Cosmetic Eyelid Surgery in Beverly Hills – Dr. Guy Massry

Revisional Blepharoplasty

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Blepharoplasty is upper or lower eyelid surgery to improve appearance and at times vision (upper lid blepharoplasty).  Blepharoplasty surgery is performed by many specialists including general plastic surgeons, facial plastic surgeons and oculoplastics surgeons.  As eyelid surgery is a very specialized form of cosmetic surgery it is important to make sure your surgeon has specific expertise in aesthetic eyelid surgery.

When surgery does not turn out as planned, or complications occur, a re-operation is often needed.  The reoperation is referred to as a revisional procedure – or in this case revisional blepharoplasty.

Revisional blepharoplasty takes surgery to an even greater degree of difficulty and requires even more experience and expertise with the various eyelid procedures needed to correct the problem (ie. revisional blepharoplasty (EYELID SURGERY), revisional canthoplasty (LOWER LID TIGHTENING/ELEVATION SURGERY) and revisional ptosis repair (UPPER LID ELEVATION SURGERY), etc.).

Few doctors perform revisional blepharoplasty on a routine basis.  It is difficult and challenging surgery and the learning curve is steep.  In addition the results to revisional blepharoplasty surgeries are less predictable than to similar first time surgeries.

This does not mean that excellent results cannot be achieved.  To the contrary they can.  What is important is to place yourselves in the hands of a revisional blepharoplasty specialist who can give you an honest opinion regarding potential outcome and who can perform the procedure in the best and safest way.

Open the following link to get information on and view results to some revisional eyelid surgeries

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Blepharoplasty Surgery

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Blepharoplasty is the surgical procedure in which skin/muscle and fat (one or any combination) are excised from the eyelid.  Blepharoplasty can be an isolated upper lid surgery, lower lid surgery or both – commonly referred to as four-lid blepharoplasty (as both upper and lower lids are addressed).  Blepharoplasty surgery can be performed under local anesthesia (the patient is awake with the skin numbed), under conscious sedation anesthesia (IV medications given for comfort), or under general anesthesia (patient asleep with some kind of breathing tube in place).

Blepharoplasty surgery can be performed in 45 minutes if only the upper lids are operated on and in 1 ½ hours if a four-lid blepharoplasty is performed.

The postoperative course involves frequent application of ice to reduce swelling and the use of topical antibiotic ointment and or drops to prevent infection.  The ointment tends to blur vision, showering is ok the day after surgery, and physical activity (working out) should be avoided for 2 weeks.  The sutures placed are removed in 5-7 days.

In the hands of an experienced eyelid surgeon (Ophthalmic Plastic Surgeon) surgery is safe and effective.  Be sure to make sure your surgeon has experience and appropriate training with blepharoplasty surgery before proceeding.  Remember the eyes control out most important sense – vision.  Put your trust in the right person.

Open this links below for more information and before and after photographs on blepharoplasty surgery

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Male Blepharoplasty – Fat Repositioning and Fat Grafting

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Male blepharoplasty or blepharoplasty in men is very different than similar surgery in women.  The goal in male blepharoplasty is to avoid over-excision of skin/muscle and fat as to not feminize the patient.  This requires experience and an artistic hand.  Surgeons who perform male blepharoplasty should approach surgery with this very important concept in mind.  Many consider blepharoplasty in men a specialized form of eyelid surgery.  I agree to an extent.  While the surgery (male blepharoplasty) is the same as blepharoplasty in women, it is the approach which is different.

Like in women, preservation or augmentation of eyelid fat (fat repositioning or fat grafting) is an important part of blepharoplasty in men.  If more than a small amount of fat is excised a hollow appearance can develop.  This is both unsightly and tends to lead to an aged appearance.  Fat repositioning in lower blepharoplasty is a procedure whereby local eyelid fat is moved from areas of excess to where it is deficient ,  while fat grafting in lower blepharoplasty is where fat is taken from distant sites and transferred to the area around the eyelids where it is needed

It is very important to keep in mind that men are having cosmetic surgery much more than in previous times.  To assure appropriate surgical outcomes to these procedures surgeons need to be familiar with the nuances of male blepharoplasty which allow the best surgical results.  This requires a detailed knowledge of eyelid anatomy, function and surgical techniques and significant experience with male blepharoplasty patients.

