Cosmetic Eyelid Surgery in Beverly Hills – Dr. Guy Massry
18Oct/170

The Brow and Upper Eyelid: An Aesthetic Unit

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Did you know that the brow and upper eyelid should both be evaluated when considering blepharoplasty? Many patients come in for upper blepharoplasty (cosmetic eyelid surgery) thinking that it will address their upper eyelid bags. However, what most don’t know is that the position of the outer brows often affects the upper lid fullness.  When the outer brow falls, which is a normal change of aging, the upper lids become heavier.

While cosmetic eyelid surgery is a very common procedure these days, it is still very important to find an eyelid specialist who knows that the brow and upper eyelid should really be approached as one aesthetic unit in order to get the best results. Dr. Guy Massry is an oculoplastic surgeon who is internationally recognized for his unparalleled eyelid rejuvenation results. Below he has put together some keep points for patients to keep in mind before having upper blepharoplasty:

  1. Always ask about the brow. If the brow has drooped, blepharoplasty alone will make things worse (more corded appearance to the upper lids).
  2. This does not mean you need an outer brow lift – but surgery of the upper lids needs to be altered to accommodate the depressed outer brow.
  3. Don’t fear brow lifts.  If done endoscopically and by an experienced surgeon, it's less traumatic than the lid surgery.
  4. Outer brow lifts, also called temporal brow lifts, DO NOT MAKE YOU LOOK SURPRISED.
  5. An outer brow lift is done for support only.
  6. They limit the length of the upper lid incision so that it only includes the eyelid and the incision is hidden.
  7. An outer brow lift provides a natural arch to the brow (which was present in youth and will increase the beauty of the lid itself).
  8. Talk to a specialist about this – ONLY an experienced surgeon should perform an outer brow lift with upper blepharoplasty.

Before & After Outer Brow Lift with Upper Blepharoplasty

Below are three examples of patients who underwent upper blepharoplasty with an outer browlift for support.

Patient 1

Upper and lower blepharoplasty with outer brow lift.

Upper and lower blepharoplasty with browlift.001

Patient 2

Outer brow lift with upper and lower blepharoplasty with Dr. Massry.

Outer brow lift upper and lower blepharoplasty - Dr Guy Massry

Book Your Consultation Today!

If you are interested in learning if you are a candidate for upper blepharoplasty with an outer brow lift, please call our office today to schedule a consultation with Dr. Massry - 310-657-4302.

Dr. Massry customizes every surgery he performs to the needs of his patients so that the results are as beautiful as possible. This means that during your consultation with Dr. Massry not only will he evaluate your needs, but he will also listen to your anti-aging goals so he can exceed your expectations. We look forward to meeting you!

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12Oct/170

Lower Eyelid Fat Grafting: Understand What You Are Doing

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Lower eyelid fat grafting (or fat transfer) has gained widespread popularity amongst plastic surgeons over the last few decades. It can be a great option for replacing lost volume in the face and is a potentially permanent option, as compared to fillers.  This is all well and good.  However, it is important to really think this procedure through prior to proceeding with it, especially when fat grating the lower lids.  Why? Because some bad complications can occur.

Here are important facts to consider about fat grafting:

  1. Grafted fat has an unpredictable survival. A 50% survival is what is quoted. This has never been proven scientifically. It is only an opinion!!!
  2. Fat is typically taken from the inner thighs, abdomen, or other areas where fat can deposit in the body. This type of fat is different than facial fat. This fat can grow as we gain weight. There have been many patients whose faces have become large over time after having fat grafted to the face.
  3. The body may attack the transferred fat (to remove it). Even though it is our own tissue, it is placed in a different location, so the body considers it foreign. When this happens, lumps, bumps and contour irregularities can occur (what Dr Massry calls "LBCs").
  4. The eyelid skin is very thin and cannot hide even minor irregularities (LBCs). These can be disfiguring to the facial appearance.
  5. Dr. Massry is soon to publish data that in a large series of patient studies this problem (#4 above) can occur in as high as 8% of patients who have fat grafting to the lower lids.
  6. Dr. Massry has treated many patients with fat grafting related LBCs to the lower lids. THIS IS VERY HARD TO CORRECT.
  7. Make sure to educate yourself about lower eyelid fat grafting before proceeding with this procedure.
  8. Most importantly, make sure that only an eyelid specialist does this procedure for you.

Case Studies - Fat Grafting Repair

Patient 1 - LUMPS & BUMPS

This patient had lower eyelid fat grafting a couple of years ago from another surgeon. In her pictures below, you can see she has lumps and bumps from the fat transfer. This appearance made her very self-conscious. To improve her appearance, Dr. Massry performed his cutting-edge procedure to remove the lumps and bumps through an incision inside the lower eyelid so he did not have to make any skin incisions.

Eyelid fat grafting repair - Dr Guy Massry

Patient 2 - CONTOUR IRREGULARITIES 

This patient was very unhappy with the results of under eye fat grafting from another surgeon. She came to Dr. Massry to remove the contour irregularities from the fat grafting to her lower eyelids. As opposed to the first patient, this patient had primarily lower eyelid prominence from fat grafting. This is another way fat grafting complications can present. In addition to the revision lower lid surgery, he also performed an outer brow lift and upper and lower blepharoplasty to rejuvenate her overall appearance.

