for all swelling to go down before determing if a revision is necessary. I have an appt. at 6 weeks to look at what the muscle has done since my 2 week checkup. Do you think this big bump is muscle or fat? It starts at my lower lash line and bulges out. So ugly. Can a revision be done at six weeks? I`m sick of looking in the mirrow. Can`t be hidden. Also, when will the feeling of heaviest go away? They don`t look heavy, but feel it. Is that from swelling, still?

Answer:

it can be muscle and I agree you need to give it time to let it all settle down and then a proper evaluation can be made. JG 11.8.07

Question:

Dr.Garcia, I probably need a skin graft because of to little skin after blepharoplasty, I have lower eyelidretracion. Does this skin graft gives a bad and coloured scar and other skintone? Does it take awhile to heal and is it visible for some time? Thanks

Answer:

it heals pretty close to the same color if taken from the other lid, and it will take a number of weeks before it looks OK, it will be visible for at least 4-6 weeks if not more. JG 11.8.07

Question:

Hi, ( male 40) I have had something that I thought would be a lifting and some horzontal streching of the outer part of the brows, ( ``sad sam eyes``) and very moderate ( at best nothing of ..) removal of upper eyelid skin/fat.... After the operation the brow was not moved in tat direction at all, but quite much skin an fat from the upper eyelid was gone. Can still not close the one eye when I try to sleep, wakes up often because the eye opens by itself, and this is 2 years after the operation !!! It also looks not good, the eyes are more sguare and hollow, brow seems even lower, the eye area look not as a younger version of me, rather like a different person... I feel the surgeon did something quite different than was indicated at the consultation, namely eyelid operation, rather that brow adjustment. He used a procedure where he went in via incision in the upper eyelid to reach the brow.... Can anything be done here ?? I am willing to consider high cost and several procedures... That operation is probably one of the things I regret the most in my life. Sincerely, S

Answer:

if you have pictures of your before and present appearance,please send them to me at drgarcia@lvcosmeticsurgery.com so I can see what can be suggested as options. JG 11.10.07

Question:

I have undergone 2 upper eyelid surgeries and the results have unsatisfactory. I now face significant crease asymmetry. My plastic surgeon suggested removing more skin from the other eyelid (with the lower crease) even though I like the current crease height. Can anything be done to lower the crease height of the other eyelid? Will the revisional surgery be much more complicated compared to the above suggestion? Thanks.

Answer:

I think advancing the higher crease down is a better idea and should not be more complicated than the first one. JG 11.7.07

Question:

Thanks - that`s good to know. I`ll get in touch later about my facelift - mmaybe take in a week`s holiday beforehand. One more question though - what do you think about a `brow suspension through a temporal approach`. My eyelid surgeon is offering that along with my upper eyelid incision at the same time. You know I get better answers from you than the surgeons over here in Belgium Thank you so much

Answer:

I think if the lateral brow is what has sagged it is a good option, I do it when needed. Best of luck. JG 11.5.07

Question:

Thanks for your answer about having my brow dealt with first. If so should I just have an internal brow lift at the same time as my upper eyelid op? Don`t really want if I can avoid it a full forehead op. Your opinion really appreciated. Wish I was closer to you. Maybe could come and see you next year for further work I need. How long would I have to stay put if I have a facelift? Thank you

Answer:

I think it is best to do then seperately. I have my facelift patients stay here for about 10 days usually. JG 11.4.07

Question:

I am about now to have my upper eyelid incision. But I have one brow much lower than the other (about 7mm at least). Do you think that my brow should be addressed before the eyelid op? The skin overlaps more on the right side than the left? Thank you so much.

Answer:

absolutely, brows first. JG 11.3.07

Question:

I had upper lid blepharolasty one week ago. The swelling has gone down and now I see that my upper lid skin is loose and crepey on the eye shadow area. The skin is no longer plum looking as it was before. Is this due to fat that was removed ? Or from streching of the skin due to swelling ? Is there anything that can be done for this ?

Answer:

likely from the swelling, give it some time and it should improve. JG 11.1.07

Question:

Dr. Garcia,I had a scar revision 2 weeks ago on the extended cut on the corner of my left eye from lower eye lid surgery from 5 months ago. While the whole area is red,I notice the incision line is white.The original incision healed with my flesh color but had a lump of excess skin tag that really reflected the light. Now at only 2 weeks later the incision line is bright white. Is this the final look and color of it?

Answer:

no, it will get better, just too new of a scar, give it a few months. JG 10.31.07

Question:

Hi Dr. Garcia, I had lower eyelid surgery 11 days ago and my right eye is already looking slightly hollowed. I have been reading up on micro fat transfer and a Dr. here in toronto states in his article that he places the fat deep on the bone under the periosteal level just above the bone or on top of that layer for fat survival. What do you think the success rate is of this procedure? Do you think the fat will be permanent? Will juvederm or restalyn help? I can see my orbital rim marking.How long would it last and how much syringes are usually needed if I just need it on one eye? How long till all swelling is gone? Thanks

Answer:

I think it is very low, it will not survive but it will cause swelling for awhile and that will make it look better while swollen. I think Juvederm and Restylane also are difficult to get to correct over-resection of fat. The rim responds well but only the rim and it can last 8-12 months in most people. JG 10.30.07

Question:

hi again,what kind of injections do you recommend as ive heard of so many fillers .thanks

Answer:

I usually use Restylane or Juvederm at present. JG 10.26.07

Question:

hi,a have very deep set eyes and large deep round sockets as well as very dark rings,is there any hope of any kind of surgical or non-surgical treatments as this really depresses me and affects my confidence.thankyou

Answer:

I feel that injections on the lower rim will offer something but it will not correct a deep socket shadowing I am afraid. JG 10.26.07

Question:

I have a scare under the eye area cause by a cut to remove a fastoon. have used mederma, no results. tail end of scare a lttle open looking because stitch was taken out to soon. Also the fastoon is still there, but not as large before cut. Is is possible to cut over scare ? to repair scare and remove more of the fastoon. If not is there any procedure to lessen the site of the scare. thankyou.

Answer:

could cut the scar and a little more of the festoon out and reclose it. JG 10.25.07

Question:

Hi Dr. Garcia..i have milia around my upper eyelids, concentrated near the lash line.is there a treatment for milia? i consulted with a plastic surgeon and he suggested that since i have excess skin on my eyelids (i have asian eyes, very small creases),to remove some of it where the milia is concentrated.wasnt sure about that as i am worried that it`ll change how i look.do u think that suggestion is possible as a cure for milia and would the changes to my eye shape be too noticeable? thank you for your help.

Answer:

might want to se an opthamologist to have them taken care of, I do not think a blepahroplasty is indicated. JG 10.25.07

Question:

Hello, 22 days ago I had lower eyelid surgery for severe bags. My eyes are now hollow and are almost black in the hollows. Will this go away w/ time? Also is it still normal to be very sensitive to light?

Answer:

hard for me to tell without actually seeing you to determine what the cause is, sorry, wish I could tell you more. It is still normal to be a little light sensitive at this time. JG 10.23.07

Question:

To your knowledge, has necrosis ever happened due to upper blepharoplasty?

Answer:

not that I have seen or heard. JG 10.23.07

Question:

Hi! Dr Garcia, I have noticed, during researching upper blephs, that some PS do half moon incisions and some do them with wings (even for those without lateral hooding). I was just wondering why the difference in the cut. Can some type of upper incisions create a more uplifting smiley look to the eyes without canthopexy (as I already had that done last year during my midfacelift)? When I was younger, my eyes always looked smiley even when I wasnt and the brows were low. The uppers have gotten too heavy/puffy in the past couple of years...so I had a browlift, also last year, but it didnt get rid of the fat roll upper eyelid. I will undergo an upper bleph 31/10/7 (already paid for) but cannot find any info regarding the best incision to get the results I want. My PS also said that my brow could lift MORE with an upper bleph as the excised muscle would be released at bit? That surprises me as I fully expected/preferred the mid brow to lower if skin was taken away. Anyway....I will send the link so you can see how I looked at 22 and now (age 45) perhaps you can comment on what may be best technique? http://www.makemeheal.com/pictures/viewAlbum.php?albumid=828 Thanks Tracy

Answer:

the shape of the excision is actually tailored to each patietn, some peopel need different skin excisons because of their anatomy. A skin removal will not change the shape of the eye like a canthopexy can though. From what I see the blepaharoplsy is what I would do to deepen the upper lid if that is what you desire. JG 10.23.07

Question:

My husband is 76 yrs. and had a drooping lower eye lid surgery 3 weeks ago, he has a thick gel like sustance in his lower eye, it is reddish in color and goes almost up to his iris. The Dr. put him on steroid drops three times a day a week ago because he said his eye looks gel like, it doesn`t seem to be getting any better, so far has not affected his eye sight.

Answer:

it is called chemosis and will get better but it will take time, a couple of weeks at times. JG 10.22.07

Question:

Hi Dr. Garcia, I had fat implants first. Now I have the fattest face on earth but that is not the problem. I got lumps under my eyes from that and the very famous doctor would never talk to me again. My eye dr recommended another famous doctor who said he could cur ethe lumps and I wound up from that surgery with ectropion and still had the ;lumps. Went to another dr who cured the ectropion but caused imbrication or overlapping. I had a surgery for the overlapping of top to bottom with very very slightly visible results if any. Now the surgeon feels he can cure the lumps and perhaps the ovrlapping. Can you recommend a dr who you think is the best in these severe eye cases? Thanks

Answer:

where are located? JG 10.21.07

Question:

Dr. Garcia-Thank you for answering my question about lasik. I really appreciate it. I have an appointment with you next week---looking forward to it. Autumn

Answer:

see you then! JG 10.21.07

Question:

Hi Dr. Garcia :-) Do you think it is better to have lasik before upper bleph surgery or after? I would think it is better to do it before upper bleph surgery but want to know what an expert thinks. The lasik dr told me to do the lasik 1st and that the bleph can be done 1-2 months later. Thank You for your time.

Answer:

I agree, before is better. Best of luck. JG 10.20.07

Question:

Hello, I had a ptosis repair done on both eyes 7 months ago. I am happy with the improvement, but there is some slight asymetry in my left eye, could eyelid massages help at this point? I thought I read something about steroid injections, how about that? Is there anything that would help short of another surgery? Thanks

Answer:

most likely massage and injections will not do much at this point out form the surgery. Surgery is likely the only thing. JG 10.21.07

Question:

i am on my 6th day post op upper bleph and transconjunctival bleph with chemical peel. i started to notice yesterday a small round bump beneath the skin below my inner lower eyelid. it definately feels hard and i can see it somewhat when i look in the mirror. i called my ps office and the nurse told me it is probably tissue granulation. i see my ocuplastic surgeon on friday. a friend who describes something similar was put on steroid drops by her ps. does this scenario sound at all familiar and are you able to shed any light or opinion on it. thank you and i look forward to hearing from you.

Answer:

could be a small hematoma, or some granualtion tissue or some fat that is begining to dissolve, all will get better, the steroid eyerops might help a little. JG 10.16.07

Question:

I had Lasik last year, I was very nearsighted. Now my right eyelid and eyebrow look lower than the other. Is it possible that something happened due to the retractor being in my eye that caused this, or is this from being 44? I don`t see this in pictures of myself when I was younger. Aren`t I too young for this to have happened as a matter of aging?

Answer:

it is possible that the insertion of the levator muscles was stretched. An unusual occurance, yes. JG 10.15.07

Question:

What determines if a person needs canthoplexy versus just a blepharoplasty? Also, ? is transconjunctival eye surgery, and what determines its` need?

Answer:

it is determined by where the lateral lid is and also the laxity of the lower lid. A transconjunctival incision is from the inside and it will only treat the fat, no canthopexy or skin removal can be performed throuh that incision. JG 10.13.07

Question:

Dr. Garcia, I had upper and lower eyelid surgery in July. The doctor assured me the basic shape of my eyes would not change - it would just get rid of the loose skin. After waiting months for the swelling to go down, it appears the shape of my eyes did change - the outer corners now droop down, giving them unpleasant, closed off look. My eyes were my best feature, and I feel as if I lost the basic character of my face. Is there anything that can be done to correct this?

Answer:

might be able to be improved with a canthopexy. JG 10.13.07

Question:

Hi Dr. Garcia, I was noticing some puffiness along side my eyelashes on my U/lids. I am 2 months post op. Is this normal?

Answer:

still can be from the surgery, yes, will get better on its own in time though. JG 10.11.07

Question:

What is the difference in recovery time for upper and lower blepharoplasty versus face/neck lift? Is it better to do them both together? Is doing the blepharoplasty a few months ahead and the face/neck lift a few months later worth doing this way? How much more of a cost difference is this if you were to do it separate?

Answer:

about 4-7 days more for a facelift I would say. I think if they are all needed, best to do them together. It is more expensive doing them seperate, maybe more than a $1000 difference. JG 10.10.07

Question:

Hi Dr. Garcia - I`ve been using Retinol for 5 months, for wrinkles under my eyes. I also have bags under my eyes and am considering using EyeDerma (Ocupeptide-3). I may later consider eyelid surgery for both upper and lower eyelids. What non-surgical product would you recommend for under-eye bags that would not have adverse drug interaction with the Retinol? Thanks so much.

Answer:

not much that will work I am afraid. JG 10.9.07

Question:

If you have a lower and upper blepharoplasty, and the surgeon says they can pull the cheek fat up a little at the same time - what procedure is this called? What are the pros and cons? What is your opinion on this being done? I believe I read somewhere that pulling the cheek fat up with a lower bleph can pull on the lower eyelid?

Answer:

it is a type of midfacelift. I think the complication rate from attempting to lift the cheek fat through a lower lid incision is very high and I do not recommend it. You assesment is correct. JG 10.9.07

Question:

JG 10.6.07Hi Doc, thanks for your quick response. Just to follow-up about the powder mineral makeups, do you feel they provide as good a coverage as a heavy coverage liquid foundation. Seems soo hard to imagine that it covers redness, uneven skintones, flaws, etc.,with a light powder, but like you said, it`s the in thing and people rave about them. 1). Just to doublecheck, you recommended glo minerals over sephora`s I.D mineral powder ? 2). Even if I`m not pregnant yet, you still would not take the chance with using the Retina-Micro? 3). Saw that you feel the regular retina works better on wrinkles than the Retina-micro 1.0%, which I was dissapointed to see, since just filling a new prescription for the retina-micro, 1%. You had said the cream in the micro, makes it less effective? Does that mean that the micro is less harsh on your face, due to the cream in it? 4). lastly, if I had upper/lower transbleph, a little over 4 months ago to remove fat pads I`ve always had, will they ever come back? even 20 years from now? or are they most likely permanently removed, even though I will of course age on my face as I get older? if they do come back, when will the fat pads reappear? SOO SORRY FOR THE MANY QUESTIONS...thanks for answering them all. You have been a true blessing! :)

Answer:

no, I just think it is another brand, we have used it and have been happy but I cannot say it is better than any other brand. If you are not pregnant then the Retin-A Micro is OK, if you get pregnant then stop it. I think some people like the Retin-A Micro, I just have not seen any significant difference and the Micro is more expensive. Just a way to extend a patent. As to the fat removed with your blepharoplasty, that fat will not come back but not all of the fat was removed so as you age some more fat may droop or pooch out. JG 10.6.07

Question:

Hi Dr. Do you suggest massaging the lower eyelid after a transcon bleb to reduce swelling? How many days after surgery do you suggest to start and how often? Thanks

Answer:

yes, can start day 3, just rub gently up and out towards the corner of the eye. 2-4 times per day for 2-5 minutes. JG 9.28.07

Question:

Hi Dr. Garcia, I am 45 days PO from u/bleph and open brow lift. I was very happy till just a few days ago. Every day it gets worse. My scar from the bleph extends outside the outer corner of my eye. Above and below the scar looks like my skin is puffy or swollen or can even resemble a bug bite. It is very noticable. My forehead wrinkles are more noticable too now over that eye. I had very heavy outer corner hooding before surgery, thus the reason for the brow lift. It almost looks like the hooding is returning on my left eye. The other eye looks great, no visable crows feet lines. But the eye in question has the crows feet lines back. Can anything be done for this and what is my best option. thank you so much, Dianne

Answer:

I think most of what you are seeing is all the tissues getting back to normal, things will shift and move for another 4-6 weeks, just keep out of the sun, use Mederma or ScarGurad on the scars and give it some time. JG 9.28.07

Question:

For upper eyelid hollowness, where can fillers be safely injected? Along the entire bony rim beneath the eyebrows? How effective is this?

Answer:

I feel it is not as effective and it is harder to control than the lower lids but can be done. JG 9.26.07

Question:

Hi Dr. I had fat injected into my tear trough but some moved into the center of my lower eyelid area. I became round and hard. It cant be seen but I can feel it. Is there any problem with leaving this in place if it doest go away on its own? THANKS

Answer:

if it is not affecting the motion of the lid you can leave it. JG 9.24.07

Question:

I had lower bleph with canthopexy 9 months ago. I am having a chronic problem with the left eye I would like your opinion on. Every month I get periorbital swelling and numbness even to the point my cheek swells. The upper lid pulls down and it is very uncomfortable. I get put on zylet 10 days and it helps. I feel the lt outer corner pulls when I look up or to the right. I believe it is the canthopexy. Is it too tight? Suture irritation? Is this something that will resolve on it`s own or need surgical repair?

Answer:

could be too tight, doubt suture irritation this far out. Might need the canthopexy cut and released to make it better. JG 9.24.07

Question:

Dr. Garcia, I would like to start by thanking you for your prompt responses to my inquiries. I`ve written you about three times so far and you`ve been very helpful. I have a question regarding tanning after eyelid surgery. I occasionally go to tanning beds and I`m wondering the length of time before it`s safe to go again after bleph. I had upper and lower bleph. about 6 weeks ago. I was told from my surgeon it would be safe to go after about 2 months. Is this accurate or is it longer? I am aware of wearing sunscreen for 6 months and have been doing that. Thank you so much.

Answer:

I think 2 months is OK, but also wear the eyelid shields to be safe. JG 9.23.07

Question:

Dr. Garia, I had upper and lower blepharoplasty with canthopexy in mid August. I noticed that with my left eye, the fat seems to be coming back again. Not as bad as I had as before surgery, but puffy again. Do you attribute this to swelling, or did I waste all that money and the fat will just return?

Answer:

well the fat removal is all done in a conservative fashion because if too much is taken out it will look hollow, it might still be swelling at this point though, I would give it at least 3-6 months to decide if you need a touch up. JG 9.23.07

Question:

Eleven days ago, I had a lower bleph with a skin pinch and a light chemial peel. When the sutures were removed, I noticed raised red lumps/bumps on the skin surface at the beginning point and end point of both suture threads on the right and left eye. My doctor brushed off my concerns and told me it would soon go away. It has been a week since then and there is absolutely no change. Additionally, I observe that when I smile, I have many more wrinkles than I had previously...to the point of it looking like ridge/skin folds under both eyes, particularly the left eye. I am devastated at my appearance and hope and pray it is just a matter of normal healing. However, after reading many of the questions and answers on this site, it seems to me that after about 2 weeks, most of the swelling should subside. Looking for some honest answers. Please reply. I am very very upset.Thank you so much

Answer:

the irritation at the end of the incision is common due to irritation, especially when a chemical peel is done at the same time and will get better in another week or so, as to looking like more wrinkled, that is because the skin is dry and has lost its moisture, normal after a chemical peel and over the first month and some moisture will get better. I do not think the wrinkles are from swelling. JG 9.22.07

Question:

Hi Dr. Garcia, I had a transconjunctival lower blepharoplasty 5 weeks back. I get this weird feeling that my left eye is too heavy to support. What can I do to make it go away? Many thanks for answering my question.

Answer:

All I can say is gentle massage to help the swelling that is stil there to resolve. JG 9.20.07

Question:

What is the correct way to massage the eyes after blepharoplasty? Where does a person go to get lymphatic massage? What is lymphatic massage?

Answer:

some masseuses do lymphatic massage, for the eye surgery just a gentle wiping from the nose to the side of the cheek. Lymphatic massage is just a technique to push fluid or swelling into the lymphatics to get it to resorb, so the massage is done in certan directions. JG 9.20.07

Question:

Why is it not a good idea to have blepharoplasty at the same time as a brow lift? How do you determine which one should be done first, and why? I had an eye surgeon tell me that my brow is detached from the periorbital so I`m assuming I do need a brow lift too.

Answer:

well when you lift the brow it pulls on the upper lid skin so it can be difficult to gauge the proper amount of skin to remove. I usually perform the browlift first. JG 9.20.07

Question:

If your brow is detached from the periorbital, what type of surgery will correct that? Is it the blepharoplasty or the brow/forehead lift? How is the brow reattached to the periorbital?

Answer:

need to do a browlift. It reattaches at a higher level after the tissues are lifted and pulled back. JG 9.20.07

Question:

Why and how does having hypothyroidism effect the eyes? I read one of your questions about a person having undereye puffiness, bagginess, and you stated something about as long as your hypothyroidism is at correct levels? I`m curious because I have hypothyroidism, and my eyes seem to get puffy.

