Cosmetic Eyelid Surgery in Beverly Hills – Dr. Guy Massry
25Jan/150

New Textbook Published

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CPS_v42_i1_COVER.inddLower Lid and Midface: Multispecialty Approach

Following the success of the first volume published by Dr Massry and Dr Azizzadeh, the Editors present a second Multispecialty volume. This text is dedicated to Midface and Lower face rejuvenation techniques. An expert team of Editors spanning the practices of Plastic Surgery, Oculoplastic Surgery, Facial Plastic Surgery, and Dermatology discuss anatomy, techniques, procedure planning, complications, and outcomes in each specialty field.

16Jan/150

Lecturing at 8th Annual Oculoplastic Symposium in Atlanta

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8th-Annual-Atlanta-Oculoplastic-SymposiumDr. Massry is presenting 4 lectures at the 8th Annual Oculoplastic Symposium in Atlanta in January 2015. The titles of his lectures include:

• 10 Truths About Lower Blepharoplasty: A 17 Year Experience
• New Insights Into Lower Lid Retraction
• Volume Preservation Upper Blepharoplasty
• A Personal Perspective on Eyelid Fillers

18Jun/120

Closed Canthoplasty – A New Surgical Option

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Canthoplasty is a specific eyelid surgical procedure aimed at tightening or suspending the lower eyelid.  It is both a reconstructive surgery (for eyelid malposition – i.e. lid turns out – ectropion, or lid turns in – entropion), and a cosmetic surgery (to support the lower eyelid during blepharoplasty).

Traditional canthoplasty has been reconstructive in nature and has involved releasing the lower lid from its attachments to bone, shortening it, and the re-securing it to bone.  This is an excellent operation for patients with eyelid problems (as mentioned above); however, it can be a frustrating procedure for patients seeking cosmetic eyelid surgery (blepharoplasty).  This is because such disruption of the lateral canthus (where the outer part upper and lower eyelids meet) can lead to symptoms such as pain, tenderness, tightness, mal-alignment of the two canthi from one eye to the other, webbing of the canthus and a change in the shape of the canthus (canthal angle becomes rounder or too narrow).

An option in cosmetic patients to avoid these potential problems is what we call a closed canthoplasty.  This is a canthoplasty without cutting the canthus.  This is performed by making a small incision in the outer upper lid crease (where a line or crease already exists) and accessing the lower lid for suspension through this point.  This procedure suspends the lid without altering the canthus externally.  While this may not be ideal for reconstructive cases – it is especially beneficial for cosmetic eyelid surgery (blepharoplasty).

Closed canthoplasty is an advanced surgical technique.  It should only be performed by an eyelid specialist or a surgeon who has advanced training in eyelid surgery.  Please do your research on this and consider the option before proceeding with traditional open canthoplasty during cosmetic eyelid surgery (lower eyelid blepharoplasty)

 

27Feb/120

Midface Lift and Canthoplasty Surgery for Retracted (pulled down) Lower Eyelids

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One of the major complications of lower blepharoplasty surgery (cosmetic lower lid surgery) is lower lid retraction (pulled down lids).  Lower eyelid retraction leads to the white showing under the iris (colored part of the eyes).  This called scleral show (sclera is white part of eyes).  When this occurs the eyes become red, irritated, and dry.  The dry eyes can lead to reflexive tearing.  Repairing this condition (lower eyelid retraction) requires a specialist in eyelid surgery who is well trained in procedures such as canthoplasty surgery (open link) http://drmassry.com/#/1-1, canthopexy surgery, and midface lift surgery (open link) http://drmassry.com/#/1-0 .

Below is an example of a woman who had lower lid retraction (pulled down lower lids) from surgery by another surgeon. On the right are her photos after repair (canthoplasty surgery, midface lift surgery) by Dr. Massry.

 

26Feb/120

Eyelid Filler Injections with the Microcannula

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Eyelid bags and depressions can be treated non-surgically with filler.  Around the eyelids Dr. Massry (Beverly Hills Ophthalmic Plastic Surgery) prefers to use Restylane as his filler of choice. Traditionally, eyelid filler (Restylane) has been injected around the eyes with needles.  While the results have been good, there is often significant bruising and swelling associated with the treatment.

Recently, blunt-tipped microcannulas have been developed for injection of filler to any area of the face.  While these have taken hold, few injectors have been comfortable with injections around the eyes.  Dr. Guy Massry, an experienced eyelid filler injector has transitioned almost all his eyelid filler injections to the use of the microcannula.  Dr. Massry prefers this method, as it is safer (no chance of injecting into a blood vessel), more comfortable (not painful), easier to perform, and yields minimal to no bruising and swelling.

Below is an example of a woman who had Restylane eyelid filler injected to the hollows under the lower lids to improve appearance.  On the right are her immediate post-injection photos.  Note that there is slight redness (gone in 30 minutes) and no bruising and swelling

31May/110

Canthoplasty Surgery Part 3 – The Surgical Procedure

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In my first two blogs on canthoplasty surgery I discussed canthal anatomy http://drmassry.com/blog/?p=190 and why canthoplasty surgery is important http://drmassry.com/blog/?p=194

Please refer to these links for review.

Today I will describe with surgical photos and accompanying illustrations the traditional canthoplasty surgery or “lateral tarsal strip procedure.”

In the series below the top photos show the opening of the canthus (canhotomy), the middle photos the surgical cutting of the lid from the oribt bone (cantholysis), and the bottom photos how the lid is dynamically free after its release from bone.  This is how canthoplasty surgery begins

In the next series the photos demonstrate how a tarsal tongue (what we use to re-anchor lid to bone) is formed.  Top: tarsus (skeleton of lower lid) is released, middle and bottom: surrounding skin is cut away from tarsus.  This is how canthoplasty surgery progresses

In the next series on canthoplasty surgery the tarsus is prepared for suturing to bone.  Top: residual skin istrimmed from the tarsus, middle: tarsus is shortened, bottom: suture placed through tarsus in preparation for anchoring to bone.  The canthoplasty surgery is almost complete

In the final series below the canthoplasty surgery is completed. Top: suture placed through lining of the bone (periosteum), middle: lid tightened, bottom: skin closed.

As you can se there are many critical steps in canthoplasty surgery.  All the steps are important in order to get a good result.  For examples of before and after pictures of patients having canthoplasty surgery open the following link from my website http://drmassry.com/#/1-1

If you are interested in information on canthoplasty surgery you can contact Dr. Guy Massry (Beverly Hills Ophthalmic Plastic Surgery) at his office (310) 453-8474 or through his website http://drmassry.com