Revision fat grafting surgery - Dr Guy Massry

See more patients before and after revision surgery with Dr. Massry.

Consult With A Fat Grafting Repair Expert

If you have experienced complications from a previous fat grafting surgery, please do not hesitate to contact Dr. Guy Massry to learn more about how he can help you. Dr. Guy Massry is an oculoplastic surgeon who specializes in complex revision fat grafting procedures. To schedule a consultation with him, please call our office at 310.657.4302. For patients who live out of town, we offer initial Skype consultations so you can have your first appointment with Dr. Massry from the comfort of your own home!

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5Oct/170

How to Inject Fillers: Much more important than the product selected

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Injectable fillers have become one of the most common facial aesthetic procedures performed in the world. They have become a standard in facial aesthetic practices and can make a profound difference in improving facial appearance.  Most patients feel fillers (Juvederm, Restylane, etc) are a simple procedure, performed quickly with immediate and gratifying results. While this is typically true, fillers can lead to many complications - some of which are very series. It is important for patients to be aware of these issues and make sure they see the most qualified physicians that know how to inject fillers so that complications can be avoided.

What Are Possible Filler Complications?

In this post, Dr. Guy Massry will review the most serious of complications - vascular occlusions (a blocked facial blood vessel) which can lead to skin necrosis (death) and even blindness. These are very RARE complications which most injector will never see in their careers. This is not meant to scare patients, but rather to inform them of the issue and educate them on how important it is to see a well-trained physician injector.

Here are the important points:

  1. Facial blood vessels interconnect (communicate with each other). This means if one blood vessel is penetrated by a needle or cannula when the filler is injected, the filler can get to another area on the face. When this occurs, a nearby or distant area blood vessel can get blocked by the filler material. This is how vascular events occur.
  2. To prevent this, an intimate "MEDICAL" knowledge of facial vascular anatomy is needed (through continued medical education).
  3. Injections can be given with a sharpe needle or a blunt tipped cannula. There is no scientific evidence, that cannulas are safer (less vascular events) - but most feel this is true. There is a learning curve to using the cannula. In Dr. Massry's opinion, it is worth it. Also, recent scientific publications have shown that cannula delivery of filler is more exact/precise than filler given by a needle delivery.
  4. Injection technique is also critical to prevent such consular issues. Injections should be placed away from vessels, with fine movements, when the needle or cannula is drawn out, and not until there is an assurance that the injection is not in a blood vessels (by drawing back on the plunger of the syringe). Also very small amounts of filler should be given, with very low-pressure injection. ALL THESE STEPS ARE CRITICAL.
  5. Finally, NEVER have filler given (Hyaluronic acid gels such as Restylane, Juvederm, etc.) without a reversal agent (Hyaluronidase) available. THIS IS CRITICAL. Make sure your injector has this product for all injections or DO NOT DO IT.

Remember, always be safe and fillers can be an amazing facial aesthetic treatment!

Contact Dr. Massry To Learn More

If you are interested in learning more about facial fillers, please contact our office to schedule a consultation with Dr. Massry. He is highly experienced in filler injections and provides his patients with safe and beautiful results! Call us at 310.657.4302!

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3Oct/170

Cannula vs Needle For Facial Filler Injections – The Great Debate

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Cannula vs needleFacial fillers are an increasingly more common cosmetic intervention throughout the United States, and the world, in general.  We have learned much about filler materials, injection techniques, and how to prevent complications.  What is still “hotly” debated is how to best deliver the filler material - a cannula vs needle?

Here are some points to consider for the patient when the filler treatment is performed.

  1. Fillers were initially given only with needles.  The cannula – a blunt tipped delivery device – was introduced in the last 5 years to give an option other than using a sharp needle, which can cause more bruising than a blunt device and can more easily potentially enter a blood vessel which can lead to severe complications.
  2. There is a learning curve to using the cannula, so make sure your injector is well-experienced in using one.
  3. All well-trained and experienced injectors should be comfortable with both the cannula and the needle.
  4. Experience has shown that both techniques are effective and there are no evidence-based studies showing superiority of one over the other.  However, a recent cadaver study has shown the cannula delivery is more precise in where the filler is placed.
  5. When the cannula is used one entry site is usually sufficient to deliver the filler to many locations.  With the needle, this is less so, and more entry sticks are needed, which is more traumatic

While the needle and cannula can both be used to deliver filler, patients should know the differences so they can be involved in their treatment plan.

Contact Dr. Guy Massry To Learn More!

If you would like to learn more about cannulas vs needles for filler injections, please feel free to contact Dr. Massry to schedule a consultation - 310.657.4302. Dr. Massry is dedicated to educating his patients so they feel comfortable and confident before any treatment.

Read more of Dr. Massry's blogs about fillers: 

A Filler Warning - Not All Hyaluronic Fillers Are The Same

5 Things to Know About Eyelid Fillers

What Are Eyelid Fillers And How Should They Be Used?

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