Answer:

the only effect low thyoird has is maybe dry eyes, because less tears are made. In some cases there is also puffiness due to edema or swelling, but that can come and go. JG 9.20.07

Question:

Hi Dr. Garcia, thank you so much for setting up this for this Q&A section.I couldn`t find any answer to my questions and have been quite bothered by them for a long time. I had a lower blepharoplasty 8 weeks back. It was done using the transconjunctival method. Two weeks after surgery, I cried and the area around my right cheekbone was puffy and appeared to be swollen. The following day, I felt something tearing apart at the inside of my right corner eyelid. The cheekbone area felt sore for about two weeks. The puffiness subsided, but now it looks as if i have a line across my bottom lower eyelid, at the top of my cheekbone. The cheekbone area seems to be raised. The curvature doesn`t look natural. And I do still have some sensation around my cheekbone and my eye twitch quite often. What happened? It is due to the crying and tear? What should i do now? Thank you.

Answer:

unusual if it was just a fat removal of the lower lid through the tranconjunctival approach, if it was something more it could be some torn stitches from the swelling that should subside, but slowly. You should probably go back and see the surgeon just to make sure. Best of luck. JG 9.19.07

Question:

Me again, the 29 year old who may need canthoplasty. I have another question - would a canthopexy be an option, too? Is canthopexy a permanent fix? Thank you so much, I really appreciate your time.

Answer:

the canthoplasty is more dramatic and more secure, which one you need can only be determined with an examination. JG 9.16.07

Question:

I am 29. My lower lids droop and I have a lot of scleral show and creases under my eyes. I want a canthoplasty but it seems like a lot of people have problems with stitches being too tight, painful, or creating bumps. Should I just forget it about this surgery - is it just too likely that I`ll have complications like this? Also, how long do the results of this procedure last?

Answer:

complications are actually not common and might be needed in your case. JG 9.16.07

Question:

I have bleophoplasty about a year ago - upper and lower lid - my eyes are still sticky(which results in blurred vision sometimes) and a little itchy still - I have been back to the surgeon but he says it is nothing to do with the surgery - is this normal

Answer:

not normal and not likely due to the surgery, might want to see an eye specialist. JG 9.16.07

Question:

Thank you for this site. I had Rhytec done on May 10th of this year and it seemed to make under my eyes more crapy. I also had a Refirm treatment and then a Titan treatment and botox.I am trying to get under my eyes smooth. They actually looked better before these procedures. What can I do?? It is possible that the acid mantle in my skin was removed by the Rhytec. The Company claims it is impossible to see a negative result, my mirror says diffently. Help!!

Answer:

well, it certainly can cause skin dehydration and the continued treatments you have done have likely not allowed it to heal, I think you need to use a good quality moisturizer and leave it alone so it can heal, I think in time it will get back to normal. JG 9.05.07

Question:

What is tear troph deformity? What does it look like. How does a person know they have it?

Answer:

it is the depression that starts at the inner part of the lower eye and goes downward on the edge of the orbital bone, it is a problem seen not felt. JG 9.4.07

Question:

Dr. Garcia, How long before all swelling goes down after upper and lower bleph. I still have quite a bit beneath where the fat pad was removed under my right eye. It`s been three weeks and it`s still quite puffy. What do you think is a time frame for all swelling to be gone?

Answer:

50% in 6 weeks the other 50% in 3-6 months. JG 9.2.07

Question:

Dr. Garcia; I am soon to be 46. I am told I look 10 years younger than I am, however I have severe undereye puffiness. Have tried numerous creams, but they either dont work or become crusty and get into my eyes. Is there some type of lyposuction or undereye surgery to remove the excess fat glands or fluid? I dont want to spend any more money on products that claim to work and dont. If so, what is the cost, recovery time and estimate lasting time of such a procedure?

Answer:

it is called a transconjunctival blepharoplasty where the fat is cut out, liposuction is not safe there, fees will vary from one surgeon to another, but it will be about $2500 or more. JG 9.2.07

Question:

What`s up, Doc? I had a handful of questions to ask you below. Thanks in advance for your time, expertise and patience. I had upper/lower trans bleph with CO2 lasering to smooth out wrinkles on 5/31 (exactly 3 months ago). Wondering a few things: 1). I definately have less puffiness, esp. in the morning upon awakening, but do malar bags at the tops of my cheekbones ever diminish from lower bleph/co2 lasering? I think you said before that some facial structures have malar bags and nothing, not even surgery can get rid of those goggle red marks/indentations at tops of cheekbones. Is this true? why do some have them and other`s don`t? 2). Still feel some fat pads under my eyes, which I thought would not be pillow like after surgery ( however, definately less). I know that my ps told me she took out a lot of fat, but do you think I still feel a bit of fat pads because she played it safe with not taking out too much to avoid the `hollowed out` look? wish she could have taken a bit more out, but maybe it would have been too risky? 3). My ps said she would submit to my insurance company to have nevi/semi clear mole removed on side of my nose that slightly sticks out when she did upper/lower/co2. however, it`s still there and even more prominent after she must have only ran over it with co2 laser. she acts as if it`s not even there by saying what mole? when I bring it up to her, even though initially she saw it, everyone else I know can see it. She hadd wanted to have insurance cover it. witout you seeing it, how do I go about the touchy subject of asking her for a free revision or more lasering on it? is it fair for her to remove it free of charge or resubmit to my insurance? what procedure would remove it? lasering or would she literally have to cut it out? THANKS FOR ANSWERING ALL MY QUESTIONS!

Answer:

Malar festoons will not be helped with the laser not the surgery of the lower lids. Some people have them due to seperation of the muscles that allows the fluid to accumulate there. Conservative fat removal is always the best approach in terms of the puffyness. As to the mole, it would rarely be removed with just the amount of lasering done for wrinkles removel, it would take much more lasering than that, I think if you can see and feel it you should point it out to her. JG 9.1.07

Question:

Dr. Garcia, I recently went out of the U.S. for upper and lower blepharoplasty to remove the bags under my eyes and a canthopexy to tighten the excess skin. It was 19 days ago. I noticed under my right eye some swelling which I hope will go away soon. My concern is the fact that my right eye looks very watery and on closer inspection I see some pinkness in the corner of the eye. It feels irritated. I e-mailed the doctor and he said what I have is inflammation of the sclera which should go away in a few days. I`m worried about this. Should I be? Is it a common occurrence with eyelid surgery?

Answer:

not uncommon and usually does go away on its own. JG 9.1.07

Question:

Dr. Garcia, I noticed that many people writing in about their eyelid surgery are not as happy as they were lead to believe. I, myself, was told that it would refresh me, and make me look at least five years younger. It`s been a month, but the horrible, new wrinkling under my eyes when I smile is still there, making me look 10 years older. I didn`t have this before the surgery, so it`s as if I paid this doctor to make me look older than my time. I`ve been very depressed - trying to convince myself everything`s okay but my spirits are sinking with each day. He`s apparently done hundreds of these surgeries and everyone was pleased - I seem to be the only one on the planet who doesn`t like her results. But who could be pleased walking into a surgeon`s office at 50, coming out looking like she`s 80? I`m afraid to smile - it`s taken away all my confidence. Are they lying to us about the possibility of these disasters? Are we all just cash cows? Some nights, I`m so depressed I just feel like dying.

Answer:

although plastic surgery results do come soon, they are not fast and at times, if someone`s skin is less elastic, the ability for it to snap back after swelling can take time. I will say that what you are seeing is not uncommon, and in time along with little things like DMAE cream or Retin-A things do get better. In rare cases if too much fat was removed that will require some skin removal or lasering to hide that, wish I had more to offer but I think you need to hang in there for a little longer. JG 8.31.07

Question:

I had eyelid surgery 8 days ago on my right eye only. Now my right eye appears alot smaller than my left. Because the incision was made right under my natural curve, I have two creases in my lid at the moment.. one from the incision and then my natural crease. This looks very strange. Will the incision eventually flatten out, and I`ll just have a more noticeable scar, rather than a crease? I`m not sure why the incision was done this way.

Answer:

I think it is too early to tell much and I feel that most likely it will all balance out as the swelling goes down. JG 8.31.07

Question:

Hello Dr. I had upper blephorplasty performed on my right lid last Thursday, and I am scared to death of what the end result will be after it heals. I know it`s only been 7 days since the surgery, but it looks awful. Not only am I not seeing any change from what it looked like previously, but in my opinion it looks much worse. Everything I`ve read on this surgery states that the incision is made in the natural curve of the eye lid, to hide the scarring. My incision was not made in that area, but pretty much between the sulcus and my lash line. This is causing my eye lid to almost look like it`s folded, making my right eye appear much smaller than my left eye. Are incisions ever done in this area? And, how can I expect the scar to heal with it being in this area? Any help with this would be greatly appreciated, as I`m very worried. Thank you.

Answer:

incisions are usually made 6-10 mm from the lashes, once the swelling goes down, if there is enough skin the incision can be advanced down to a lower site, but let it heal for a bit and see what is happening. JG 8.30.07

Question:

Thank you for taking my questions. I had fat injected into my eye trough.While the fat can be felt in th eye trough of the left eye but is diminishing, the fat moved into the middle of my right eye and turned marble hard nodule.5cm deep by 1cm wide. This has caused my lower lid to bulge and cast dark circle shadows. The Dr initially injected .4cc of kenelog 40 directly into the nodule with no effect. Now he injected 1 ml of 1/2 kenelog 40 and 1/2 5pku around the nodule. I am to return in 30 days for reassessment. Would the injection work or do i need to have it surgically removed? Can this be removed from an back/inside the eyelid cut?

Answer:

There is at least a 50-50 chance it will need to be cut out, if it is accessable it might be able to be removed from the inside, yes. JG 8.29.07

Question:

Is 1/10 of 1 cc of kenalog an ok amount to take care of terrible thick scar tissue I have in the corner of my eye after an upper and lower bleph? The scar is very thick and feels like a rope, and that is the amount I was told would be injected. Thanks

Answer:

well there are two strengths so it if it 10mg/ml that would be an OK dose but not too many times. JG 8.28.07

Question:

I have been advised to have u/l bleph with l canthoplexy, but fear that cantho is fraught with problems, i.e., unnatural eye shape, smaller, tightened appearance to eye. 1. Should one assume that one`s eye shape will change wth canthoplexy? 2. What are the indications that a candidate requires canthoplexy? 3. What is your opinion about canthoplexy? thank you

Answer:

well a canthopexy can alter the shape of the eye but it is usually done in those people where an abnormal position of the eyelid exists to begin with and we are just trying to get it back to the way it was, in those cases it should not alter the eyelid shape to something it should not have been to start with. I do it in some but not all patients as not all need it, but it is a good procedure. JG 8.27.07

Question:

I am 12 days post upper bleph and my eyes look different. My left eye has a different shape, more slanted and seems to look smaller. It doesn`t open as much.This difference has been apparent since my surgery. The left eye was more swollen and bruised after surgery but that has subsided. will they ever look the same. Thank you

Answer:

I think it is too soon to tell and most of that will all balance out in time, likely just due to swelling at this point. JG 8.26.07

Question:

Hello Doctor, I have a friend who had lower bleph surgery recently. I also had the surgery 2 years ago and the results are excellent. With my surgery, the incision was made through my lash line, which is inisible now. Her surgeon make the incision about and inch or so UNDER her lash line! This left her with a noticeable scar. Why would the surgeon cut her there????? She is african american, and it looks like she had a deep wrinkle under her eye. I have NEVER seen a bleph done this way!

Answer:

it is quite rare to do it that way for a routine blepharoplasty, I have seen a very small number of surgeons perform it that way because it is easier, in time the scar does heal fairly well but can be seen without makeup. All the best to your friend. JG 8.25.07

Question:

What is involved in a flap procedure for medial canthal scarring and protusion?

Answer:

it involves taking skin from the surrounding area and making an incision and lifting that skin and moving it over to an adjacent area, so it will create more scars than are present now. JG 8.23.07

Question:

HOW MUCH DO TEMPORAL BROW LIFTS USUALLY COST? THANK YOU!!!

Answer:

need to pick a surgeon and ask them as prices vary from surgeon to surgeon, usually a surgeon needs at least photos to detemine whether the patient is a good candidate for the surgery too. JG 8.21.07

Question:

Hi Dr. Garcia, I had a low Blephoplasty in Feb. My eyes looked aweful after because too much skin was taken off and the scaring pulled my lower lids down. I looked like a cartoon. I went to a different surgeon who tried a minor surgery to stich my lower lids up. this worked for 5 days before they pulled back down. He did a second correction surgery where he stiched the lower lids up with a permenant suture. It looked good for a week and is already pulled back down. I don`t know what to do next. Surgery is scary, causes scars, and is expensive. But I am willing to try anything to look normal again.

Answer:

well it certainly sounds like a simple fix will not work, you most likely wil need something more aggressive such as at least a skin graft along with the suspension sutures. It might also involve a flap procedure if it is able to be performed on you. Sorry to hear about the problems, JG 8.21.07

Question:

This isn`t so much a question (you answered mine earlier) as it is a general statement of thanks for taking the time to answer our concerns. Not many doctors would do this and I know the others who come to this site are as appreciative as I am, Dr. Garcia. Thank you so much.

Answer:

you are most welcome, hope I helped out. JG 8.20.07

Question:

I had a cut directly over a fastoon 13 days ago,keep tape on scare for 13 days. Procedure seem to have worked( thankyou for your previous advice) seems the last three stitches may have come out to soon, it is at this point the only part of the scare I can really see. Question: What is your advice on what to use on the scare?

Answer:

I suggest either Mederma or ScarGuard, best of luck. JG 8.20.07

Question:

Hi Doc, I was wondering how close you are to coming up with a procedure to treat the undereye area. Weren`t you working on something? thanks

Answer:

the cream is a little too irritating so I am playimg with the ingredients, maybe another month or two, as to the hollows, I am still playing, it takes time as I want to wait 6 months after each surgery to see if it works. JG 8.20.07

Question:

Help! I`m paniced and scared! I am 3 weeks post op after an endoscopic brow lift and upper and lower bleph. My right eye is healing nicely, but the left one has a problem. the lower lid is drooping open, entopion? I surgeon never told me this was a risk!It is also very inflamed, with the scar further away from the lid than the other eye. My ps put tape in the corner and told me to keep it there. Is this normal? If so how long will it take to improve? i have to go back to work next week and wonder if i need to invest in tinted glasses if a revision surgery is my only option.

Answer:

not normal and it can take 6 weeks at times to get better, I think you need to go back and see the surgeon and see what else is going on. I think dark glasses will help with the light sensitivity. JG 8.20.07

Question:

Hi Dr. Garcia ~ Its` been a while since I was on your website - I had some concerns about hollowing of the eye about 5months ago as a result of my second lower eye bleph - it`s now 6 months post op and I think, from all my research, that what I have is truly hollowing and I`m so dissapointed! I know without seeing me or a picture, you can`t tell me yes or no - but assuming my instinct is correct ~ can you tell me what do I do or what are my options for fixing this hollowing???? I also have all this skin under my eye that I thought my doctor removed??? I feel like I look worse and older than before my surgery.... I`ve heard of orbital fat grafting but it sounds new and I m afraid to go with something new... Any suggestions or information you can provide me with, I would be greatful! Sincerely, Dawne ~

Answer:

to be honest there is nothing reliable for true hollows, if it is the ridge of the bone fillers like Restylane can be used but nothing at present works well for lost fat from the orbit. JG 8.20.07

Question:

I had upper and lower eyelid surgery 17 days ago. After the swelling went down I noticed the lower areas of my eyes developing very strong wrinkling, especially when I smile. These wrinkles weren`t there before the surgery,and it looks like I have aged about 20 years. The doctor seems to be defensive and I cannot get him to say anything other than he didn`t promise me he would rid me of wrinkles. Can anything be done to correct this? I certainly didn`t undergo the surgery for this result, and am very worried.

Answer:

not uncommon when skin is removed form the lower lids, usually from the skin being stretched due to swelling and then needing to contract, it also takes some moisturizer and a little time but they should go away. JG 8.17.07

Question:

Hi Dr. Garcia, How long should I wait before I consider a revision blepharoplasty of my lower lids? I want to soften and extend the corners of my eyes which are quite slanted after the first surgery. How long will the scars be and will they be visible? I`m still suffering from bad visible scars on the left corner of my eye after the original PS attempted to stretch the left corner without even repositioning the lower lid.

Answer:

wait at least 6 months and the scars are visible for 2-6 months. JG 8.17.07

Question:

Hello Dr., I am now 8 weeks postop (remember, upper/lower eyelid, fat injections under eyes and midfacelift with enditines. The swelling I was concerned about is going down, even though left cheek is puffier than right? Question#1 there the area under my eyes are darkish , especially like a dark small long patch going down from inner eye corners down by nose, Like I have bad nights without sleep, what is this looks very ugly, people notice it and ask me If I am ill, looks like dark bags under my eyes...what is this and what could be causing this, and will it stay permanently?????? very bad dark circle look. I had a little darkish under the eyelid only when I did not sleep well(not noticeable to others), hid it with make up. But this is way worse and I cannot even hide it with make up!!!!!! please elaborate...Gracias

Answer:

cannot say if it is permanent, could be from the fat injections and the bruising it causes. JG 8.16.07

Question:

I had an upper and lower bleph in April. One of my lower lids is swollen and has a hard piece of skin inside, and it is also red. I had it removed and it came back. What is this and what can be done about this. Thank you for your assistance.

Answer:

it sounds like it could be a pyogenic granuloma and it migth need to be cut out and stitched again. JG 8.15.07

Question:

Hi,I had lower blepharoplasty 3 weeks ago for the 2nd time.18 months I had the procedure but this left a bulge under each eye,therefore the surgeon operated again, removed the fat and a little extra skin. However, although the swelling has gone every morning I wake with perfectly smooth under eyes but after about 30 mins there are 2 soft lumps just above my cheekbone. I have tried for 3 weeks sleeping on 3 pillows but they still appear. I know this is down to gravity but do you think this is fluid and how do i get rid of this for good? I can also see a definate line from the nose to outer eye, do you think this is hollowing of my eye? My surgeon says he will not operate again following this recent procedure.

Answer:

I do think it is swelling and it wil take time, avoiding salty foods and continued head elevation are about all you can do besides being patient. JG 8.13.07

Question:

I had a major overgraft of fat to my brow@ sub-brow areas, followed by micro-lipo to these same areas, as well as a ptosos repair one month later. More than one year later, there is still fat in the same areas which I can feel. The fat is distorting the crease on one eyelid. My lids are getting looser @ it feels as if the fat may finally be starting to go. Would it be best to hang in there @ let the fat slowly go on its own, rather than having it surgically removed? Can`t really have a crease revision with the fat still there. I hope that the fat isn`t permanent?..............Many Thanks

Answer:

I think if there are signs of it dissolving I would wait it out if at all possible, all the best. JG 8.12.07

Question:

Dr. Garcia, I had the fat removed from under my eyes and it all healed very nicely., However recently my boyfriend pressed his thumbs under my eyes very hard and pulled them across and down.,Now I have this nerve twitching in both my eyes., Is this eye twitching perminate and do you think It might of caused any other cosmetic dammage?

Answer:

no, just some stretching of the nerves and it will all settle down. JG 8.12.07

Question:

Dr. I just had a cut directly over a fastoon under my eye, 6 days ago. area is still puffy, looks the same Question: How long will it take to know if this procedure worked and flatend the area?

Answer:

it can take 2-4 weeks for it to settle down. Hang in there for a little longer.JG 8.12.07

Question:

I am about 9 days post-op for upper and lower bleph and endo browlift. The results of the browlift are very subtle (which is good), however, it`s painful where the tines are located. My biggest worry is that my face is still swollen and my eyes don`t look like they even belong to me anymore. Lids are swollen, incision sites are bumpy and hard, especially at inner and outer corners. My doctor promised I would still look like me after the surgery, only refreshed. The question is when?.. 4 weeks?... 6 weeks?... 6 months? I go back to work in two days and will have to wear reading sunglasses to cover all this up... it`s VERY depressing.

Answer:

should look lots better in 4-6 weeks, at this point there is still lots of swelling, hang in there. JG 8.11.07

Question:

I was using the cream for lines and wrinkels, I usually use loreal,but I have heard that it is best to never touch or put anything under the eyes

Answer:

the skin of the eyes is very sensitive and you certainly do not want the cream in the eye but if you can tolerate the creams on the eyelid skin, it is OK to use. JG 8.10.07

Question:

Dr. Garcia, Is it better to use cream or gel under the eyes or is it best just to leave them alone?

Answer:

for what are you using it and which cream or gel are you referring to? JG 8.10.07

Question:

Hi, Doctor. I had an upper bleph about a month ago. My PS is very pleased with the results but I am not. My eyes look a bit of hollow and there are no skin fold on my upper lid. My PS says that this is because of the scars. They are very tight now and this will pass after 2 months or so. But I am still worried about that. Is that really a case? Or it’s because of lots of skin or fat been removed? And by the way how long should I avoid sun exposure to my scars? Thanks a lot for your time. Kate.