Below is an example of lower blepharoplasty in a man.  Note the significant natural and youthful appearance after surgery (left before and right after surgery).


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Blepharoplasty and Botox – A Powerful Combination

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Often time’s patients come to me for eyelid surgery (blepharoplasty) with desires which cannot be addressed by surgery alone.  One of these desires is the reduction of wrinkles.  The surgical part can remove excess skin muscle and fat.  However, wrinkles will stay.  The only way to consistently remove wrinkles is to do something to the skin (laser, peel, etc.) or weaken the muscle under the skin with Botox.  Fillers like Restylane or Juvederm help in filling hollows more than in reducing wrinkles around the eyes.

There is a misconception that blepharoplasty surgery removes wrinkles.  It generally does not.  It does remove skin and all the wrinkles that are present in the excised skin.  However, whatever skin is left will still be wrinkled.  The take home message is that blepharoplasty surgery removes excess tissue only.  Botox, on the other hand, does reduce wrinkles, especially what we refer to as dynamic wrinkles (those that are present with facial movement like smile).  There is risk with injecting Botox to the eyelids themselves to reduce wrinkles, but in an experienced eyelid specialists hands, it can be done successfully.

In the example below, the patient had upper and lower blepharoplasty surgery, with postoperative Botox treatment to the lower lids.  You can see the vast improvement in appearance after surgery (left before surgery/right after surgery).  This shows how the combination of blepharoplasty surgery and Botox injections act synergistically (better together than each individually).


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Ptosis Surgery

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Eyelid ptosis is a condition where the eyelid muscle or tendon weakens and the opening of the eyelid becomes smaller.  There are many causes for eyelid ptosis – the most common is simply involution (aging).  Now aging does not always mean older.  Sometimes patients in their 30’s can have this kind of ptosis.  While they are not old - the eyelid muscle and or tendon may have prematurely aged.  It is important to separate eyelid ptosis from excess upper lid skin (dermatochalasis).  Excess skin requires skin excision (blepharoplasty) while ptosis requires repairing the eyelid muscle or tendon (levator muscle or tendon) which raises the eyelid.  This is called a ptosis repair surgery.

Ptosis surgery is a more complex procedure than standard blepharoplasty.  The surgeon must be trained in eyelid surgery and have significant experience with ptosis surgery.  If not performed correctly, ptosis surgery can lead to major problems with the eye and vision.  PLEASE make sure your ptosis repair surgeon is a specialized eyelid surgeon (oculoplastic or ophthalmic plastic surgeon) who has performed many ptosis corrections previously.

Ptosis surgery can be performed from inside the eyelid without an external incision, or through the skin.  Your surgeon will tell you in the consultation which approach is best for you.

Below is an example of a ptosis surgery on the right upper lid.  On the left is the before picture and on the right the after surgery photograph.  As you can see ptosis surgery can significantly improve vision by opening the eye and also appearance.

Please open this link for more examples of ptosis surgery by Dr. Massry


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Blepharoplasty – Blepharoplasty in Men

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Blepharoplasty (cosmetic eyelid surgery) is becoming more and more common in men.  Male blepharoplasty is different from the same surgery in women in that surgery is more conservative as not to feminize their appearance.  Over-aggressive male blepharoplasty is a common problem as many surgeons do not modify their technique when switching genders.  This has led to many unhappy patients who desire revision of their initial procedure.  The best way to avoid this is to see a well-trained blepharoplasty surgeon who has significant experience with surgery in men.

Below are two examples of before (left) and after (right) photos of male patients of mine who had upper and lower blepharoplasty.  The top patient was in his early 60’s and the bottom patient in his mid-70’s.  Note the natural and youthful improvement in appearance in both men after surgery. For more examples please open the link to my website