Answer:

it can be the case, yes. I think avoiding sun for at least three months is a good idea. JG 8.10.07

Question:

How does a person protect themselves from having an eye lift/brow lift disaster? I saw a picture of an eye surgery gone wrong by a board certified doctor, and it has made me very leary of cosmetic surgery. Do you ask the doctor if they`ve had any bad results or complaints? Would he answer truthfully? Is there someplace you can check doctor records or complaints? I`m sure doctors have some unhappy clients, but I want to avoid someone taking too much, tightening too much that would cause a disaster, etc. How does a patient protect themselves?

Answer:

I think the question is a reasonable one to ask and you can also ask to look at pictures and speak with pateints too. The state medical board keeps a record of complaints on physicians. JG 8.9.07

Question:

Why is my recovery taking long, is it me, or is itall procedures done together?? about 5 years ago, I only had upper and lower eyelid surgery, looked very nice after 2 weeks???? what happened this time..my face looks like I gained weight and it just does not look like me under the eyes with the darkish shadows covering the lower eyelid, will I ever look normal again?

Answer:

I think it is becasue of the number of things done and you are also a little older too. It will get better. JG 8.9.07

Question:

So when the fat dissolves under my eyes, now that I had a miface lift with endotines, will my eyes (underneat), look sunken in since the upper cheek is a more lifted-chubbier???? Gross, will look distorted somewhat.

Answer:

no, at worst they will look like they used to but they might look better because the cheek tissues have been raised and are not pulling on the lower lids. JG 8.8.07

Question:

remember (I hope) that I complained of deep lines/crows feet worse now than prior to surgery, almost 7 weeks post op upper/lower eyelids and fat injections under eyes....well do you think they will get better, and when do you think I can use Botox in those areas? Also, how long will the fat injections last under the eye (still little bruised), since the fat in my buttocks all gone

Answer:

Botox in the crow`s feet is OK but I think most of what you are likely seeing will get better in time. In my experience the fat injections do not last more than a few months to a year in most hands. JG 8.8.07

Question:

Dr. Garcia, I had upper bleph. surgery about 6 wks ago Both my eyes, but worse on the left seem to have a fold of skin on the inner corner of the eye and on the outer corner of my eye the skin has a fold around it also. The scar is still slightly swollen and rounded, could this make this kind of fold? It makes my eyes especially the one look weird and for some reason my eyes look further apart on my face. Also is it safe to have my eye bows waxed at this time. Thank You.

Answer:

at this point in time the swelling can certainly do that, yes. Waxing is OK now. JG 8.8.07

Question:

will the bumpy-long incision on lower/outter corners of eyes benefit from Scar Guard or will this nothelp at 6 weeks lower/upper eyelid surgery????? crows feet deeper than prior to surgery, will scar guard worsen this????

Answer:

I do not think the ScarGuard will make it worse and is safe to use. JG 8.6.07

Question:

Dr. one more question. I had kenalog injection 5 days ago in under eye pouch. I have an appt. tommorrow to have pouch cut. Will the kenelog cause a problem with the procedure?

Answer:

nothing long term, just might need to leave the stitches in a little longer as the skin heals slower when there is kenalog around. JG 8.6.07

Question:

I had a blepharoplasty and brow lift 3 mos. ago. The recovery was difficult as I had inadvertently removed most of my sutures by cleaning and had to have them redone in the office a week after surgery. I am happy with the final results but after crying a few days ago my right eyelid has become inflamed and looks like it did after soon the surgery. Is this common? It has been 3 days and it has not gone down. I tried ice and then warm compresses....also apply antibacterial eye ointment. What do you think?

Answer:

it is common and it is temporary. Time and ice and elevating your head along with avoiding the crying and salty foods will help. JG 8.6.07

Question:

Dr. I have a pouch of fluid under the right eye, had 5ml. kenalog injection around it 5 days ago. Kenalog is not going to solve this problem. I am going to have a cut directly over pouch to flaten. My question is how long after the kenelog injection can I have this done?

Answer:

I think 6 weeks is OK. JG 8.6.07

Question:

I had an upper bleph on both eyes a week ago with a ptosis repair on the left. My right eye lid now looks lower than my left. Yesterday I thought it looked better. Is that possible? What could be causing the difference in the height of my right eye from day to day. If anything, I thought it would be raising. My left eye is also more swollen than my right eye.

Answer:

I think it is still normal swelling trying to go down, not uncommon. JG 8.5.07

Question:

Thank You for accepting me on your site. i had eyelid surgery 3 days ago as i was not liking people telling me that i look tired and I figuered i`m 55 so I had a smartlift and eyelid lift...on the inside of my right eye where the stich starts it looks like a bubble is this normal i feel like crying !! it is friday nite and i have no one to direct this question to as the weekend is here.

Answer:

all normal and will settle down in time, just hang in there for a little. JG 8.4.07

Question:

Dr. Garcia. I have a small pouch of fluid under the eye. Just had 2 days aga 5ml. of Kenalog injected around the area.At this time still looks the same, a little more puffy. made appt in 4 weeks for another injection , if needed. was told it could take a few injections to solve. My question is will this flaten the area ? If not what would you suggest ?

Answer:

I am afraid it will do little good. JG 8.3.07

Question:

I had upper bleph on both eyes with ptosis repair on the left 5 days ago. That eye looks great. My right eye now appears to be drooping very slightly. Is it from swelling or can a new ptosis develop from the surgery? Also what is Herings Law? Thank you!

Answer:

most likley swelling and the eyes trying to readjust after the ptosis repair, give it some time. Herring`s law is where the normal lid rises up to try to match the message from the brain to the ptotic lid. JG 8.3.07

Question:

So using the scar guard on my eye incisions, after lower/upper eyelid surgery is ok, no danger of anytype, wond develope rash or scar tissue? will the wrinkles subside somewhat later...now 6 weeks post op

Answer:

it does irritate the skin in some people with sensitive skin and you need to be very careful not to get it into the eyes. The wrinkles most likely will get better in time. JG 8.2.07

Question:

hello i recently saw my PS about a slight tear trough deformity , which gives me the appearance of a hollowness under the eye. i am 36.. he told me with age, this will only improve and to leave it alone, as the infraorbital fat pad gets pushed out.. yielding bags as we get older.. is this correct..? hence, he said i should leave it alone as it will improve with age.. thankyu

Answer:

boy, I disagree, I think it will look worse. May want to consider a filler for the rim. JG 8.2.07

Question:

Hi again Dr. Garcia, I saw my plastic surgeon today regarding the facial tic under my left eye, which also draws up the left corner of my mouth. He agreed with you that it shouldn`t have anything to do with my bleph, or rhinoplasty. He suggested I see a neurologist. The one both he and my internist recommend can`t see my until Septmeber. I am afraid the tic will get worse and cause damage to my facial nerve and or muscle. The stress is starting to get to me. Do you have any suggestions? My MRI did show a compression in the cervical area. Also, is there a chance that a tooth could cause such a tic? Thanks so much.

Answer:

the tic will not cause any damage besides just be a nusance, there will be no long term effect on the muscle, actually it keeps the muscle in tone. I will say that at times stress is a trigger for that tic, could try some valerian root or 5HTP from the heath food store and see what happens. If the tooth needs a root canal it could from the swelling in the bone, yes. JG 8.1.07

Question:

Hi Dr. Garcia, is eye lift surgery a good choice for hollow eyes and aorund how much would it cost? Thanks.

Answer:

the hollow eyes will not be repaired with an eyelid surgery because that does not replace lost fat. JG 8.1.07

Question:

Hi Dr. Garcia, I recently posted a question regarding a twitch of my left eye and corner of left lip. After reading my question, I didn`t think it was what I really wanted to ask. Sorry, I hope I didn`t lead you to believe my internist thought my twitching was due to my neck. She actually said she thinks my ps nicked my facial nerve during the upper bleph. I see him tomorrow and am not sure how to ask him this without offending him. I think he is an excellent surgeon and I am quite happy with the results. How likely is it that a facial nerve can be nicked during a upper bleph or a rhiniplasty, septoplasty, turbinate reduciton? Thank you for your wonderful insight and helpful forum.

Answer:

I think just telling him what you are experiencing will not hurt their feelings but those nerves are very unlikely to be damaged through that particular surgery. JG 7.31.07

Question:

HI DOC. SO GLAD YOU ARE BACK, I AM SURE THAT YOU ENJOYED YOUSELF, AT LEAST I HOPE YOU DID. QUESTION: IS THERE SUCH A THING AS JUST LIFTING CORNER OF EYE AREA, AS THEY ARE ALL THAT ARE SAGGING AT THE COTNER ESGE OF THE EYE?

Answer:

yes, there is, it is called a canthopexy and can be done but at times a more extensive procedure with eyebrow lifting is required, varies from patient to patient. I had a good time on my medical convention trip too, thanks for asking. JG 7.31.07

Question:

Hello, I had an upper bleth, rhinoplasty, septoplasty and turbinate reduction in January of this year. I had dry eyes to begin with and with the addition of restasis and wetting drops during the day, my eyes feel fine. It has been 7 months since the surgeries and I have noticed a twitching below my left eye with a slight raise of the corner of my mouth on that side. I have neck problems, but my internist thinks it may be related to my blepharplasty. I have no numbness or tingling, just periodic twitching or spasm. Do you think this is related to my bleph or rhiniplasty and will it go away. Thanks so much for your help.

Answer:

I do not think it is related to the surgery in any way. JG 7.30.07

Question:

Hi, I had a open brow lift Aug 06 followed by upper bleph surgery Dec 06 to help remove some excess skin from the upper lids of my eye which were causing my lids to go into different folds when i opened my eyes. However, one eye is slightly smaller than the other. It also feels heavier than the other eye which has been great since the operation. I am extremely self concious of this because my eye also feels heavier (as in excess skin compared to other eye) which obviously makes me aware of the situation. My surgeon carried out an small revision op and took away a tiny amount of skin - this has not helped any and the crease of the lid is very messy. My surgeon refuses to do any further work. is this something that can be fixed and would it be a small op rather than full blephroplasty again.

Answer:

I really cannto say without at least seeing some photos, please send them to DrGarcia@lvcosmeticsurgery.com

Question:

I am 12 days after upper and lower eyelid surgery. I had no vision problems until 2 days post op. My left eye developed vertical diplopia and my dr said I had a corneal infection which she began to treat about6 days ago with zymar drops. She is saying the vision problem is from the infection. I am concerned that it is someting from the actual surgery. an you comment on this csituation and offer a suggestion?

Answer:

doubtful the surgery was the casue as it would have happened right away, now if the eyelid skin was not allowing the skin to close over the cornea then maybe that could ahcve allowed the corneal infection to start. JG 7.15.07

Question:

I am scheduled to have canthopexy done on a Wednesday and my mother`s 60th birthday party on Sunday after. What are the chances that I will be able to hide the fact that I had surgery with glasses? And, is it common for the lower lashes to be shaved off prior to surgery?

Answer:

with dark glasses maybe. I have never heard of lashes being shaved off on purpose. Best of luck. JG 7.13.07

Question:

If the fat injections under the eyes are also the cause of blk/blue and a swollen puch under my eyes, are these suppose to still be there after 17 days post op (remember I also had upper/lower eyelid surgery??????

Answer:

it can be, yes. It can be like that for 6 weeks in some people. JG 7.12.07

Question:

You said the some folding of the lower lid skin could be caused by the midface lift with endotines, which is only present on the left side....if this is so will it go away,,,,,,,soooon?????? 17 days post op.

Answer:

it wil go away if the tissue was lifted aggressively and the skin removal of the lower lid was removed conservatively, as to when it will relax, there is no way to tell. JG 7.12.07

Question:

I dont know if I mentioned that beside the lower/upper eyelid surgery I had fat injected under my eyes because of some hollowness, can this be attributing for the blk/purple still under the eyes after 16 days post-up and is it still ok to use the emu oil under the eyes???

Answer:

yes, the fat injections can certainly contribute lots to swelling and bruising. Still OK for the Emu oil. JG 7.10.07

Question:

Thank you for your answer re: the visible lower eyelid muscle under my eye. You said it may not be a muscle,but if it is not, what could it be? My PS and an occular plastic surgeon both said they thought it was a muscle. I failed to ask either of them why it would be showing ....even slightly sagging. Can you answer that and can the muscle,if it is a muscle, be tightened or lifted so it does not show? Thank you so much.

Answer:

most likely it is muscle and if it is it can be consevatively trimmed, otherwise it could be a little fat, although that is less likely, or just scar tissue. JG 7.10.07

Question:

You stated it was ok to use Emu oil now (16 days posop). Can I put it on upper eyelid on incision site or just on lower eyelid, incision site and will this help the bruising/swelling I still have around the eyes and can I go out in the sun after using the oil? Also, is Emu oil good for frekles/dehidraed skin around the eyes and forehead areas?

Answer:

it is just for moisture, it will not fade the scar the way the other creams will, I think you should put sunblock on if you are going to go outside, just put it over the Emu oil. JG 7.10.07

Question:

I know you recommended mederma or scar guard for upper and lower eyelid area 15 days after surgery (still black and blue and swollen), but can I uses Emu Oil instead, would this help lessen scar tissue formation, bumps and soften the incistion site???????? can you give me your opinion, also would it help on the skin condition under the eye and is there a specific type of emu oil I should use and how often if you agree with this???? Last question, can it be used 15 days post op? Mil Gracias...Carmelita

Answer:

I think Emu oil is OK to use, yes. It will help the skin if the skin is dehydrated, no specific brand of oil though. JG 7.9.07

Question:

In reference to wrinkles/prune like under my left eye 15 days ago, No dr. They did not do any laser of any type, only upper/lower eyelid, but remember they did the midface left with endotines! still very blk/blue under my eyes??? help, what is your opinion about this...carmelita

Answer:

could just be to the lift of the midface causing somw folding of the lower lid skin. JG 7.9.07

Question:

Thanks Dr Garcia, I think you`re right I need to get my loose skin cut away to get rid of the loose wrinkly skin under my eyes. Do you know a couple of lower eyelid specialists around Los Angeles who would do a good job and they would make sure they don`t take away too much skin (if a mistake is made then not enough skin is removed instead of too little). Where the doctors could give me a really good idea of what to expect and what the final result would be after they did the surgery? Thank you,

Answer:

Due to potential legal issues, and some doctors wanting to know why I referred a patient to someone else and not them, I think you are best to go to this website and look for a plastic surgeon in the area you desire. I wish you all the best. JG 7.9.07 http://www.surgery.org/public/findasurgeon.php.

Question:

Dr. Garcia......but the bottom of the lower eyelid looks like a prune , wrinkle lines quite ugly that were not there a few days ago (remember 15 days post op lid surg.) So instead of looking better, I am looking worse!!!???? also the left side of the face is stilllllllll more swollen than the right????! Help

Answer:

did they do any laser or chemical peel to the skin? JG 7.8.07

Question:

I posted a guestion yesterday, but I can`t find it. Oh well, in short, I had a lower bleph 8 1/2 months ago and a muscle under my lower lashes is quite visible. It is thick and slightly bulging. What would cause this?.......too much fat removed?.......and would fillers help or additional surgery? Thank you so much!

Answer:

we do not like to remove muscle as it closes the eyelid, if it is close to the rim of the boney socket it is likely not muscle though. Taking fat out should not affect the muscle being seen. Fillers might help camoflauge it, yes. JG 7.8.07

Question:

Hello Dr. I am now 15 days post op endoscopic brow lift a) I just realized while washing my hair that the nurse left a staple in one of my temples, is this bad and will it open incision while getting it out after so long? Also had upper/lower eyelid surgery.....my left side which is still very swollen and different from my right (as previously mentioned to you), underneath the lower incision of left eye, many tiny wrinkle are starting to appear, which I did not have before.....it looks awful (I look like an old lady without surgery)....Can You explain to me what is this and why and will this go away????????

Answer:

no worries, just get it taken out this coming week. There can be some little wrinkles from the skin re-attaching and that should all get better. JG 7.8.07

Question:

Hi again,Doc. Wondering what the difference is between lower trans bleph versus the standard lower bleph? Is there less down time with the trans bleph? how does a ps determine which is needed. I had the lower trans bleph 6 weeks ago. Also, what do you recommend for stimulating eye lash growth? Does anything actually work to make them grow longer and/or thicker? Do facials at your ps office help with post surgery healing or do you need microderm abbrasion, IPL, etc? THANKS!

Answer:

no down time difference to speak of, the bigesst differecne is the traditional blepharoplsty is done with an outside incision so skin can be removed where the transconjunctival bleph is from the inside and therefore no skin can be removed. JG 7.8.07

Question:

Hi Dr Garcia, I had a lower eyelid surgery a few days ago to remove my eyebags. The recovery seems fine except for alot of redness in my right eye. There is no pain at all, but the redness has actually been spreading and not diminishing as the days go by. Does this mean that the wound in my right eye is still bleeding? I am worried that this will lead to complications e.g. blindness.

Answer:

no, it is a common thing as the blood leaves the eyes slowly, it is a matter of time. I would not worry about blindness though, just hang in there. JG 7.5.07

Question:

Dr., Thanks again for your response. The cut was directly over the fastoon.Months have gone by and the pouch was still there. Another Dr. tighen the skin under eye to flaten area It does look better, but there is still a pocket of fluid under the eye. Dr. said the last resort is to use cortisone. What would coritsone do to this area?, flaten just temporarely? Dry the fluid under the skin? Or would coritsone make a worse problem?

Answer:

Cortisone will do little good, it sounds like you need more cut out. JG 7.5.07

Question:

Dr. thank you for your first answer to my question. The pouch , ues is a festoon. It has been cut once already, still there. then had skin tighen to try to flaten the area, pouch still there. My last resort seems to be a cortisone injection to this area. Does coritsone dry the area. will it just come back?. or will it Finally solve my problem?

Answer:

Cortisone will not remove the festoon. In terms of cutting it, I mean a cut right directly over the pouch, not a lower eyelid incision far away and then an attempt to pull it up, the scar needs to be placed right over the festoon. JG 7.4.07

Question:

Hi Dr. Garcia - Is there any type of surgery to correct under-eye hollowness? Would a mid facelift help? I had Juvederm done in February which has made a great improvement, but I just was wondering if there is something more permanent. I understand Sculptra is not an option because the skin is too thin under they eye area. Thanks.

Answer:

no surgical correction at present. I would stick with the Juvederm for now. JG 7.3.07

Question:

I have a pouch under my right eye, mainly looks like fluid, my skin is tight I have had both upper and lower Blepharoplasty. Just recently had lower under eye skin tighten , centroplex. Still the pouch, fluid is still there. I am now considering having a cortisone injection directly into the area. What are your thoughts on this? Will this procedure finally solve this problem?. Will it flatting this area? What is the side effects ?

Answer:

I do not think it will help, it sounds like a festoon and it might need to be cut out directly. Cortisone can cause tissue loss of the normal areas around it. JG 7.3.07

Question:

Hi Dr. G, 1 month post upper/lower trans bleph and Co2 lasering and counting... Just wondering... 1). Are you familiar with or recommend Dermatolgica-sheer tint redness relief that comes with free gentle soothing booster to reduce post co2 lasering redness? my ps encouraged me to purchase it from her and not sure if it`s helping me? 2). Does Mederma help with fine wrinkle-like deep line under both eyes where the laser ended? does mederma also help reduce overall redness under eyes from post c02 lasering? 3). can a lower trans bleph take away fat pads under eyes, but still leave some puffiness, due to fluid retension? I was naive enough to think the fat pads being removed would be enough? any suggestions to reduce fluid retension puffiness still under eyes? my eyes look much better (esp. in the morning upon waking) since the lower trans bleph, but fluid retention still bothers me...is the fluid retentions hereditary? 4). Can I put Retin-a and Hydroquinone on my hyperpigmentation/melasma at the same time? if not, which goes on first and how long to wait to put on the 2nd one? if you peel from the micro retin-a 0.1%, does that mean it`s working if flaking/peeling a little? why do you peel? thanks!

Answer:

I think the Dermalogica product is OK, but not totally effective for all patients, might need to try some others, including Dermablend. Mederma will help with the tissue healing but will have little effect on wrinkles I am afraid. It does help with redness though. I think in terms of fat removal, we are always conservative as too aggressive of a removal can be nearly impossible to correct. At this point I think it is still mostly swelling though. If you had periods of swelling that came and went prior to surgery, that will never be improved. Fluid retention is partially genetic but it is also environmental in terms of allergies. I think you can use the Retin-A and hydroquinone on the non-treated hyperpigmented skin but not on the lasered areas until healed. I usually have the patietns mix them on their palms and then apply it to the skin, equal amounts of each. The peeling does mean it is working and it flakes as it breaks the bonds between the superficial epithelial cells causing them to exfoliate to flake off so new skin cells can surface. JG 7.2.07

Question:

Hello Dr. Garcia: hope all is well......10 days post op bilaeral upper/lower eyelid surgery. I see deep incision scar healing and on the lower eyelid, below...some like cuts/scratches (seem somewhat deep) what can I start putting to vanish scars. I dont want to be left with scars....my freckles are bad enough...Thank you (I do have somewhat sensitive skin)

Answer:

you can use Mederma or Scargurad, just to not let it get into your eyes is all. I will say that they will help but you will always have scars, they will fade in time though and be barely visible in most cases. JG 7.1.07

Question:

Good Morning Dr. I went for my post-op visit to check my bilateral upper/lower eyelid surgery...(9 days)my ps said my eyes look well (although I see them terrible), he placed a piece of tape under my eyes, pulling somewhat uppard to the sides..he said to keep this as much as possible. Can you explain to me the reason for this and what is your opinion about it. (he was in a hurry and I was not able to ask too many questions)...Thanks a million!!!!!!

Answer:

that is done occassionally if the lower lids are swollen and need a little support to pick the skin up and lift it so it lays against the eyeball and protects the eye from getting dried out, it should not have to be done for very long. Best of luck. JG 6.30.07

Question:

Hello Dear Dr.....well, today the swelling is starting to go down (from midfacelift with endotines, upper/lower eyelid and endoscopic eyebrow lift 6 days) I am a little concern about how tightttttt the area around my eyes feel and my upper cheecks, the right eye is even a little hard to close and have to constant keep blinking because i feel the need to, somehow it feels abnormal ....could the endotines be causing this or is this solely related to the upper/lower eyelid surgery???????? Gracias...Carmelita

Answer:

no, just the swelling. JG 6.28.07

Question:

Dr. Garcia, remember 6 days post up upper and lower eye surgery, should I keep rinsing incision areas, how often with peroxide and bacitrin ointment..??? if so how often, or do you recommend I leave them dry, leave them alone???? still feel very tight around the eye areas! Also, Stitches around the eyes will be removed tomorrow Friday....if they bleed do I just leave them alone or what do you recommend I do afterward....Thank you very very much for your direction and time...God Blessssssss Carmelita

Answer:

just twice per day is all on both. If the incisions bleed after the sutures just hold a little mild pressure and it will stop, nothing else needed. JG 6.28.07

Question:

I have olive skin and dark circles under my eyes. I was told a lower eyelid surgery might make my eyes look sunk in. I only have alittle fat under my eyes. Would you recomment lower lid surgery? One dr recommended co2 feathering laser. I`m concerned about the laser with my olive skin, but will it make the darkness look better. Also, is it true you will never tan where you are lasered?

Answer:

I think laser on olive skin is risky and a removal of lower lid fat will make the dark circles worse. There is a small possiblity the skin that is lasered will not tan but a greater risk is that it will get darker. JG 6.28.07

Question:

Dr. Garcia- Thank you for the quick response related to the canthopexy, ear lobe reduction, etc... Can you tell me if it is possible to do the canthopexy incisions INSIDE the eyelid vs. outside? I am finding that some doctors are doing that. Thanks.

Answer:

only from the outside I am afraid. The internal one is more for prevention than treatment. JG 6.27.07

Question:

Hi Dr. Garcia, I never knew what they were called until your last posting concerning malar bags, but I had upper/lower bleph and CO2 lasering almost 1 month ago and there is still puffiness at the top of my cheeks, combined with it being red still from the lasering (I had it before surgery, but now it looks worse since the lasering redness)..will the natural healing process get rid of redness and minimize the malar bags when not as red anymore?. questions: 1). Are malar bags stubborn and hard to get rid of? will chemical peel, IPL or YAGAR helpful to dimish malar bags? what will in your opinion? 2). although everyone`s healing is different, what`s the quickest you`ve seen someone`s redness subside from lasering..what`s the longest? permenatly or up to a year? I`m worried, since I`m still pink/light red with blotchiness under my eyes with melasma and 1 white spot under each eye left from laser healing. Will Retin-a or hydroquinone make the white spots worse by bleaching them or not? THANKS FOR YOUR TIME AND PATIENCE AND HAVING ANSWERED OTHER QUESTIONS OF MINE. :)

Answer:

in time the redness will get better, yes. The only good solution for malar bags is to cut them out, the methods you suggest I feel will not help. As to the redness, it greatly depends on the type of laser used, your skin type, and how deep the treatment was done, so no way to tell without knowing all of that. I would not put bleaching cream on the white spots. I have seen the redness take up to one year but it is usually gone in 3-6 months in most people if it was a CO2 laser, best of luck. JG 6.27.07

Question:

regarding the extended lower bleph for malar bags. From what I am told, I do have true malar bags (puffiness on the cheek bone). By lifting up the skin on the outside corner of my eye, the bags go away, so I assume that`s what he means will happen with the lower bleph.

Answer:

all I can say is good luck and don`t be surprised if they do not go away, but you might get lucky. JG 6.26.07

Question:

Thank you for your prompt reply. I have blink that I use when I wear my contact lenses. Do you think I can put that in my eyes at this time (will not burn or harm the incisions)? Also, if it is the protective ointment how is that removed. I have already been letting water run down my eyes when I shower in hopes of blurriness subsideing, put still present, especially on the right side. You are so kind to reply with such promptness. God Bless. Carmelita

Answer:

I think the blink is OK to use, yes. If it is protective oitment it needs to dissolve on its own I am afraid, no way to get it out. Hang in there. JG 6.25.07

Question:

Hello Dr. Garcia, I am impressed with the time you dedicate to people like me that have questions and need real answers. 3 days post up lower/upper eyelid surgery and endoscopic mid face lift; my vision is very blurry what care do I give my eyes at this time and myface swelling has gone down to my upper neck area and now greenish bruising that I did not have 3 days ago. Help is this normal? Carmelita, who admires your caring

Answer:

well the green is normal brusing resolving, as to what is affecting your eyes, it could be a reaction from protective ointment put into the eyes at the time of surgery, it could be due to abnormal tightening around the eyes not allowing the fluid of the eye to drain properly. I would use some eye drops to moisturize and lubricate your eyes and if not better in 2-4 days I think you should see an eye specialist, all the best and thanks for visiting. JG 6.25.07

Question:

I had a lower blepharoplasty done by you about six months ago, and love the results. But just in the past two weeks, I`ve developed a twitch. My right lower eyelid has spasms. Will this go away, or is there anything I can do to correct this? It`s not painful at all, just annoying a bit. Thanks, Doc. DFW 6/25/07

Answer:

most likely not related to surgery and most likely will go away on its own in time. JG 6.25.07

Question:

My doctor swears that he can get rid of my malar bags with an extended lower bleph. He also wants to remove the fat in the lower eyelid but I hear too many bad stories about it leaving a hollow look. Should I be concerned?

Answer:

I would be concerend, ask him if he will refund your money if they are not gone and see what he says. If they are true malar mounds I think it will require more. JG 6.25.07

Question:

I had eyebrow lift and lower and upper bleph four weeks ago. I don`t know which of the surgeries may have caused this, but my left eye won`t blink hardly at all and much slower than the right. It also curves up more on the outer corner (upper lid) than the other eye. I do still feel a little sore. Do you think there is still time for this to correct itself or should I be worried? Also, on that same eye in the corner of the crow`s feet area, there is a little bump that is not going away. It feels like something hard is in there. Will that go away any time soon or should I be worried about that too? Thank you so much for your help.

Answer:

I think it will still settle down in time. The bump could be a stitch, may want to show it to the surgoen. If it is it can be taken care of easliy. JG 6.13.07

Question:

Hi Dr. Garcia. thank you so much for your website. It is very helpful. I am thinking about having a canthopexy procedure. My surgeon would like to do this in conjunction with laser resurfacing under my eyes. He said that he would insert stitches in the corner of my eyes, with no cutting of the tendon. Does having laser in conjunction with the canthopexy increase risks of scarring or residual redness due to swelling in the area? Would you recommend having them done separately, or do you believe it is safe to do both together? Thanks again.

Answer:

the canthopexy will not affect the redness from the laser or increase any risks from the laser. I think both procedures can be done at the same time safely. JG 2.2.8.07

Question:

Dr. Garcia, I had a canthopexy procedure about one year ago. My sutures have been very uncomfortable, and my surgeon removed one of them back in July. I also had laser resurfacing done under my eyes, and had a lot of redness and inflammation from that fora very long time. The skin under my left eye swelled quite a bit, and seems to have become looser since the stitch was removed. I would like to have the second stitch removed soon. My question is how the skin may be tightened, non-surgically, if possible, under my left eye. My surgeon said that Thermage or Titan might be used, but not for a while, as the skin is still healing. Is there anything else that you would recommend?

Answer:

I do not think anything but a true laser will tighten the skin and you have aleady had problems there so I would be cautious. JG 2.27.07

Question:

Hi Dr. Garcia - And thank you for your site/service.... I have recently just had a second lower eye bleph (post op almost 3 weeks) and pretty much I believe all is going well - bruising is still visible but fading....and same with swelling. However, I noticed (as someone else mentioned on a post) that the corners of my eyes pull when my mouth is opening to say eat an apple and I asked my dr. and he said that it is normal and that it is the scar tissue that builds up right about this time post surgery and that it will eventually lessen, fade and get better with time.... My question to you is.. 1. Do you agree? and 2. Do you believe there is a bad risk for more scar tisse or a bad buildup of scar tissue which will stay permanately BECAUSE this is my second time doing the surgery in the same area???? Thank you so much and I look forward to your answer..... I do want to say I love and trust my surgeon 100% - it`s just nice to get a second physicians opinion..... Dawne

Answer:

it is not scar tissue but the swelling that has extended to the cheek to a mild degree and hwen then muscles move, since they are swollen, they pull on the lower lid, he is correct that in time it all gets better. JG 2.24.07

Question:

Dr. Garcia, it has been a year since I had my lower blepharoplasty. I am contemplating a revision, i.e. I want the corners to come down and the left eye to extend a bit more. What other complications are associated with revision bleph that are not already seen with the original surgery?

Answer:

pretty similar to the first I feel. JG 2.22.07

Question:

Hello Good Doctor. I had a second lower eye bleph reviosion done 6 weeks ago on my right eye. Once again the initial results looked very good (I guess I was still swollen) but now I once again notice no improvement. I keep a detailed photo album of my progress and based on my first lowere eye bleph surgery I don`t expect much more improvement at all 6 weeks later. I did go to see my surgeon and even he seemed disappounted in the way the eye turned out (It still has a fine wrinkle bag under it). He wants me to come back after six months and mentioned he could always take a bit more skin (He is he cautious sort). Do I just have really bad skin quality or would more drastic measures be needed on this stubborn lower eye area (such as laser?)

Answer:

rally hard for me to say without seeing you , but I think waiting 6 months, at least, is a good idea. JG 2.20.07

Question:

Hi Dr. Garcia..Its me again..What specific kind of laser treatment can you recommend for hollow eyes and crows feet?Thanks.

Answer:

for crows feet either a CO2 laser or a Rhytec Portrait, no laser wil fix hollows. JG 2.19.07

Question:

Hi Dr. Garcia it`s me again.. I asked you yesterday about multi-yag laser if its an effective treatment for hollow eyes and crows feet and you said no.. But will it somehow improve the appearance of hollow eyes and crows feet after series of treatments?..Thanks..

Answer:

sorry but no. JG 2.18.07

Question:

Dr. Garcia is multi-yag laser treatment an effective treatment for hollow eyes and crows feet? Many thanks.

Answer:

no. JG 2.18.07

Question:

Dr. Garcia, Thank you for your candid quick response. I will probably ask for the lower bleph like you suggested instead. I am doing TT at the same time, so I will have enough to deal with, I`m sure. Another note, Upper bleph, if done in the hands of a good surgeon, does this procedure yeild good results? Or should I can that one too. My eyelids only need small ammt of skin removed, as my Doc stated. Thanks!!! ....k

Answer:

I think in general upper eyelid surgery is a great operation. Best of luck. JG 2.14.07

Question:

I had upper and lower eyebag surgery with laser resurfacing under my eyes 18 days ago. After about 1 week I noticed that when I fully stretched my mouth, for example to eat an apple, the lower outside corners of my eyes, more noticably my left eye, drooped slightly. I think it is getting a little bit better but it is still noticable. Please can you advise me if this is common and, more importantly whether it will correct itself naturally? If so, do you have any ideas how long this might take? If not, si further surgery required to correct this? Thanks

Answer:

common, normal and will get better as the tissues heal, give it a little time. JG 2.10.07

Question:

Dr. Garcia what type of procedure can you recommend for sinking and wrinkling around the eye are including crows feet to tighten my skin? Its like there`s a hole below my eyes...Around how much will it cost? Thanks.

Answer:

I suggest Rhtec Portrait or a CO2 laser, fees for the Rhtyec Portrait would be about $1250. JG 2.9.07

Question:

Dr. Garcia is TITAN Procedure effective in remowving wrinkles around the eye area and crows feet? How much does it cost? Thanks.

Answer:

I do not perform it and am unimpressed with its ability. JG 2.8.07

Question:

Hi Dr., I had a canthopexy procedure performed about 8 months ago, and I`ve noticed that one of my eyes twitches a lot. It happens practically every day now. What do you think is causing this? Is it that the stitch it too tight?

Answer:

it can be some of the nerves being caught in scar tissue and irritating the nerves that go to the muscle, not much can be done except massage and time I am afraid. JG 11.30.06

Question:

was wondering if phosphatidycholine injections would help improve fat injections that have lumped and hardened in the trough of the eyes.

Answer:

I seriously doubt it. JG 11.29.30

Question:

Hi Dr. Garcia. I previously asked you about releasing the stitches from a canthopexy. My surgeon released the stitch from one eye but not the other, which still hirts 7 months after the procedure. Does your office do this, and if so, what would it cost (for one eye)? Is it possible that releasing the stitch would cause greater asymmetry? Perhaps I can send you a photo. Thanks very much.

Answer:

releasing the suture can cause some asymmetry, yes, the fee would be $2650. Please sned a photo to drgarcia@lvcosmeticsurgery.com as that would help me tell you more. JG 11.27.06

Question:

Dr. Garcia, I sent you a digi pic a few weeks ago. It is about my lower left lid malposition, it is quite high even after one revision. I`d like a second intervention to rotate the lid downwards and extend so it is symmetrical with the right lid. How much will it cost me to get it done at your office? It has been 6 months post revision but I still have a deep, dark revision scar. How long before I see you for the actual procedure? Thanks for the reply.

Answer:

please see adjacent answer

Question:

I had a lower bleph in march 2006, I have huge bags under my eyes, like on my cheek bone, I think they are what you call festoons, I want them gone, can deal with a scar better. How much does it cost to remove.

Answer:

price will vary but about $350-500 per side, depends on the size, if done under local anesthesia only, in the office. JG 11.26.06

Question:

Hi Dr. Garcia, I hope you had a nice Thanksgiving Day. You and your website are one of the things that I am thankful for. I had one revision of my left eye following lower blepharoplasty. There was still lid malposition after the revision and I had a deeper, darker revision scar after six months. Will the scar lighten and soften eventually? I want to have a second intervention to rotate the left lid downwards and extend so it becomes symmtrical with the right lid. Should I wait until the scar fades and softens before considering another revision? Thanks for your reply.

Answer:

yes, the scar will soften and lighten but it might take up to one full year for it to fully mature. I think waiting for the scar to soften will allow the greatest amount of motion and make it easier to perform, so I would wait as long as you can. JG 11.26.06

Question:

Dr. Garcia, Five weeks post up....lower Bleph...I have raised, thick flesh colored scars..not Keloid, I dont think...lower lids are not swollen, actually tight. What specifially causees these scars to be like this and what can be done about them. I know a number of my Dr.`s patients are getting Kenalog injections without a lot of success. Thank you for this service.

Answer:

well I must say that is highly unusual, especially on the eyelids, I think a visit to your surgeon might be the best and it might require steroid injections but agian, those should be rare occurances. JG 11.26.06

Question:

Hello I am the lady with the blepharoplasty and mid face lift problems. I would like to ask can it be undone. Can the obicularis muscle moved to my orbital area be detached from there and just put back? I hate my rounded eye and the awful sceral show. I just want my old face back. If you have had significant skin removal what happens if obicularis is put back in original position. My ps says canthopexy not a good idea as support is to weak. He just wants to redo lift. I desparately need advice.

Answer:

well although the tissues can be released, if too much skin has been removed, that can only be put back by adding skin, that means skin grafts and they will never look like the original skin. If you have scleral show a canthopexy is almost always a must, the midfacelift tissues will not correct that. JG 11.24.06

Question:

hi dr garcia its me again the woman with perlane under the eyes, the lumps seem yo be dissolving into one big lump under my lash line, could it be filler not draining properly as my bleph are lower down than normal?. you said it was to high up to be a festoon, what is a festoon? the surgeon is still not sure if it is edema but has agreed to give me the solution to try and dissolve it, but is not sure it will work. he says it is not draining because of my scars being low. i value your opinion thank you

Answer:

a festoon is a little area of swelling that occurs where the muscles of the lower lid end and the cheek tissue starts. I think that incisions on the lids might affect the draining some, so let`s see what the doctor can do with the injections. JG 11.24.06

Question:

Dr. Garcia - I had lower bleph and septo/rhino at same time. Now have problems with my eyes. Whenever I blink, my eyes have to correct themselves. One has to go up a bit, and one goes down a bit. This makes me dizzy and I need to see someone about it. My question is this: what is this phenomemon called and which medical specialist do I consult about it? Thanks so much for your time in reading my question. I`m anxious to get going and see someone about this.

Answer:

I would see an eye specialist, it might just be swelling in the muscle of the eyes that will get better in time on its own. JG 11.24.06

Question:

Dr., I previously asked you about removal of sutures from a canthopexy procedure. I saw an occuloplastic surgeon for a second opinion, who said that I should leave them alone and wait to see if they loosen at all. The sutures are very tight and uncomfortable. After about 8 months, they still hurt when I blink, and often throb or twitch . Does this mean that they are loosening? You said that it is not a simple procedure to have them removed. What complications can result and how often have you seen them happen? I don`t know what to do at this point, as I am concerned about having them removed. Thanks so much for your time.

Answer:

the throbbing and twitching do not mean they are loosening, no. As to removing the sutures, what can happen is that the lid will not be in the correct position and might bow downward. JG 11.23.06

Question:

hi, i`m a healthy active 36 yr old woman, and i`m 12 days post upper/ lower bleph plus co2 resurfacing on my eyelids and forhead. rough first week due to crazy reaction to steroid treatment post-op. i lost a couple of nights sleep and had some hallucinations. weird, but i was aware of what was happening. i have been taking ambien for the past 5 nights and am feeling more and more rested and my skin and eyes look great. for skincare i am using obagi gentle cleanser, then skin medica TNS rec. cmplx, plus obagi healthy skin spf35 during the day. do you think, if i wear sunglasses and a hat, i could get out & walk for a little exercise each day...of course not overdoing it?

Answer:

sounds like a good idea, best of luck. JG 11.22.06

Question:

Dr.Garcia, know this may sound stupid,But with a transconjunctival bleph. and removing the fat pads only on the lowerlids;where is the repositioning of the fat on the eye that was taken out? Also, is still possible to have swelling on my eyes as I`m 6 weeks post op.I still feel the numbing, but have noticed that I still have some swelling on the upper and lower lids. Thank you!

Answer:

well, if the fat is removed, it cannot be repositioned, it is one or the other. There can still be swelling at 6 weeks, yes. JG 11.21.06

Question:

Thanks so much for your quick response. Another problem I have after the lower bleph (conj.)and laser is I`ve still got a small pouch under my right eye. My cosmetic derm. said I could have a cortisone injection right in the pouch which might diminish it. That scares me to death! What are your thoughts? I`ve had cortisone injections for other reasons in my rear end and it`s left an indentation. Thanks again.

Answer:

I think I would wait it out, I only use cortisone shots, especially on the eyelid in severe cases and it is not very effective if it is residual fat that is there. JG 11.21.06

Question:

Hello: I had erbium laser done on my lower eyelids 14 months ago. I`m 38. The healing time was outragous, 8 months. Now, the right side of my eye where my crows feet are (upper cheek) are much more prominent than my left side. A cosmetic derm. gave me some samples of Retin-A micro gel to use daily on the crows feet. I`ve used Renova 0.05% for a couple years which I loved. Do they still make it? I`ve read the gel is only for acne. Is that correct, or can I use it on my sentitive skin in the eye area? Also, I`ve got hyperpigmentation on the left eye around the crows`s feet. Any suggestions?? The Dr. only game me sunscreen. Thank You.

Answer:

They still make Renova and the gel is more commonly used for acne as it is alcohol based and helps a little more with acne than the cream based. I am sorry to hear about the problems with the erbium, your healing time is highly unusual unless a deep second degree burn occurred. I think for the hyperpigmetnation I suggest mixing the Renova with some 4% hydroquinone to help fade it, and continue the sunblock, not sunscreen. JG 11.20.06

Question:

Dr.Garcia,I was wondering if it was normal to get a small like white pimple in the corner of your upper eyelid as my eyes are coming down more from the swelling and numbness of a bleph....I`m 6 wks post-op. Thank you

Answer:

not unusual, it can be where the sutures were and some warm moist heat should help them open up, not a long term problem. JG 11.20.06

Question:

What is arnica montana? How does one take it and what is it used for? I have seen this on other sites before. I was never informed about this by my ps.

Answer:

a homeopathic material used to decrease swelling and bruising. It is not a prescription medicine. JG 11.19.06

Question:

Hi Dr. Garcia., I am 20 weeks p/o u/b. I have pains in the outer corners of the eyes and it appears to be that the absorbable stitches used caused some kind of reaction, which my 1st ps should have noticed because not only did they not completely absorb but now are causing irritation in the upper lids and redness and scarring.He also removed too much on one eye and not enough on the other giving me a sleepy look on one side of the face. I was told by my new opthomologist to speak to another occouplastic surgeon because the stitches might have to be surgically removed and then another surgery performed on both eyes. the right upper lid is extremely uncomfortable. is it possible that the absorbable sutures did this. I know that silk was used inside and I feel pinching in the eye too. surgery was performed on the eyes at 1 week apart, different place, how many different brands of absorbable sutures are there? Thank you in advance

Answer:

there are many different brands of absorbable sutures and they can at times cause a level of inflammation, I agree that more surgery might be needed. JG 11.19.06

Question:

I posted a question and I see you have answered others but not mine. Maybe a problem with the email??? There is an answer under my question but not the answer to my question. I started my question, I was referred by Dr. Steven Cohen of San Diego. He said you know each other and said if I needed anything to contact you. I wont type the whole story again unless you cannot find my original one. I think I need a cortisone shot and can you do it after two weeks of a revision. I will re-type question if you cant find it. Thanks. I want to make an appt with you but dont know if I should wait a few weeks.

Answer:

please call and make the appointment with my office. I am unsure what may have happened to the email except if you posted it on the agelessforever.net site and it pertains to plastic surgery it got transfered to my plastic surgery site at lvcosmeticsurgery.com. JG 11.19.06

Question:

Sorry, I see my question went through twice. Maybe I posted my question after you were through answering posts yesterday. I think I need to be a little more specific as to what my problem is. Dr. Cohen did lower face and another doctor did mid-face and several eye procedures. Because I developed bumps on upper eye incisions he excized them and at that time removed some of the fat pad in corner of eye that was still remaining from 6/06 procedures. This was done two weeks ago. I saw the occuplast last week at two week mark since he was in LV for a conference and I now live here. Under the small, about 1/8 inch, incision that he made to remove remaining fat pad, there are a few bumps even though no stitch was made. He used glued because of my problems with bumpy incisions. Also as mentioned before there is a web type piece of skin going from upper to lower corner of eye. He said it is still swollen and will go away but he would have given me a shot of cortisone if we were in San Diego. I assume Kenalog. I want to get it done now, I have been looking bumpy since 6/06 and want to stop wearing sun glasses. Can I come and see you now or should I wait. He said it would be better in 3-4 weeks, 3-4 months for complete healing w/o the cortisone. I would appreciate your advice.

Answer:

I think we can do it now, please call the office at 870-0058 for an appointment and we can do it in the next week or so. JG 11.19.06

Question:

Hi Dr Garcia, I am a little over 2 weeks post bleph. My left eye is healing quite well with just a bit of numbness in the upper and lower lids. My right eye, however is still red and a bit bruised underneath the eye and the lower lid is pretty numb-basically immobile. Is this all normal? I am thinking that it will be about a month before I look 100%!! Also, I realize that the bleph did not get rid of crow`s feet. So, I was going to get botox in about a week and a half-is that ok? Thank you for your time.

Answer:

all normal and should get much better by the end of the first month.I think that amount of time of waiting for the Botox is adequate. JG 11.19.06

Question:

How complicated is it to perform a canthopexy reversal? Is the incision smaller than the original incision? Does the dr. use a local injection of anesthesia?

Answer:

it is not a simple procedure. The incison is the same length as the original. I usually use genral anesthesia. JG 11.19.06

Question:

Hi Dr. Garcia:I was referred to you by Dr. Steven Cohen in S.D. CA. Dont know how to make this short. I tend to get sucture cysts. First surgery in Chicago 11 yrs. ago and Dr. just hyfercated them. All was good. Had to have a redo in Chicago and got cysts again but no one in CA would hyfercate. A doctor removed thin amount of skin to get rid of cysts and all was good. 11 yrs ago. In June 06 had several procedures and still got cysts over upper eye lid. Dr. excized cysts. He also had to remove some fat pad in corner of eye. Used glue, no stitch, so I would not get cysts. Well got them. Saw him, live in L.V. now, he was at convention. He said if I was in S.D. he would give me a cortisone shot. I have a large bump under the incision that he closed with glue and a web going under the eye. He said it is just swelling. It has been 2 weeks. Could you do a cortisone injection or hyfercate now or should i wait. I also want to see you for botox and resty. Also he did more skin removal over other eye and used dissolvable stitches and lookes peely. Should I make appt now or wait. Only two weeks out but I have been waiting for over 5 months to look normal. I have been told I take longer to heal and part of this is because of multiple incisions. Thanks for your anticipated reply

Answer:

I would be happy to hyfercate them for you, just call the office and I can see you as soon as you can. JG 11.24.06

Question:

Hi there, I noticed someone wrote about injectibles for malar mounds. What in your opinion is the way to go, plumping up with a filler to even it out the festoon, or a direct exicison? Or would it depend on the individual case? Thank you in advance.

Answer:

depends on the case and what the patient wants to do, in terms of wanting to avoid a scar, either can help but the injections need to be redone every so often, time interval varies. JG 11.18.06

Question:

Hi Dr., I asked you about having a canthopexy reversed by having the stitch released. Assuming the scar tissue is also removed, how long does it typically take for the eyes to relax again? If the stitches are not released, how long does it typically take for the eyes to relax so that they look more natural (not wide-eyed )? Thanks for your help.

Answer:

it should relax in a few weeks if the scar tissue is released, in some cases you should see it almost right on the operating room table. JG 11.16.06

Question:

Hi Doc, thanks for your reply. What`s a hyfercator? You said I might need a laser or hyfercator to burn them off .

Answer:

a small electrical machine that can burn things off. JG 11.16.06

Question:

how does a plastic surgeon perform a lower bleph, and what is the round about cost of it? thank you so much doc. this is the greatest website, it is so very interesting!

Answer:

it varies, at times we use an incision on the outside and at times on the inside, all varies with what the pateint needs. I could quote you fees but that varies greatly form doctor to doctor. I suggest you get a fee quote from the doctor you are considering perform the procedure. I can only quote fees for people that are going to have me do their surgery. If you desire that fee quote, contact us via email at drgarcia@lvcosmeticsurgery.com rather than the message board. Thank you. JG 11.15.06

Question:

Hi Dr. Garcia, I wanted your opinion about addressing the undereye area. I have fine lines and just starting to get a little bagging. Is laser eye surgery effective there? I definetly need some firming up. Purchased your eye cream in the interim until I go ahead and do laser or surgery. Thanks a million for your generosity:)

Answer:

laser will help with the fine lines but not for the bags, that will take surgery. Best of luck. JG 11.14.06

Question:

I sent a question two days ago and I have not gotten a replay; It was my first time on your site. Did I do something wrong??? vicky

Answer:

probably asked on the agelessforever.net site and it was referrred her due to it being a plastic surgery question, please post it again here. JG 11.14.06

Question:

Hi Dr.Gracia,I have been thinking about upper blefaroplasty for 2 years and still dont decide.Sometimes I feel so bad with my eyes,hardly keeps it open and more else.I am from Bosnia,sorry if you wouldnt understand me and I would ask you if I can sand a fhoto of my eyes that you tell me do I need blefaroplasty?Thanks

Answer:

a photo will help, yes, please send it to drgarcia@lvcosmeticsurgery.com JG 11.14.06

Question:

Hi Just wondering, after lower eye being done I have a couple of red marks. One looks like a red sort of pimple right on the lash line and the other,a a little lower, looks like a bright red dot. I had my eyes done in march. how do I get rid of these? what can I do?

Answer:

might need a laser or hyfercator to burn them off. JG 11.14.06

Question:

Dr. Garcia, First of all, thanks for this forum! It`s truly helpful for a lot of people. I`m 3 weeks post-op upper bleph and chin implant. I`m symetrical and healing well, except that I have a bump in the corner of my left eye, and a less noticeable one on the right eye. My doctor said it`s caused by the skin folding over during surgery, and to keep applying pressure. When I do that however, the area around it looks almost concave, so I release the pressure, and a few minutes later the bump reappears. Will it go away?

Answer:

it wil go away, if it reacts the way you describe it is swelling and in time will flatten. JG 11.14.06

Question:

Hi, Dr. G, I am 62, in good condition andhad eye lid surgery almost three months ago (second, first was 20 years ago). I bruised incredibly and my scars are still red and thick (no keloids). I went for a second opinion to a oculoplastic and he thought I might have created an allergic reaction to the stitches. Is it possible the stitches were old??? I heal exceptionally well, so I can`t figure this out. My dermatologist has recommended Kelo-Cote. Will this redness ever go away??? My skin is fair.Please let me know how I can speed up the healing process... I can still feel scar tissue under my eyes..one more than the other. Thank you.

Answer:

very unusual, and allergies to sutures can happen but those sutures should have been removed so all that should subside. Kelocote might help but it is hard to avoid getting it into the eye itself, tough problem. I think it will get better in time but it will be weeks I am afraid from what you are describing. JG 11.14.06

Question:

hi doctor can perlane filler injected under the eyes make lower eyelids buldge out if so will this go when filler has disolved?

Answer:

yes it can and it should go away when it dissolves. JG 11.14.06

Question:

Hi Dr. Garcia. I had a canthopexy procedure performed about 6 months ago and was displeased with the shape of my eyes. My dr. removed the stitches, but the eyes have not fully relaxed (it has been about 3 months). I consulted another occuloplastic surgeon recently who said that a steroid injection can be used to relax the muscle (or tissue?), but recommended that I wait about 6 months to see if the eyes relax on their own. Is this safe to do? I am concerned about the muscle or tissue perhaps relaxing too much. Thanks for your help.

Answer:

It might but I would not be too hopeful of the steroid shot helping. It might need more surgery to release the scar tissue and do a canthopexy, but not quite as tight. JG 11.14.06

Question:

Dr.Garcia, I had a transconjuntival bleph. a month ago and was wondering if its still possible to have puffiness under my eyes? I guess I expected the results to be more dramatic than it is. I always had the bags under my eyes and thought they would be totally gone by now. I`m still a little numb on both my upper and lower lids. Also, what is your opinion about microdermabrasion to hlp with fine lines and a little blotchy skin? I`m 45 yrs old, have an medium to olive complexion and just want to do some non surgical things to take care of my skin. Thank you for your time

Answer:

it is still a little early for all of the swelling to go down to yield your final result and I do not feel the microdermabrasion will do much. JG 11.14.06

Question:

had upper lid bleph 5 days ago--looks great--huge bruise on upper cheek(not near where surgery done)--has blood just moved down and pooled --will it go away? it is dark red/purple

Answer:

all normal as the blood does move down with gravity, just keep it out of the sun to avoid staining. JG 11.13.06

Question:

Hi again, I am the lady with the questions regarding the midface lift,bleph and problems with lower lid retraction. I have spoken to my ps who says to wait till 6 mth mark as he says he is not sure what is causing my retraction and just hopes it will resolve. If not as a remedy he wants to redo the op and just use more stitches to secure it. To me this is overly invasive and possibly futile. He says the worst that can happen is it will not work.Cold comfort for me. Is this likely? My cheeks aren`t dropped just my lower eyelids are retracted one just at the lateral canthus and one the eyelid is quite bowed. Would a canthopexy do the job do u think? My eyes are quite rounded too and smaller looking. I would like their almond shape back. Is this possible and to restore the horizontal width? Thank you for your wonderful site.

Answer:

you might need a canthopexy and a skin graft to the lower lid if the problem was that too much skin was removed. I think the canthopexy will help with the rounded shape. Hang in there. JG 11.12.06

Question:

Dr. Garcia, Thank you so much for responding so quickly. I was the lady who asked about the bumps on the outside corners of the eyes from and U and L bleph, who is 15 months p.o. I am almost 51 and female. The p.s. had tried a light CO2 laser about 10 weeks ago. I have to sincerely apologize. Neither doctor used the word hypertropic scars--but rather like an overgrowth of scar tissue....hyperplasia maybe. I do apologize. The bumps are flesh colored and sometimes seem reddish. They are about 1/4 of an inch in size. I don`t know what made me type hypertropic--maybe read something somewhere and I don`t know if it makes a difference in your opinion, but I did want to let you know. Once again , thank you so much.

Answer:

well a hypertrophic scars is almost the same thing as a keloid, but the difference is the keloid extends past the line where the cut was whereas the hypertrophic scar does not, but they behave and react in the same way.JG 11.12.06

Question:

Hi Dr. Garcia, I just want to say thank you for having this great web site. You are a very kind person to take your spare time (which I`m sure you don`t have much)and answer questions for people that are worried and stressed about the surgery that did not turn out like they expected. Just having someone like you that cares helps so much. I have been to your office 2 times for evaluations and when I am ready to have my surgery, I want you to do it. Again Thank You.

Answer:

Thank you for all the kind words and let me know if you have any questions. JG 11.10.06

Question:

My initial surgery was a disaster and I was left with two different sized eyes and a terrible case of muscle damage which causes me to see double vision all the time and which I still have problems with. The initial doctor took too much fat out of my lower lids which cause my left lid to droop dramatically. On August 8th my new surgeon (which I love dearly) added more fat to my lower lids and this has made the shape of my eyes return to normal. The problem I am having now - besides the double vision issue which I believe may be permanent - is that this new doctor over compensated the insertion of the fat and now I have terribly huge bulges under my eyes. He stated that usually 60% of this would normally disappear on its own so they do normally over compensate for what will disappear. Now he is suggesting, rather than go in and have another surgery because of the double vision factor, that we use the lipo dissolve procedure on my undereyes. Is this safe? I understand that he doesn`t want to cause any further damage to my muscles, but is this the route you would take to correct the over compensation? He told me straight out that this is a very controversial procedure - especially on the eyes - but that he feels safe in performing it or he would never have suggested it. I have gone through so much and I am afraid that something may go wrong. Is there a possibility that it will dissolve all the fat and I will be back where I was before with my undereyes caving in from the hollowness? Please - your opinion is greatly appreciated.

Answer:

I do not think Lipodissolve is safe, the material they are using was initially studied in Brazil and subsequently taken off the market there. I would just wait it out a little and let the fat dissolve a bit on its own and it will. JG 11.8.06

Question:

I wrote to you a few months ago about my lower bleph - one eyelid retracted and seemingly frozen (you were a great source of comfort, btw, and I thank you for that). I`m now 4.5 months post, and retraction is 99% resolved. All looks almost normal, although my squint is not the same, i.e. lid does not have complete functionality. But I`m still feeling a lot of activity under the surface in that same lid, like itching, tingling, achiness. Sometimes even my eyeball feels achy -- though my sight seems unaffected. Is that normal at this point? Can it still be healing this much after almost 5 mos, or is something wrong?

Answer:

yes all normal and actually all good signs. It can in certain cases take a full year to heal totally. Hang in there a little longer, it seems like things are going well, albeit slowly. JG 11.8.06

Question:

Hello Dr. Is there anyway to make the eyes bigger in size with eyelid & eye brow lift surgery? Is it done in the hospital or office and how long will it take for the bruises and swelling to go away.

Answer:

well the eyes might be able to be seen better but their size does not truely change, what procedure would be best in your case would require me to see you or at least some photos. JG 11.8.06

Question:

would it be possible with malar mounds with no lax skin to have a filler injected to even it out.

Answer:

you would need to inject around the malar mound, not into it directly. JG 11.7.06

Question:

Hi doc 12 years ago i had to have my left eye lower eyelid reconstructed because of bcc. 2 years ago i had lower eyebag removal it has left me with lower droopy exposed eyelids can anything be done to corect this?

Answer:

possibly a canthopexy can fix it. JG 11.7.06

Question:

Thank you for your prompt reply re my midface & bleph eyelid retraction. You mention some changes might be permanant if not fixed. They are..? I know it is difficult for you to say without seeing me but in your experience what is the least invasive way of fixing this problem. Can anything be done by the conjunctival method? My eye looks as though a stitch in the medial canthus area would pull it up. I am scared to get the lateral canthus cut yet again.When I first presented to my ps with this concern he said that it was just collagen forming at the scar site and that when I developed muscle strength it would come back..didn`t sound feasible to me. What do you think? Thanks a million again.

Answer:

the changes would be to the cornea of your eye, potentially developing a cataract like problem. I am afraid what you are describing will take some invasive option. I think the muscles should be working by now. JG 11.6.06

Question:

I am 4.5 monthes post midfacelift and lower bleph(done via incisions on outside of eyes) I have aprox 3mm scleral show on left eye and about 1mm on right. I have been massaging and screwing up my eyes to no avail. Lower lid margin really bowed. My eye is watery and sore. should I insist on revision now or wait will it resolve. I had entropic eyelids b4 surgery which my ps seemed to ignore. I have enough skin as when I consciously lift lower lid it comes to iris quite comfortably. Just won`t stay there. Appears to have no strength. What do you suggest. Thanking you for your time.

Answer:

What you describe unfortuantely is a common complication of that procedure. If you are having significant eye probelms I think you need to have it revised before you develop some eye issues that can become permanent, best of luck. JG 11.5.06

Question:

Hi Dr Garcia, I had an upper and lower blepharoplasty 2 days ago and I am ectremely bruised abd swollen. I know this is normal, but I am noticing that there is still abit of sagging on one eyelid. Is it way too early to even remotely determine results? I am a bit obsessive! Based on your experience, what is a realistic time frame to determine final and lasting results? 2 weeks-2 months? Thank you!

Answer:

all that you describe is normal, it will look much better in a couple of weeks, it should look pretty good at one month but might take a few months for the final result. JG 11.5.06

Question:

Hi Dr. G, I had upper bleth just shy of 3 weeks and I am having double vision (mostly with reading) on my right eye with difficultly closing it at times. I really feel it when I wash my face and water goes on my eyelid. My ps check to see if any sutures were the problem but he did not find anything wrong with my eye. My vision is worse at night and it is still swollen on the eye lld. Also my eyeball itself feels swollen with pain at times. Is this normal? It is getting very hard to read and I have to go back to work soon. Can you help me? Thank you for this service. LL

Answer:

very unusual I must say, I doubt any sutures being the problem although some swelling to the eye muscles is more likely the culprit. I think you need to see an opthamologist for an exam so they can test your extra-occular muscles. As the swelling improves I think it should get better. JG 11.5.06

Question:

Hi Dr garcia, I am two days out after blepharoplasty (uppers and lowers) and I am extremely swollen and bruised. And, I may be paranoid, but it looks like he may not have taken enough skin off one of my eyelids? Is it way too soon to judge results? (I am a bit obsessive!) What is a realistic time frame to determine final results? 2 weeks-2 months? Right now I look like a monster, so it is a bit scary! Thank you!

Answer:

way way too early, especially in cases where there is lots of swelling, you have to give it time. By one month things look better but final results are often not seen for three to six months. Hang in there, it will all get better in a bit. JG 11.5.06

Question:

I had upper eyelid surgery about 8 week ago. I seem to get a recurring red `pimple` by the incision line above my left eye that comes and goes.....what is this?????

Answer:

most likely a cyst where one of the sutures was, may need to get the cyst opened with a small needle by the docotr. JG 11.4.06

Question:

Dr.Garcia, I`m so paranoid as I am 3 weeks post of a transconjuntival bleph.and upper with a pinch and I still have swelling and numbness on both my upper and lower lids.It feels funny putting on makeup and I`m wondering if this numbness could be permanent?

Answer:

It is normal and that numbness can take months to totally resolve, just give it some time. JG 11.4.06

Question:

HI there, back to the malar festoon issue. A doctor suggested restylane injections to build up the area around the festoons to make them less noticeable, stating that should I have them cut out I will be left with a big scar. Your opinion? I live in Canada and so far haven`t found a specialist who would consider excision. I may have to make a trip to Las Vegas.

Answer:

well, it is possible but it will need to be redone every so often. JG 11.16.06

Question:

I had upper eye lid surgery done 3 days ago. The left eye lid was more droopy before the surgery. The right eye is wide open, and looks great. The night of the surgery, the left eye lid dropped alot, and is not coming back up. The stitches were done on the inside only. Could it be from the novacaine? It doesn`t appear to be swollen more than the right eye. I have another appt. in 4 days. It looks terrible. I am so worried it won`t come back up. I am using the cold compresses more on the left, also. How soon can he do anything to correct it to make it even with the other eye? Thanks so much for your advice.

Answer:

it appears you had some type of ptosis surgery from you describing the stitches on the inside. If the lid has dropped and the surgery involved a raising of the lid it needs to be repaired at the earliest opportunity, no need to wait. JG 11.1.06

Question:

Dr. Garcia I am 5 weeks post op from lower bleph and mid facelift (incisions in hairline). I have developed really thick scars under my lower lashes. They are not red but are clearly visible. I have had two rounds of Kenalog injections and am using a steroid cream on the scars. Is this typical? Also, I have a little scleral show (about 1-2 mm) below my iris. The lids are a little rounder and droopier out toward the corners. Can that scar tissue be causing this or could the residual swelling from the MFL be the culprit? Does it ever self correct? Thank you so much!! I have no idea how you manage to run a practice AND offer such great advice!! It`s appreciated more than you know.

Answer:

no, not typical, especially on the eyelids. I am not sure how much the topical steroid will do. The scar tissue might be causing that but it is also a known phenemenon with certain techniques for mid facelifts. Revision of the scars later might be needed along with a canthopexy to support and correct the scleral show. Best of luck and thanks for visiting. JG 11.1.06

Question:

Dr.Garcia,why do the eyes numb so much from a blepharoplasty? And do they numb more if you do fat re-dispositoning? Also, is it a good idea to do some laser around the eyes for fine lines during the surgery or to wait a few weeks afer? Which is better to use a laser treament...and what is a good one or botox? thank you 10-31-06

Answer:

I do not think there is much difference in the numbing between fat repositioning or removal, as to why it gets numb, it is because there are many tiny nerves in the area where the incisions need to be placed but in most cases the vast majority of the sensation returns in time. I think Botox for the fine lines is not a good idea and the laser can usualy be done at the same time, I use a CO2 laser or a Rhytec Portrait. JG 10.31.06

Question:

Thank you for responding to my previous question about festoons. Boy they are a difficult thing to treat it seems. I have had cosmetic surgeries with 3 physicians and none of them would perform a direct excision. The most recent physician was an ocular plastic surgeon who did a lower lid revision with grafts. I must say it turned out excellent. He stated he did not do direct exicison and that I could end up with a scar AND the festoon not completely removed. My question to you is, how complicated is the procedure and what in your experience is a realistic outcome? The festoon under my right eye has to go. It is 3 times bigger than the one under the left eye. I could live with a fine white scar if the skin would lay flat.

Answer:

it is very effective and easy to do but it will leave a scar so you need skillful closure. JG 10.30.06

Question:

Hello Dr. Garcia: 4 months post op upper bleth. Thin raised white scar in inner corner of eyelid & forms a half moon and goes halfway over the middle of the eyelid. I would like to have a scar revision, but the p.s. said I am not a candidate due to webbing. Does this mean there is not enough skin there to take out the scar? Couldn`t it just be re-excised and sutured? How often is re-excision done? Would it be okay to send you some pictures? Thank you. C.N.

Answer:

if there is not enough skin removing the skin could create more tethering or webbing, may need to wait until the skin gets a little looser. Re-excision is very rare in eyelid surgery for scars alone, unless there is too much skin and that is also needed to be done. JG 10.30.06

Question:

Dr. Garcia, What is the implant called you sometimes mention for the tear trough area? You`ve remarked that there is a new implant for the under-eye area, and does it have a general name or brand name? I`m meeting with an ocuplastic surgeon and would like to know the best way to reference the implant.

Answer:

it is called an orbital rim implant, tear trough implant, designed by Dr Ed Terino. JG 10.30.06

Question:

You stated that festoons have to be cut out, which leaves a permanent scar. Would one be able to minimize the scar at a later date with perhaps a laser procedure?

Answer:

possibly, but the scar will always be there. JG 10.29.06

Question:

Dr.Garcia,thanks for this website,as I have asked questions before regarding a transconjuntival blepharoplasty.I have seen good and not so good results on some of my friends.How long does it take the swelling....not the bruising to go down to normal to see the full results? Also, how long should someone wait to have lasik surgery for nearsideness done after the procedure is done? I am still leary about the procedure,but would love to see my puffy eyes gone.

Answer:

majority of the result is seen in 4-6 weeks but it will take three months and at times more for all of the swelling to be gone. Lasik is OK one month later. JG 10.29.06

Question:

Hi Dr. Garcia, Should there be pain or severe pinching in the eye lid by the where the incision is 16 weeks after an upper/b.

Answer:

no, not the way it should be. JG 10.28.06

Question:

Hi Dr. Gracia: Thank you so much for your help last time. I was born with congenital ptosis. I did take your advice and went to see two oculoplastic surgeons. One suggested supermaximum levator section first, if it didn`t work then we`ll do frontalis slings with leg grafts. The other one would just do the slings with Polytetrafluoroethylene suture . My questions are: 1. What are the differences between these two sling materials? Which one is better? 2. I understand that supermaximum levator resection may not work for me since the levator function of my right eye is absent. I`ve done the similar surgery twice but it didn`t correct the problem. Should I trust my doctor and give it a try? 3. If it fails, how long do I have to wait until I can have the sling surgery? Thank you so much for your time and I look forward to hearing from you soon. Keep up the good work and God bless.

Answer:

I feel the muscle slings are less bulky and more natural than the PTFE sutures which are permanent threads. I would always wait at least three months, and preferably 6 between the surgeries. If the previous times yo have had surgery and the leavator procedure failed and we have to assume they did it well, then maybe going to the sling is the shorter route. All the best. JG 10.27.06

Question:

I have written a few times regarding the puffiness under my eyes after laser resurfacing... after 3 times it has no gone away. If these festoons need to be removed, would the festoons be removed and then tigthening, if possible or would you tighten and then remove the festoons. I live in California and did not know if you knew of any good Ophthalmologists? My plastic surgeon does not want to remove these? I would trade the puffiness for a scar. Thank you for all your advice. SLT

Answer:

I think cut them out and then a laser if needed for some other reason. I am not familiar with many opthamologists in California though, may want to try another plastic surgeon. JG 10.26.06

Question:

Dr. Garcia- I am hearing of a new cosmetic craze- Eyelash transplant, similar to a hair transplant. Have you heard of this? Do you recommend this?

Answer:

although they can be done it is difficult and they do not always grow, need to see someone experienced who does alot of them I feel, not for everyone, and there is lots of swelling too. JG 10.25.06

Question:

I was reading further down where someone mentions transconjunctival blepherplasty. At 56 and a believer in less is more, I am not ready for eyelid surgery but I have started to accumulate what I believe is fat in the upper inner eye areas. On a web site originating from Kansas City I actually saw photos of a surgery to only remove fat from the eyes where the surgeon made incisions from inside the eyelids. Is this what is meant by transconjuntival? If I were to have only this done would it leave little baggy areas where the fat was? At 56 I use bioidentical HRT and I have excellent skin without sagging or fine lines. Would losing weight reduce the size of those fat accumulations without having to resort to surgery? I am 5`4 and weigh 150 pounds.

Answer:

yes, and it can be done for the upper with difficulty but is usually done for lower lids only. At your age it might leave some loose skin, yes. Weight loss would not affect those fat pockets I am afraid. JG 10.24.06

Question:

Hi, I already emailed you, I guess it didn`t go through, so I`ll ask again. I had blepharoplasty on my lower lids about 1 1/2 years ago. It looked good, very tight. I had the CO2 laser on the inside of the lid, as I`m only 45 years old. About 6 months ago, I was more than vigorous with massaging them and now it seems the lids have dropped, if that makes sense. Their certainly not tight any longer and the skin seems and feels like it is droopy. One side seems to have more fat in it. What do you think happened? The occuplastic surgeon I went to, suggested taking more fat from the right, where there appears to be a little more fat. When it doesn`t feel and appear puffed, it feels droopy. Can you give me an idea of what might be wrong?

Answer:

well all I can guess happened is one or both of the sutures placed into the lateral canthus for support have dettached or broken allowing the skin to get loose. Might need some more tightening of the skin along with fat removal, it is not due to the laser. JG 10.24.06

Question:

Hi Dr. Garcia, I have been using the Obagi products and started in March of this year. I have some good results, however not as much as I hoped for. I still have some fine wrinkles on my face that I want to get rid of. They bother me more each day. Do You think if I keep using the Obagi products I will get the results I am looking for? It seems if I don`t use the product everyday, I can see the wrinkles more. Is there a reason for that? I came to your office 2 times last year. I want to get my upper and lower eyelids done and a light chemical peal below my eyes. Do I have to get a new evaluation? Will the eyelid surery get rid of all my wrinkles on upper eyelid and botttom euyelids. Thank You

Answer:

if you have been seen before we might just want to see you to make sure of what we have planned or what we can do. JG 10.24.06

Question:

dr.Garcia, I`ve been told that I`m a good candidate for a transconjunctival blepherplasty.I was wondering if the recuperation time is longer than a standard bleph. and will the results still look nice. i don`t want a hollow Look, as I have a small face but still want to see the bags and puffiness under my eyes gone. gg 10-23-06

Answer:

it is a litte less as there are no external incisions and you are able to wear make up sooner. The hollow look only happens if too much fat is removed, and that is rare. JG 10.23.06

Question:

I`ve been having trouble sleeping for the last 2-3 months, one day last week I woke up and noticed my eyelids drooping! It wont seem to go away. What type of procedure other then Blepharoplasty could I get? or is there any cream that I can use to help tighten that skin? what about thermasage? I`m 36 years old.

Answer:

I do not think Thermage will help and I think there is no cream that will shrink loose skin, try to get some better sleep is about the best. JG 10.23.06

Question:

Dr. Garcia, I had asymmetry resulting from lower blepharoplasty-the left eye was rounder at the corner due to a eyelid malposition and the right eye was more extended but approximated my natural lid position. My PS performed a revision on the left eye but did not address the malposition which could have been corrected by releasing the corner and rotating the lower lid downward. I am moving on to a different PS but am not sure if other surgeons are lukewarm to the idea of revising somebody else`s work. I see no value in going back to the same surgeon. Please advise. Thanks.

Answer:

well, although I am sure it is not their first desire, they can do it for you. Best of luck. JG 10.23.06

Question:

I have had a face lift with upper and lower eyes.I had bags under my eyes although they are much better I still have bags under my eyes cheek area, could this be corrected by taking a bit more off the sides of the face?

Answer:

well if it is fat of the eyelid a little more fat removal might work, but if it is on the cheek itself, making it a festoon, more tightening of the face may not correct it. In severe cases it needs to be directly cut out, leaving a scar there. JG 10.22.06

Question:

would small-needle lipo be the only fix for removing these fat injections?

Answer:

possibly. JG 10.20.06

Question:

JG 10.20.06dr. id like to know your opinion on the accent lasar. only information i have is that it is not yet fda approved. wanting to remove a fat injection that is bulging and has hardened causing a fat pad. whats your expert opinion.

Answer:

I do not think it will work, but it probably won`t hurt to try it. JG 10.20.06

Question:

Hi Doctor, I sent a digi-picture of my eye area to your e-mail address in the hope that you can advise me on what kind of revision is needed for my left eye. If this e-mail is unaceptable form of communication, please accdept my apologies. I will just post my questions/concerns on this web page.

Answer:

I will get back to you individually after I review it. JG 10.20.06

Question:

Hi Dr. Garcia, I had ptosis surgery 4 months ago. I did not like the way the eyes were healing and the scarring. I went for a 2nd opinion. The new ps told me that it could possibly be re done after 16 wks post op of the first. After she got me records and reviewed them she happened to run into my old ps at a convention. She said because of what he did something with the muscles in the lids a revision could not be preformed until 1 year post op. she also stated that he said he would fix it if I wanted that. first off he left stitches in the rt and left eye. He scarred me, my vision is worse and I have eyes that are the same size or shape. there is still bagging over the left eye and the right eye is pulled extremely tight. When i mentioned that to her i was actually shocked that she actually thought i would go back to him to have him correct it, or more importantly she told me well it could get better, then she tried to cover the scar with some makeup and i told her that no amount of makeup will cover it I am a makeup artist and have tried everything. I am wondering now if I can trust her to do the right thing. I know that he messed up and it seems that now she is trying to cover for him. She told me to massage the eye because it is all bumpy and the lids are very swollen and red. she also gave me this gel to use called generation 111 topical scar gel. She also stated that she cannot give me cortizone in the eye because of the muscle repair he did it will make it not heal well

Answer:

I agree about the cortisone in the eyelid and she may have said all of that in order for you to go back to the original surgeon to avoid hard feelings, but if you have lost confidence in her you should seek out someone else. JG 10.20.06

Question:

hello again. a revision of a hard palate graft to shorten it would also make as much swelling as the 1st time cause the 1st time the swelling was HUGEEEEE. thank u so much

Answer:

probably less swelling than the original placement. JG 10.18.06

Question:

is there a treatment to make longer thicker eyelashes?

Answer:

nothing reliable I am afraid. JG 10.17.06

Question:

what is exactly the rounding of the corners after a canthoPLASTY? how does it show in the corner of the eye? if its there, can it be reversed or corrected? gracias

Answer:

the rounding comes before the canthopexy, typically from the lower lid being pulled down ,causes are multiple, a canthopexy typically creates a deeper angle of the corner of the eye. As to revisions, they can be performed but are not easy to do. JG 10.17.06

Question:

hi,had lower blephs done 6 months ago,always had problems with one eye.Now this eye seems smaller and less round than the other one.Is it possible for this to happen after just a straightforward lower blephs?Could it have been sewn up differently to the other one? thanks.

Answer:

it can happen, at times there are sutures placed that are not a formal canthopexy which can do that, or the other side might be a little pulled down and too rounded, either one can happen. May need a little revision work. JG 10.17.06

Question:

Dr. Garcia, Is communication with you only limited to this webpage? Can I send a digital picture of my eye area to your e-mail address so you can evaluate what revision needs to be done after undergoing lower blepharoplasty? My left eye appears to be the problem.

Answer:

certainly, please forward them to drgarcia@lvcosmeticsurgery.com and I will get back to you. JG 10.16.06

Question:

Last week I asked you about your opinion on percentages of successful Alloderm grafts. Unfortunately, I cannot visit you personally since I live 1500 miles from you or I WOULD!!!! But, what I failed to mention in the context of my question (inadvertantly) is that I am also having a facelift. My surgeon seems to think that the extra skin will give him what he needs. I wonder if I would need the graft having the extra skin? Would my lid then kiss the eyeball? I`m considering doing the facelift first then if necessary going back for the graft. Is this plausible? I`m so afraid of an unsuccessful look after reading of multiple horror stories. Supposedly, I healed this way because of chemosis which caused the lid to pull down and then scar tissue took over. You`re an angel - thanks for your time!

Answer:

the Alloderm essential froms a lattice work for your own tissues to grow upon, it in and of itself does not survive. As to the graft, usually the Alloderm is placed internally not externally and if the facelift lifts the tissues vertically to the eyelid, it might and it might not give you the tissue in the location or layer you need, I cannot tell without seeing you, may need to ask your surgeon about this. I seriuosly doubt chemosis caused any lid retraction, chemosis is an issue of the eyeball itself and does not influence the lid. JG 10.14.06

Question:

Dr. G, I had upper/lower blepharplasty in 2003 (at age 30)to remove puffiness around my eyes and laser on the skin under my eyes. The first 6 months after the surgery my face was full, swollen and looked good. However, now 3 years later my face has lost the fullness and appears too long, thin and narrow. My upper eyelids looks indented and it seems that too much fat was taken out. Also, the scar in the right eye is very noticable. Is there anything that can be done to bring back the fullness to my upper eyelid? What about making my face look fuller again, is that possible? Also, after the laser my skin appears whiter in that area than the rest of the face. Is it possible to correct this? Any adivice will be much appreciated. Thank you!

Answer:

for the scar it can be cut out and revised, for the fullness of the face, maybe Sculptra, but is is not permanent, for the hollows of the eyes, I am afriad there is not much. As to the color difference, you may need to laser the rest of the face to get the color more even, sorry. JG 10.14.06

Question:

Dr., I had a canthopexy procedure performed about 6 months ago. I hated the shape of my eyes. My dr. removed the stitch from one of the eyes, and advised me to wait to remove the stitch from the other (which is extremely uncomfortable). The eye that had the stitch removed (about 3 months ago) has not gone back to its original shape. Will just massaging the area daily help it to go down, or will I need to have the dr go back and remove scar tissue? Thank you.

Answer:

most likely you will need the scar tissue removed. JG 10.14.06

Question:

Dr. G, I am 1.5 years post op u/l bleph with both lower lids retracted. My Dr. is going to do a revision with an Alloderm graft. May I ask you what is the sucess rate in these types of revisions? Can I expect a decent outcome? I`ve asked my doctor these questions and he leads me to believe everything will be perfect. However, this complication wasn`t supposed to happen either. Just wanted to get your opinion as to the percentage of successful revisions to your knowledge.

Answer:

well, the success varies, depedning on what is being corrected. Alloderm will help with relatively small problems but if there is a large amount of retraction and loss of support it might not be enough. Really hard to tell without seeing you in person to see how pliable the tissues are. Maybe you should seek a second opinion by someone in your town. JG 10.12.06

Question:

hi,6 months ago i had lower blephs done still having problems.At first left eye always looked tighter and looked like it had more fat taken out than right one but i had a lump at outer edge by incision which i was told was swelling.Both eyes looked to be stitched differently and now the scar on right eye is still very visible while on bad eye it isn,t.Also things have changed the bad eye now looks fatter than the other eye with the lump still there and giving the appearence of a bag. The opening looks smaller than the right one and i can feel it sort of sticking under the lid, like i want to pull it down all the time.P.S said it must have been like it before but it wasn,t and that it wasn,t possible to stitch it up different. He said a revision might make things worse and he couldn,t use the same scar easily.What do you think has happened?All of this seems to have made my upper lids heavier too as he thought he had done those as well till he read his notes.Doesn,t give me a lot of confidence in him i don,t know what to do next.Thanks for listening.

Answer:

well, the pictures that should have been taken before surgery should tell if it was there before the surgery. As to repairing it, it is difficult for me to say without physically examining you as I would need to feel the tissues to tell what can be done. JG 10.11.06

Question:

hello dr garcia. i asked earlier about the fat and tear trough implant. Actually it wasnt injected fat, it was fat pearls that where put in there. According to some dr, this fat can be easily excised because it was placed in specific places and not injected into muscle or eyelid ...what do u think better take it out before 6 months? thank you so much

Answer:

I would just wait and do it all together. JG 10.10.06

Question:

HI DOC. I`M 20 YEARS-OLD..IS THERE ANY SURGERY FOR CHANGING MY EYE-BROW HORIZONTAL LINE(MAYBE LIFTING THEM UP) AND HOW MUCH COSTS?

Answer:

a forehead lift can be done, prices unfortunately will vary from doctor to doctor, so you need to see them in person, or you can send me pictures to drgarcia@lvcosmeticsurgery.com so I can estiamte time needed. JG 10.10.06

Question:

i had fat surgically implanted to lower eyelid. one side is nice while on the other one i have a bulge of fat above my tear trough making me look like i have fat bag wich is not nice at all. Is it possible to trim this fat 6 months post-op so it can at least even out with the left side? I also have tear trough deformity, the dr suggested TT silicone implant. Do yu think its possible to have this implant at the same time of revision and is there a risk that the implant show when talking or smiling (cause i red elswhere that those implants might show when talking...???) thank u

Answer:

I think it might be possible to do both at the same time but removing the fat can be difficult. JG 10.10.06

Question:

Dr. G, I consulted earlier with a second PS regarding revision blepharoplasty. My lefy eye corner is way higher and more slanted upwards than the right. I was told that I needed a canthal release to rotate the lid downward and outward. What is exactly involved in this procedure and how much scarring should I expect? Thanks for your time and generous reply.

Answer:

it involves cutting the incision open and then cutting any sutures and scar tissue to allow it to drop, all very similar to what you had done already, just reversed. JG 10.10.06

Question:

im 3 months post reconstructive lower eyelid (hard palate+lateral canthoplasty+fat) The left side look good, the eyelid reached the desired position (eyelid margin just on the limbus, rounded). Right side: before surgery it wasnt as retracted as the left, but still the dr placed the same amount of graft in there (4 mm). Now my eylid is pretty high compared to the left , my right eye is small compared to the left and the eyelid margin is about 2 mm higher than the limbus, no visible rounding compared to the left, wich gives a real asymetry. is it realistic so far to hope to get the hard plate graft out of the right side so that the eyes equalises...i think a canthoplasty would have been enough for the right to adress the problem If so how long before moving this graft out if ever needed...please dont tell me 1 year, i would live in hell if i have to wait 1 year with this asymetry! is 5 months a feasable period? Beside if the graft is moved out of the right side, would it show that i have one in the left and not on the right in term of thickness and stifness of eyelids? PLEASE HELP, im having nervous breakdown so far knowing that i need most probably a 2nd revision and i hate looking at the mirror so far....

Answer:

I think 6 months is reasoanble time to wait, I think reducing the graft size is better than total removal and canthopexy, in order to achieve easier symmetry with the left. All the best. JG 10.6.06

Question:

how long before the tissue relax after a lateral canthoplasty? i hate my eye shape 3 months have been now, i wont my eyes to drop down! is it ever gona happen anytime soon?

Answer:

if not relaxed by 6 months it proabably will not relax much more without more surgery. JG 10.4.06

Question:

is there a device that a chiropractor might use that would help in toning down a bulge from a fat injection?

Answer:

external ultrasound. JG 10.4.06

Question:

hello dr garcia. im suffering from asymetry 3 months after revisional lower eyelid surgery. I really hate my right side where a canthoplasty where done among other reconstructive things like palate graft. This lid is not opening much and i feel its too tight when i try to squeeze my eyes. I read that canthoplasty do CUT THE TENDON and reattaches it. Is it possible to loosen the right side to make the eye open more? is it the canthoplasty or the palate that is not allowing the lid margin to move down? how long to wait before taking any decision regarding what to do? is 4-5 months enough? HARD PALATE GRAFT: if the eyelid doesnt move down anymore, does it mean that the hard palate needs to be shortened? or even taken out? or its just the canthoplasty that needs to be adjusted? my eye is not rounding enough so far while the left side is round, and reached the desired position so far....GOD HELP MEEEE

Answer:

It can be both that is causing it and it might need a revision at some point in time. I sugest at least 6 months, preferably one year if possible prior to the revision. The palate graft may need revising too. Soundss like you had a mid facelift before. JG 10.4.06

Question:

Hello Dr. García: I had a transconjunctival blepharoplasty 5 months ago, I had a very small residual portion of fat in one eye, something almost imperceptible, and i remember the surgeon told me that i could not do anything to avoid the fat appears again, and he told me that nothing but people that wake up with swellen eyes in the morning is more susceptible, is it true?, and I am worry now because I just came back from europe two days ago, I dind´t sleep well because of the trip and I went to sleep very late almost 2 weeks because I went to visit family, and now I have under my eyes puffyness and they seems like before the surgery, with some bags, could sleep less and late cause new fat appeared?, I am worry about it, and I try to sleep early everyday and the doctor never recommended me not to sleep late.

Answer:

most likely just swelling from fatigue and poor sleep and should all get better, avoid salty foods and use cool compresses on your eyes. Hang in there. JG 10.4.06

Question:

Dr. Garcia, I had revision blepharoplasty four months ago. The results were still unacceptable and in fact worse due to scarring. How soon before I start considering a second intervention?

Answer:

I would wait at least another two months to allow the tissues to soften, preferably even longer than that. JG 10.4.06

Question:

Dr., how realistic is it to have a canthopexy procedure reversed, particularly at about 6 months to 1 year? I had a procedure performed and the eyes look so fake and tight (there is no skin under the eyes outlining the eyes, which would appear natural). I had some crepey loose skin under the eyes and the dr thought that this would tighten some of the skin, but it is too much. I was hoping that if the stitches were released, I might have some of this skin back. My other option is waitin and letting gravity run its course, but how long does that take? Thanks very much for your time and help.

Answer:

I think at this point you would need the suture cut and the tissues released, so a bit more then just cutting the sutures as the tissues have healed and need tt be relaxed. JG 10.4.06

Question:

I had upper eyelid belpharasty (sp??!) surgery on Friday - it is now Sunday evening and all seems to be going well. I am in excellent health and exercise regularly. My question is - is it okay to resume mild exercise tomorrow (day 4 post op) - as long as I`m feeling well and do NOT over extend myself? I typically run 5-6 miles every other day and am hoping to simply be able to walk about 3 miles slowly. My thinking is that the mild exercise will help to circulate everything - but I certainly don`t want to risk anything. Any advise, input, etc is greatly appreciated! What is your opinion? Thanks!!

Answer:

I suggest you wait at least ten days before walking in order to avoid excesive swelling, bruising and bleeding. No bouncing like in jogging or running for at least three weeks. JG 10.1.06

Question:

I am 13 weeks out from a midface and lower bleph. I have what i feel is marked assymitry in my eyelids and shape. The left eyelid is retracted with more scleral show than the right and the right eye is noticeably more rounded. My ps has acknowledged this but was somewhat dismissive of my concern and says to wait until 6 mths and come again. I cannot see how either eye will self correct. Should I be doing some massage etc to improve retraction. The eye even feels wider open and teary. In your experience should I wait the 6 mths or should I seek revision before scar tissue formation. This is my second bleph I has one 19 years ago. Thanks for your great site.

Answer:

massage will help and it might improve some, but I think the reason for the 6 month check is they need to let the tissues soften before any corrective surgry can be performed. I would only suggest surgery sooner if something were compromising your eye. JG 10.2.06

Question:

Dr. Garcia This past April I had blephorplasty performed on my upper lids. the right eye was almost perfect, with fat still in the corner near my tear duct, but it was okeh. The left eye cut was too short and fat was left in. In August, the doctor was suppose to have corrected the left eye saying it had developed a milia, but once again the cut was too short, and I am very displeased. Now, I will once again have eyelid surgery to correct the short cut, but I am afraid that when he does it, he will remove the fat in the left tear corner and not the right. do you think that he should remove the fat from the right as well? And, so you not think it is too soon to have anymore cutting done on my eye? I told him this is the last time for him cutting me, either it will be performed correctly or someone else will perform it and he would pay for it. Do you think I am being too harsh?

Answer:

we always strive for symmetry so if there is enough fat that needs to be removed on both, then both should probably be treated. We run a fine line though as we do not want to remove too much fat as that problem is almost impossible to correct. I can understand your frustration but I would let the surgeon try to make it right, I am sure they are concerend with getting it right too. JG 9.30.06

Question:

Hi Dr G. How is the levator muscle repaired? Can it be done under twilight anaesthesia? Thankyou!

Answer:

by placing sutures from the muscle to the cartilage, and it can be done under twilight. JG 10.1.06

Question:

Hi Dr. Garcia I had upper lid surgery 12 weeks ago the incision on one eye is placed real high not in the crease and very jagged and not a neat line. This eye also does not close all the way.It is still very tender to the touch. Lids on both eyes are still puffy and red. The other eye is scarred and there is no difference except that there is a lump in the outer corner of the eye. They 1st ps did them 1 week apart. I am slated to have surgery again on both eyes because the original reason was to correct my vision and not only did it not do that but I now have double vision peripherally. My new ps said that she would have to correct both eyes and place the incision in the correct spot. Also there is a lot of scar tissue on the inside of the rt. lid. She will be doing both eyes the same day. How long can the surgery take and will my eyes be closing the same because now i have lot of dryness in the eyes and itching. If there needs to be a skin graft on the right eye will I ever look normal again.

Answer:

I am sory but what you are asking me cannot be answered without examining you in person. A skin graft will improve some things but it will never look normal as that skin is of different texture and thickness. JG 10.1.06

Question:

on eye lid surgery, upper and lower what is the comparison between lazer and regular scapel surgery thanks dorine horan

Answer:

lots of hype, at 5 days absolutley no difference. JG 9.30.06

Question:

I had lower eye surgery (eyebags)in March after 2 months it appears my eyebags are back but not as bad as before. What can be done? Where is your office in Las Vegas? Can I get a 1 time free consultation?

Answer:

our consultations are $50, we are at 6020 S Rainbow, and it might just take a little more fat to be removed. JG 9.28.06

Question:

Hi Dr Garcia, I am scheduled for upper/lower bleph on November 3rd. Dr. said a realistic healing time is 2 weeks. Is that your experience? Also, he prefers giving 2 pills for sedative versus an IV (fine with me)! Do you often use oral sedation? Thanks for your time!

Answer:

I think two weeks is reasonable and as to the oral I use both oral and IV, the IV is easier to control and works faster if you need more. Best of luck. JG 9.27.06

Question:

how long does the swelling subsist in the eyelids and around the eye area after a revision surgery with a composite hard palate graft, canthoplasty and orbital fat implanted? its been now 2.5 months and my god, my eyelids are still huge! do u recommend cutting salt from diet or any massage or any compress to speed up a bit? how long before eyelids go back to normal volume? thank u

Answer:

at least two months and typically it can be 6 months. That is a a very invasive surgery to correct serious issues and the tissues transplanted take a long time to heal into position and develop ways to decrease the swelling. I think massage might help some but salt probably will not make a big difference. JG 9.27.06

Question:

Dr. Garcia, I posted a question about a month ago. Thank you for answering it, but I cannot find the question anymore. I am a 29 year-old with Graves` Disease with normal thyroid levels for the past 6-9 months. I am scheduled for an upper and lower bleph with an eye specialist and surgeon, orbital, ocular plastic and lacrimal surgeon in Australia. You gave me a website to look at other doctors. Could you give me that again? Also, I have a couple more questions after reading your site. What is a snap test? What other questions, things should I say to the doctor when I go in for the procedure next Thursday? We are not meeting again and I feel like he wasn`t very informative. Should I talk to him about not being too aggressive removing fat on the lower lid? I have always had terrible puffy bags and was told at a young age they would have to be removed (way before Graves`). So I am excited to finally get rid of them but am worried about excessive fat removal. Do you have any suggestions or advice on what I should say or talk to the surgeon about before surgery? Thanks so much!

Answer:

certainly express your concerns, I am sure they wil be receptive, the only silly question is the one you do not ask, as to the site, it is www.surgery.org/public/findasurgeon. The snap test is when they pull on your lower lid to see how strong the muscle is in terms of pulling your lid back against the eyeball. All the best. JG 9.27.06

Question:

Hello, What cream or treatment do you recommend for an upper eyelid blepharoplasty scar? It has been almost a month and the scar is lumpy and kind of hard. Is this normal? I`d like to try something (cream) to help it along while it is healing - if that is possible. Thanks very much.

Answer:

all normal, I suggest ScarGurad or Mederma. JG 9.25.06

Question:

Help Doc. Six weeks post canthoplasty and the swelling is still making my eyes extremely watery. Is this normal? Is there still time for the corners of my eyes to smooth out?

Answer:

yes, still early to decide. JG 9.25.06

Question:

Hi Dr. Garcia. I am a 20 year old and have very hollow eyes. I do not know how this happened, it was pretty sudden and I`ve never seen anyone under 30 who has hollow eyes? What can I do to correct this and what do you think caused it?

Answer:

I am sorry but there is not much that cna be done and as to why it happened, in your case most likely it was a genetic predisposition to not having much fat there to begin with and as you lost your baby fat as you aged it became more apparent. JG 9.24.06

Question:

hello. fat injections for lower eyelids. some drs are very good in it with no lumps and such a smooth contour. the question is: for how long will the non absorbed fat survive around the eyes? how long does it take to know how much will stay in there after an injections (3 months???) thank u

Answer:

well, if the fat survives it can last for years, and if you gain weight it can also grow like the fat could from the area it came from. Usually what you have at 6 months will stay. JG 9.23.06

Question:

hello dr garcia. im afraid of having scar tissue developping in my left eye as its margin is pulling down much more than the right side (im 9weeks post reconstructive surgery hard palate+canthoplasty+fat)and at 2 months post op the eyelid margin on the left side is already barely touching the brown of my eye. Do u think that i might redevelopp retraction on the left side? is it possible that im having scar tissue that is pulling my lid down? i know that scar tissue can be soften with injections (5FU??) if so, how long after can i still have those injections? is 4-6 months post-op is way too late? please help

Answer:

it sounds like some scar tissue is the issue, I suggest seeing your surgeon to see if something can be injected there to soften things up a bit, I think it is safe to do so at this time. Best of luck. JG 9.21.06

Question:

hello dr garcia. im afraid of having scar tissue developping in my left eye as its margin is pulling down much more than the right side (im 9weeks post reconstructive surgery hard palate+canthoplasty+fat)and at 2 months post op the eyelid margin on the left side is already barely touching the brown of my eye. Do u think that i might redevelopp retraction on the left side? is it possible that im having scar tissue that is pulling my lid down? i know that scar tissue can be soften with injections (5FU??) if so, how long after can i still have those injections? is 4-6 months post-op is way too late? please help

Answer:

It sounds like the scar tissue might be forming, I suggest seeing your surgoen to see if they can inject something to soften it up a bit,I think it would be safe to do so at this time, best of luck. JG 9.21.06

Question:

Hello good dr.It is Kentucky. I would like to ask what the price of removal of festoons usually cost? By the way you are not comming to Ky. any ways soon are you? If ever please let me know!thank you so much.....

Answer:

it varies depending on the size but typically between $500-$750 per festoon if done under local anesthesia in the office. Sorry, but no plans to work in Kentucky at present, beautiful place though. JG 9.21.06

Question:

Hello Good Doctor. 5 months ago had mini-facelift and lower bleph. Eye bags and snap quality of lower lid on right eye still very poor (no improvement even after surgery). Left lower eyelid marginally better. PS agrees revision on right eye is nescessary and will perform it free of charge. My question- would he normally perform revision on only one eye (the worse one) or can I realistically ask him do do revisions on both so they match? Is revision lower bleph easier to perform the second time around or just as complicated. Thuankyou.

Answer:

revisons are more difficult than the first go round and one can at times operate on only one if the other side is OK. JG 9.19.06

Question:

Hi Dr. Garcia. First of all, I`d like to thank you for your service. People`s lives have been changed because of you. I was born with congenital ptosis. Half of my eyes are blocked by my upper eyelids. I have to raise my eyebrows in order to see straight. I`ve seen an oculoplastic surgeon lately and he suggested that I should do frontalis suspension. My question is: Will my eyes look bigger without having to raise my eyebrows? Do I still have to raise them in order to see more every time I look up? Thanks again for your time and I look forward to hearing from you soon.

Answer:

yes, the frontalis sling will open the apeture of the eyelid so the eye will look bigger with less effort on your part. The sling should correct it so you do not have to think about lifting the eyebrows any more. There are other options though so you may want to see if there are other options like a levator advancement that could work, a little less invasive and if it works it would be eaiser to recover from. Best of luck. JG 9.18.06

Question:

thank u dr for ur reply regarding my eyelid revsion surgery (hard palate graft) In fact, when the swelling is there, does the eylid margin look higher beeing pushed up by fluid or would it look lower beeing pulled down by the swelling? thank u

Answer:

when it is swollen it pushes it up and also makes it stiff so it does not bend or fold as well, making it look bigger too. JG 9.18.06

Question:

hello dr garcia. if i had an eyelid reconstructive surgery 2 months ago with hard palate graft and so far it shows that the right side is more overcorrected than the left giving a real asymetry in both eyes. is it possible to have the right side eyelid margin to be at the same level than the left side? if so how to do so, will it need to have the graft taken out and to reput another one that takes the eyelid margin to a lower level or is there any other intervention to do so and how soon should this be done? thank u so much

Answer:

It is difficult for me to give you much advice as I would need to see and touch the tissues to do that, I will say that swelling will always go down unevenly so give it some time. I would wait at least 6 months prior to any revision surgery though. JG 9.18.06

Question:

My 12 year old daughter had ptosis surgery one week ago. Is it normal for her eye to be swollen causing the eye to look larger? Also she doen't blink with her post op eye. The doctor said to stretch the inner corner to make the lid look better. Please let me know where I can see images of one week post op ptosis surgery. Thank you 8-18-06

Answer:

I am not aware where you can see pictures of ptosis surgery one week post op but what you are describing is common and normal. JG 8.18.06

Question:

Dr. Garcia, I am 26 years old. I have under eye bags. I do not want to do blephroplasty. I heard about Thermage procedure. can this procedure will be helpful to reduce eye bags ? Thank you. 8/5/06

Answer:

save your money, it will not help. JG 5.7.06

Question:

Dr. Garcia, Are plastic surgeons at liberty to perform canthopexy or canthoplsty with blepharoplasty without informing their patients before hand? I was only informed of this procedure at my first lower bleph post-op. I only consented to have excess skin and fat removed but not to have my lid position altered. Canthopexy or -plasty was never part of my informed consent. Can the unacceptable results, such as asymmetrical eye shape/size and elevated corners , be reversed or revised? I guess I am practically at a loss as to what to do now since this is my first cosmetic surgery procedure.

Answer:

it can be reversed. As to whether it is part of a blepharoplasty, most of the time if one is planned it should be explained before the surgery, it is not always done. You should be able to tell before the surgery if one will be needed. JG 5.7.06

Question:

Hi Dr. Garcia ! I had u/l bleph with cantho 1 year ago. Some fat was removed, some repositioned.The undereye area looked smooth and beautiful post op and after 2 months the bags started slowly to reappear. One eye was stll looking good for almost 8 months, but by 1year mark both my eyes have bags again .I am 51 (no wrinkles),totally healthy what could possibly cause it. Could it be MLD massage that was almost forcefully administrated starting 3 days post op by my PS ? Thank you very much.

Answer:

it appears that the sutures that were supposed to hold the fat in its repositioned location did not hold up and may need to be done again. JG 5.6.06

Question:

Is it more difficult to correct hollowed eyes in the lower eyelid in the outer part of the eye than the inner. My eyes are hollowed more in the outers so I have an uneveness, almost a big dip taken out of the lower. If I was to try to correct this, what would be the best way to go? fat transer or belph revision?

Answer:

I am sorry but neither one may help. Improving the inner aspect is a little easier. JG 5.6.06

Question:

Dr. Garcia, any recommendations on a topical usage to eliminate/reduce under-eye bags? My skin is in excellent condition other than under-eye bags. My age is 50. Thank you!

Answer:

the bags are usually due to fat pockets and I am afraid there is nothing topical that will improve that. JG 5.6.06

Question:

Hi Dr. Garcia ! I am glad I found this site. I had u/l bleph exactly one year to the day, canthopexy or canthoplexy was also performed during surgery which I was not aware of up untill after the surgery.Dissatisfaction aside I am left with slightly visible and very uncomfortable pea-like sutures in the outer corners of my eyes.What exactly is this, should I have something done about it, because my eyes feel uncomfortably tight and I still have chemosis on and off.

Answer:

it is the permanent suture used for the canthopexy and at this point can be removed without affecting the canthopexy. JG 5.6.06

Question:

hi dr. garcia, I had my upper eyelid done like 5 days ago and I had put a warm moist towel over my eyes. I have a feeling that i burned them with it. I didn't think that it was too hot but maybe it was. I know that it's supposed to be swollen and red around the eyes but i'm getting little bumps on the lids and on top of them. Is it normal or did i acturally burned them and what can i do?

Answer:

sounds like its OK, just a skin reaction, just make sure the next time it is not as hot. Should all get better. JG 5.5.06

Question:

Dr. Garcia, I had lower bleph done 3 months ago. I thought the corners were too high and I therefore look very exotic. I just want to maintain my natural lid position. Can my lid position be revised?

Answer:

yes, especially if a canthopexy was done that can be revised. JG 5.5.06

Question:

Hello, Dr. Garcia, I am almost three months post blepharoplasty. The corners are swollen and hurting, much more now than the first few weeks post surgery. It feels like something is rubbing against my eyes, it feels gritty. Is this an indication of infection? Should I see my surgeon ASAP? I will see the surgeon on May 8th so what do I have to do in the meantime?

Answer:

I think you should if you had any internal sutures placed they may be poking throuh and causing the problems. Hang in there. JG 5.4.06

Question:

I had lower bleph 3 months ago and my eyes are hollow from it, but I also have loose skin. Do you think if the skin was pulled up in the corners, this might help to reduce the hollow eyes. Thank you....

Answer:

probably not, it would just tighten the skin. JG 5.4.06

Question:

Hi, dr. garcia, It has been three months since my blepharoplasty. I have reddish indentations on both sides of my eyes. will those heal or disappear over time or do I need corrective or revision surgery for these?

Answer:

should all go away in a couple more months. JG 5.4.06

Question:

Dr. Garcia, This is the second follow-up to my initial inquiry. I am interested in revision blepharoplasty and you gave me a price quote for it. You mentioned that I should wait for at least 6 months unless there is potential danger or complication to the eyes. May I know what these dangers/complications might be? Thank you so much for your generosity and help.

Answer:

if you are having probelms that are affecting your vision or affecting your cornea, the I would move on it. Things like the cornea drying out and ulcerating. JG 5.4.06

Question:

Dr. Garcia, You gave me a price quote for revision lower blepharoplasty. It has only been 2 1/2 months since the first procedure. How long must I wait before considering a revision?

Answer:

I would suggest 6 months if possible to allow the tissues to get soft enough to work with, but if there is potential danger to the eye, then we go sooner. JG 5.2.06

Question:

Dr. Garcia, I had lower blepharoplasty 21/2 months ago. My left eye looks more open and extended than the right eye. The right eye has a smaller eyehole, looks raised and rounder at the margin. Can the margins or corners be revised to achieve symmetry? Will I have worse scarring from the revision? How much do you charge for revision eye surgery? I'm looking for a surgeon with experience plus an eye for symmetry.

Answer:

yes it can be revised and the scarring should not be bad at all. The cost will depend on how involved it will be but between $2000 to $2650, all inclusive. JG 5.2.06

Question:

Hi Dr. Garcia, I had a bad bleph and revision and now I have visible scars on the side of my eyes. What do you feel is the best way to revise these? Also, I have an indentation and ledge on the side of my eyes and upper cheek. Any suggestions for correcting that? Thanks

Answer:

may need more surgery with more skin shifted around to minimize the depression I am afraid. JG 5.2.06

Question:

Famous oculoplastic surgeon in LA suggested fat pearl graft to THE ORBIT TO correct overresection of fat to lower eyelids! also suggested tear trough silicone implant! Dr said that fat that stays after 3 months is PERMANENT! How permanent will the pearls be? are we talking about 2-3 years or more? Is the TT implant safe, does it have to be replaced in few years or its permanent? thanx a lot

Answer:

the tear trough implant is permanent, as to the pearls, I would say maybe 2 years in most cases, some may get longer, and some may get less. JG 5.2.06

Question:

Typically how long does it take for all the swelling and bruising to go down after a lower bleph?

Answer:

3 months. JG 5.2.06

Question:

I had a lower bleph. 3weeks ago with a muscle ightening procedure. The sutures did not approximate the lateral canthus area well @ has healed slightly open. Is it possible to have this revised? Much more bothersome is a suture knot that I can feel @ is raising the skin @ causing redness. I can sort of feel the sutures @ I am afraid these may have to be removed. Can another suture material be used? Can the fixation be deeper so as not to disrupt the skin surface? Thanks

Answer:

yes, to all of what you are asking but you should wait a little until the tissues are more pliable and easier to move and work with. JG 5.1.06

Question:

I had u/l bleph 3 months ago. The outcome has been devastating! I had a large orbital eye area to begin with, but now I have such hollowed out eyes as well. One eye actually has an indentation line under it. My PS claims he pushed back the fat with cautery. I do have some loose skin left. Would a revision help take away the hollowed look? How about a lateral canthopexy to tighten muscle and skin. Would this procedure help reduce the large orbital area or would a complete midface lift be needed? I heard that if a midface lift was done through the eyelid, when the midface wears off, you would actually look worse and more hollowed? Is this true?

Answer:

hard for me to say without examinging you but tightening muscle will not fill in hollow areas, just will smooth the skin. A mid facelift will lift the cheek and give you some extra lid skin but will not replace fat. May be a difficult thing to correct. JG 5.1.06

Question:

I dont have bags under my eyes, but It looks more like fat underneath my eyes. Its been there for many years now, but I have pictures of me in elementary school without them. I'm in 11th grade. Is there any type of exercises I can do to get rid of them, because there is no way I am going to get a transcutaneous lower eyelid blepharoplasty that I've read about. Its not that bad, but it takes away from the appeaance of my face. since it is fat, there has to be some way to burn it.

Answer:

most likely it is thicker muscle at your age and there is not much you can do except try not to squint as much because that makes the muscle bigger. JG 5.1.06

Question:

LB:04/30/06 Dear Dr. Garcia, I had Blepharoplasty approximately one month ago. My right eye did fine almost immediately, but my left eye was very swollen. It has gone down alot, but there is still a small area that remains swollen between the socket and a quarter inch down. Sometimes it seems better and then it comes back swollen again. It is always alittle swollen, but often looks worse. Is this normal? What are the chances it will still be reduced after one month out?

Answer:

normal and should all go down in a little more time. JG 5.1.06

Question:

I had bleph a few years ago. I am only in my early 20s. The surgery left me with a small crescent shaped skin fold at the outer canthi due a vertical shortening of skin. Luckily the shape of the eye easn't affected. Will this improve as I age? Have you ever seen this complication? Thanks

Answer:

it should all get better in time, yes. JG 4.30.06

Question:

I had lower transjunctival blepharoplasty performed about one month ago. My lower eyelids are still swollen and I still have the appearance of bags. Additionally, I now have much more pronounced wrinkles under my eyes. I'm only 32. What accounts for this and will it improve with time?

Answer:

should all improve in time and most likely is due to swelling that in some individuals can take longer, hang in there. JG 5.1.06

Question:

I am a 30 year old woman who had bilateral transconjuctival blepharoplasty four weeks ago. The bruising from the surgery faded within two weeks; however, my lower eyelids are still very swollen. My bags appear pretty much the same as they did prior to the surgery. Is this abnormal? How long should it take before I see a difference in my eyelids and before the swellling subsides? I read that 85% of the swelling should be gone within the first few weeks, but this certainly does not appear to be the case for me. Thanks so much for your help!

Answer:

in certain cases it can take much longer, just give it some time. JG 4.30.06

Question:

I'm 4 months post lower bleph and midface elevation. I still can't squint, and have a tight feeling all throughout my cheek area. The sides of my nose, beginning near my eyes are very tight and appear swollen too. Is this normal. My doc says I should be better and doesn't know why I'm not.

Answer:

well, it can happen, is not totally normal but should get better in time. JG 4.30.06

Question:

Hi Dr G- My lower eyelids were hollowed after a botched bleph. I tried doing a search through the archives, but it seems like there is really no hope for a permanent fix. Is this true? What do you recommend for a long lasting solution? Thanks, as always for all the information, AF

Answer:

i think there are things that can be tried but they all have risks of lumps I am afraid. JG 4.30.06

Question:

Dr. Garcia, I had transcutaneous lower blepharoplasty 2 1/2 months ago. during my first post-op the PS told me that he also put knots on both corners of my eyes to keep the lids from sagging. I am now wondering if he did either a canthoplasty or canthopexy because I am experiencing some complications as I heal. The left margin is more elevated than the right one and my left eye appeared to have shrunk making the eyehole smaller. Furthermore, I am still experiencing soreness and some swelling right where the knots are. Will these knots dissolve or should I ask my PS to remove them? Can the corners be revised so my eyes will become symmetrical?

Answer:

whether they will dissolve depends on the kind of sutures placed. The corners can be released but it will take more surgery. JG 4.30.06

Question:

Hello and welcome back! I had an u/l bleph 6 weeks ago and I'm 75% thrilled. Much more fat left under one lid than the other...the dr saw it too. He said it's sometimes difficult to judge how much fat will come forward when a patient is upright. He said he could fix it in his office under mild sedation and local anesthesia. He said he would do it any time I want...now or next year even. I'd like to know what you think I should do. Is the area still too tender? Do you think the longer I wait, the less complications/pain/bruising?Thanks.

Answer:

I would give it at least 6 months and then decide, best of luck. JG 4.30.06

Question:

Hello, I had a upper and lower bleph (from inside of eye) w/c02 laser resurfacing under eye almost a year ago. the skin under my eyes is especially saggy when I smile. It bunches up. Will any additional laser help with this or should I consider a revision of the lower bleph from ouside of eye? I also have two little noticable bumps where the incision came together at the outside corner of the eye when I smile. Will these smooth within time, or is there something that could be done about these to make them go down. They aren't painful, but I feel a dead giveaway I've had surgery.

Answer:

well laser helps skin quality while surgery from the outside relieves excess quantity so it depends on what you need. The lumps should have smoothed out by now so you may need a little revision there if it has been one year already. Best of luck. JG 4.30.06

Question:

Hi Dr. Garcia, This is a great website, and the first I've seen like it. I've searched all over the web for a place to ask my question. Anyways, I'm a 28 year old guy and, within the past few months, I've noticed a bag under JUST my right eye. I don't know if it's fluid, or what. The thing that's confusing is that I have NO bags under either eye when my face is expressionless. However, when I squint a little, my right eye develops a puffy bulge under it, while my left eye doesn't. It's very uneven. If it helps, my nose curves to the left side a bit. As a result, I've noticed that when I smile, the right corners of my mouth contract futher up than the other side. Could this just be that the muscles on the right side are just contracting differently because of the placement of my nose, causing the bulge? Or is this fluid? I mean, I've never noticed it before...it's a new development. Thank you! MJ 04/28/06

Answer:

it is most likely a small hypertrophic thicker muscle right below the eye and it might be able to be fixed with a little surgery, but it needs to be done very conservatively. JG 4.30.06

Question:

Hello Dr. Garcia, I had u/l eye lifts, endoscope brow lift, and a full face lift, my pc did not go into the hairline behind the ears, but stopped just behind them about half way up in the fold, he said because I did not have a lot of neck skin to lift, it has only been 3 weeks and 2 days ago. They did not explain anything about how it would look behind the ears, I was horrified by the site (I wear my hair up a whole lot) It was really bunched up at first, it looks like the left ear might be ok but behind the right ear is about an inch long speed bump that is VERY visible. I just dont see how it will ever go away. Dr. says to not worry, that it will in time. If it does not, what kind of revisions do they do to take care of it. More surgery? Good Grief. What is an acceptable amount of time to wait to see if it will go down, I would never wear my hair up again if it were to stay that way, I am so glad I have long hair Peananner

Answer:

in many cases they do go away and if it does not then the scar just needs to be made a little longer and the pleat cut out. I would wait at least 6 months and the doctor in most cases will take care of it in my experience. Down time would be small and it might be able to be done under local anesthesia. Best of luck. JG 4.22.06

Question:

Dr. Garcia, how long does your eye looked pulled away at the corner after a hard palate graft? Also, in your experience does this procedure have a pretty good success rate? Most of the information I found said the success was good, but I just read a site from a CA doctor that said the hard palate graft would eventually deform the eyelid and it has scared me to death. Thank you for your insight.

Answer:

it might look like that for 2-6 weeks in certain cases. In experienced hands it does work well. I think in good hands it will do well. JG 4.21.06

Question:

dr. Garcia, I had lower bleph done 9 weeks ago in which excess skin and fat was removed. The corners are high and a little tight on one side making my eyes different in size and shape. Is this all part of the healing process or should I be worried about my eyes being asymmetric permanently? Can the corners be revised and when should I consider having this done?

Answer:

it can happen in normal cases, may need a little massage. But the corners can be revised if they remain that way. I would wait 6 months after the surgery. JG 4.21.06

Question:

Hello: I had lower eyelid surgery about 4 months ago which left my lids gaping open. After having massage and steroid injections, they improved about 85% (at least they don't fall open when I put my head down now). About a month later I had a midface lift. I am fairly happy with the results however, one cheek is hanging off the lower orbital bone which has created an ugly ridge. I am getting married soon and the dr. didn't want to start any repairs in case it looked worse. Do you have any suggestions for repairing this ridge? I am 53 years old and thin built. I might add that, by the end of the day, it looks worse. Thank you!

Answer:

all I can suggest in the short term would be to inject a filler to plump it up for a while. JG 4.19.06

Question:

I had lower bleph around 10 weeks ago. The ps cauterized some of the fat in my eyes and removed 3 mm of skin on each eye. Now, the skin under my eyes is actually more wrinkled and is loose. I actually feel the loose skin sort of sinking into the inner corners of my eyes. How could it actually be looser when I had skin removed. Could it be that he cauterized too much fat which is causing it to be more loose and wrinkled. If in general, someone had a little more fat removed than they should have and had some more skin removed to tighten the undereye, would that person have even more of a hollowed look? Also, down the road, would that person generally age worse because of aggressive amount of fat cauterized under the eye?

Answer:

at times the fat can keep the skin plump amd your assessment can be what has occured. Aging will be acclerated in excessive fat removal cases I believe. JG 4.18.06

Question:

Im am 48 years old and had an upper/lower bleph on Mar 29. Things were looking fabulous even only after one week out, and then a massive infection set in in the right eye. The next day, it spread to the left eye, but to a much smaller degree. In the right eye, the lower eyelid was swollen, and dark red in color, and the under eye area was puffed way out and full of pus. It has been an ongoing battle. The infection was resistant to all kinds of medications, and finally started to respond to Levaquin (sp?) This was in addition to hot packs, ointment, and eye drops. The surgeon was in daily contact with me, and last time she saw me (one week ago), felt it was getting slighly better. Here I am, 2 1/2 weeks later, and still, at this point, the lower eyelid is deep red, and oozes occassionally - alot of the swelling that had the pus has gone down, but it's still there to a degree. I realize it takes time to recover from these eye procedures, but I'm concerned as this eye infection just doesn't improve past the point it is now. My next follow-up is in one week. My medications are now gone, and the surgeon wanted to see how things went without them. Have you ever encountered this in your patients, and if so, how did it finally get resolved? Also, under the left eye at the top of the cheek bone, is an area of puffiness w/a brownish colored spot - you can tell there is fluid build-up in this area - what causes this? Thx so much. cmk

Answer:

I luckily have not had it happen but it can. I think what is being done is the correct thing but it might take a number of weeks to get better as that skin is quite thin and shows any swelling easily. JG 4.18.06

Question:

Dr. Garcia, when a PS tells a patient to massage the area around their eyes or cheeks to help improve the stretched or pulled lid, does that ever really work or is it done just to pacify the patient for a while? Thank you

Answer:

no, it really does help the swelling but also more importantly helps to soften the scar tissue and make it more pliable so the lid will move better. JG 4.16.06

Question:

hi dr. garcia, I am so pleased to have found your sight, i had upper and lower bleph 3 and half months ago, both lower parts of the eyes and pulling down as if too much skin has been taken or i was stitched up too tight, you can see inside both eyes as in the red area at the bottom of an eyeball. like when you pull your eyes to remove a lash or piece of grit, i am really upset about this i have been left with mis-shaped eyes, i was told to try tape and have done this every night. I have to see my surgeon next week and want to be ready with my answers if he says he can see nothing wrong. I also have dark circles under each eye, which i am now reading from your site is due to fat removal which i was not informed may happen, i have to use concealer every day, will this go away. I will appreciate any answers you give me as i am really upset about this.

Answer:

the darkness may not get better although end result for that will be aother months. As to the lids pulling down and giving you what appears by your description is called cicatricial ectropion,all due to scarring, and may need more surgery to improve I am afraid. How extensive will depend on how severe the problems and how stiff the tissue is. You may need to see another surgeon if your doctor does not agree with you. Best of luck. JG 4.16.06

Question:

Hello Dr Garcia, I've just read your response to my question about botox and ptosis. I cant see any significant 'drop' in my eyebrow 'levels' if you know what I mean, what concerns me is what appears to be inner eyelid swelling. Could it be an eye infection, or is this part of the syndrome you described - forehead related eyebrow drop? Finally, you say this could take longer than eyelid droop to resolve - ballpark figure? In hindsight I think this happened before - very heavy feeling along the brow, which I'm feeling again. Thankyou once again.

Answer:

infections are rare but if the brows drop, then the fullness can be from the skin being looser there. If it is the forehead that has dropped it might take months to go away. Thee may have to avoid injecting the Botox too low in the center of your forehead in the future. JG 4.15.06

Question:

Hi Dr Garcia- I had upper/lower bleph, canthoplasty + brow lift three weeks ago. It seems the crease in my right eye is lifted too high. I am having touble closing that eye and I can see the white of my eye above the pupil when my eye is open. How soon before I can go for a revision and what I can do about this now? I'm just constantly putting eye gel in to stop it from drying. My plastic surgeon is in another state. I don't want to travel back there as I feel he is not competent to deal with this. He keeps saying give it a few more weeks when I call him. Thanks so much for all your advice.

Answer:

the brow lift may relax and fall and then you may not need anything more, I would wait 3-6 months. But if you are having severe eye problems, something may need to be done sooner, if the brow lift had suture fixation, at times they can be cut and allow thenbrow to drop. Hang in there. JG 4.14.06

Question:

Dr. Garcia I am 60 and had an u/l bleph seven months ago. My lower lids are quite wrinkled now; however my main concern is the upper lids. The right upper is very puffy (the ps pressed on this and said this may go down [both he and I knew that it would not]); but the inner corners have excess skin that is draped. He said that this could be fixed, but since I did have excessive bleeding, he would not recommend it because of the possibility of blindness. I am heartsick, since I waited 20 years to have this surgery. Apparently, my blood pressure soared upon awakening, causing extreme bleeding. Is there any less invasive procedure to allow my eyes to look more opened--a look that I have waited so long for and which completely escaped me during this surgery. Karen

Answer:

maybe a little laser to tighten the skin some more. CO2 or Rhytec. JG 4.13.06

Question:

dr. garcia, i had upper eye and lower eye surgery. it was pretty radical as i had oriental eyes and i do not now. what i want to know is, before the surgery, i had the whites of the eyes were white as snow, due to very clean organic diet and pure water, now no matter what i do, it is yellowish and with a lot of blood vessels. i have a clean bill of health as i just went thru a rigorous health screening for plastic surgery. can anything be done. it seems i did not get enough oxygen for too long during surgery. when i ask him about this, he just refers me to a opthamalogist. i have already been there and they say it happens. any advice would be appreciated. the ps told me he got a great deal of fat out of my eye area. it looks a little sunken also. thank you so much.

Answer:

I think most of that discoloration should get better in time with proper sleep and diet, hang in there. JG 4.14.06

Question:

I recently had a canthopexy performed solely on my right eye, as I was attempting to mask the uneven placement of my eye orbits (the right eye's orbital bone structure is significantly lower than the left's). However, I am not seeing the results I expected. Is there any other alternative for this condition, which is one that I am extremely sensitive about and strongly desire to fix? Thank you for your time. -James Griffin

Answer:

I am sorry but unless the bones are moved, there is not much more that can be done. JG 4.13.06

Question:

Also one more question regarding the question below. What if anything can be done about this hollowness. He said that the fat will eventually come back. Is this true?

Answer:

once melted, fat will not return,it will not rise from the dead like Lazarus, may need something done but all things being tried there are fraught with complications like lumps and uneveness. Sorry. JG 4.12.06

Question:

When fat is pushed back into the fat pockets in a lower eyelid bleph with cautery, and palpebral fascia to the periosteum of the infraorbital rim aera was plicated with 7-0 Vicryl x2. What does that mean exactly? Does this mean that fat was taken out of the eye?

Answer:

it means they heated the fat to attempt to shrink it and then tried to put stitches into the layer that would normally hold the fat back in its more youthful position. No fat was taken out. If the fat was only repositioned there would not be a hollow appearnce but if the fat was heateed, it might have caused some dissolving of the fat that can lead to hollowness. JG 4.12.06

Question:

the lateral lower lid margin of my right eye sits higher than the lateral lower lid margin of my left eye. this makes the right eye smaller than the left. what can be done to lower the lid margin of the right eye? will the scars be visible? could manual stretching (pulling the lid margin down repeatedly) cause it settle in a new position without the need for surgery?

Answer:

if it is due to a canthopexy, it can be relaxed and evened out, but if it is due to scarring, it might be tough to correct. The scar may extend a little further out than the eye lashes. I am unsure whether the manual stretching will be effective. Best of luck. JG 4.12.06

Question:

Dr. garcia, My PS performed a procedure called canthoplasty along with lower blepharoplasty 8 weeks ago. Now the outer corner of my left eye is higher than the right and this makes the left eye appear smaller. In addition, the left corner is still tight and is pulling down the upper lid. Can this be revised or reconstructed to achieve symmetry? thanks.

Answer:

the canthopexy would need to be released and re-doen at a lower position. JG 4.12.06

Question:

Dear Dr Garcia- you have said below that a canthopexy can be reversed. Can a canthoplasty be reversed or relaxed as well? What is the minimum amount of time I should wait before reversal. I was hoping 6 months should be enough. Is this something I should go to an eye specialist for. My canthoplasty makes my eyes extremely asian and slanted and small. It is also crooked and assymetrical. I'm at 4 weeks post-op. Thank you

Answer:

Yes, it could. I think you should give it 3-6 months before deciding. I think seeing someone that specializes in eyes is best for what you have. Best of luck. JG 4.12.06

Question:

When a canthopexy is performed exactly where are the incisions made? Do they extend past the under eyelid. Is there a visible scar? Is this procedure performed on younger patients of 43 years old?

Answer:

lateral part of the eyelid at the lash line, extending a little further out. There may be a visible scar, yes. Age is not a consideration if it is needed to be done. JG 4.11.06

Question:

Hi Dr. Garcia- I had a lower bleph and chin lipo 3 months ago. Doctor told me not to wear the chin wrap after the second day after surgery. I see an improvement in my chin but it's not what i expected. Also, I'm satisfied with one eye but there is residual swelling in the other and they're always swollen when I wake up. At what point do I say Okay, I might need a revision? for either surgery. Thank you so much for your time and expertise!!!

Answer:

I would give it at least 6 months and then decide, hang in there a little longer. JG 4.11.06

Question:

HI DOC: I was reading that after 8 months both of a person's lower lids started retracting and begun showing more eye white than desired. Can this just happen down the track? I had lower lids done a month ago and want to know if they look alright now will it remain this way. Or can they retract down the track too? What causes this? What should I be looking for to know if this is going to happen?

Answer:

It is unusual for it to occur so far out, normally if it is going to happen it happens in the first couple of months. Usually scar tissue or over-resection of skin and muscle weakness are the usual causes. JG 4.11.06

Question:

Dr. Garcia, I asked the question about the hard palate graft. What do you think is happening with my eye? (still pulled tight and a gap showing) No one is seeing his patients and my appointment isn't until May. Should I be concerned? Thanks

Answer:

It could be that the graft is not being accepted. I think you should see another occuloplastic surgeon in your area ASAP, and honestly, I find it unethical to leave town and not leave a professional to care for your patients in their absence, it violates most standards of most medical societies and certifying boards. Most unprofessional I feel. JG 4.10.06

Question:

Dr. Garcia, I had a hard palate graft on March 17 and my OPS is out of town and I am wondering if you can a