Cosmetic Eyelid Surgery in Beverly Hills – Dr. Guy Massry
12Feb/150

Upper Eyelid Hollows or Sunken Eyelids after Blepharoplasty Surgery – Eyelid Fillers Can Be The Answer

Posted by Chris Sullivan

Hello, I am Guy Massry, MD – an oculoplastic (ophthalmic plastic surgery specialist) in Beverly Hills, California. Over the years I have had extensive experience in performing secondary surgery (revision surgery or “redo” surgery) on patients unhappy with their initial blepharoplasty (cosmetic eyelid surgery). This has been a very taxing experience as I have seen so many unhappy and emotionally damaged patients who are in the depths of what is a form or variant of post-traumatic stress disorder (PTSD). The inciting event was surgery which “altered” the patient’s natural appearance. This does not mean there is anything wrong with the patient. It means the outcome of surgery negatively affected the patient’s confidence, well-being, and most importantly, their perception of themselves. The most common statement I hear from such patients is “when I look in the mirror I see someone else.” It is essential for all of us to understand this statement. Everyone would be bothered by “losing” a part of themselves – especially their appearance or how others see them. As I practice in Beverly Hills, a city where eyelid surgery is so commonplace, I tend to see a high volume of these issues.

With experience I have realized that while surgery can help in many of these cases, in some situations surgery is limited, and there are other, “better” options for certain patients. One such situation is upper eyelid hollows after poor outcome upper eyelid blepharoplasty. Hollows are depressions form over-excision of skin, muscle or fat. It leaves patients with a deep upper lid and often times skin on bone which is a very aged, or what we call “skeletonized” look. The primary goal of surgery is to recreate youth – this situation does the opposite. It surgically ages people.

I have developed some simple in-office techniques to address the issue of a hollowed or sunken upper lid after upper blepharoplasty surgery. The technique involves the placement of a specific filler to fill and expand the depleted tissue planes so that youth can be re-created. Physician injectors tend to take fillers lightly as they are not a “surgical procedure.” However, complications from fillers also occur and it is critical that you seek an eyelid filler expert when you get treatment, especially with revisions of poor outcome surgery. It is very important the physician injector know the biochemical makeup of the various fillers (all are different and all act differently) so that appropriate selection of filler material for each individual patient is performed.

Please don’t give up if you suffer from hollow upper lids after blepharoplasty surgery. I am happy to see you in consultation and discuss the various options of treatment. Do not get stuck on a permanent solution surgically. If surgery is not indicated or cannot meet your expectations – more surgery can, and often will, make things worse. Please contact my office, Guy G. Massry, MD, at 310-863-3488 or through my website if you would like information or a consultation upper eyelid hollows or sunken upper eyelids after blepharoplasty.

Below is an example of how the situation can be remedied with filler.

 

Blepharoplasty  remedied with filler - before & after.

Blepharoplasty remedied with filler.

 

A: Initial patient presentation to me after poor outcome upper blepharoplasty surgery
B: Immediately after filling left upper lid with filler in the office
C: Immediately after filling right upper lid with filler in the office
D: A month after filling procedure. A very natural result

 

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

13Mar/130

The Origin of Blepharoplasty Surgery – Dr. Guy Massry, MD – Beverly Hills Blepharoplasty Specialist

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The word blepharoplasty is derived from the Greek words Blepharon, meaning eyelid, and plastos, meaning formed.  Blepharoplasty surgery is one of the oldest described treatments of the aging face.  The goal of surgery is to remove excess tissue which causes and overhang of skin leading to cosmetic (poor appearance) or functional (reduced field of vision) consequences. The first recorded blepharoplasty surgery was by a Spanish surgeon, Albucasis, a pioneer in the creation of surgical instrumentation, including the use of cautery (to control bleeding) in 1000 A.D.

Modern blepharoplasty techniques have certainly come a long way.  Current upper lid blepharoplasty procedures focus on the excision of variable amounts of skin, muscle, and fat.  An increased interest in lower lid blepharoplasty surgery has also evolved.  Lower blepharoplasty surgery primarily focuses on preventing lower eyelid droop (ectropion, retraction) and hollowing (volume depletion).  These complications are inherent to the more traditional excisional (tissue removal) surgery.  Modern lower blepharoplasty focuses on tissue preservation (fat repositioning) or augmentation (fat transfer)

Fat preservation and repositioning in lower lid blepharoplasty continues to develop. Dr. Guy Massry (Beverly Hills Ophthalmic Plastic Surgery), a blepharoplasty surgery specialist  has made many advancements in the lower blepharaoplasty procedure.  Most recently Dr. Massry has published on and presented results of combined fat repositioning and lid lifting (The Lift and Fill Blepharoplasty) http://www.ncbi.nlm.nih.gov/pubmed/22460677 , http://www.prweb.com/releases/liftandfill/lower-blepharoplasty/prweb9449357.htm  and comparing fat repositioning techniques http://archfaci.jamanetwork.com/onlineFirst.aspx (open PDF to article Transconjunctival Lower Blepharoplasty With Fat Repositioning: A Retrospective Comparison of Transposing Fat to the Subperiosteal vs Supraperiosteal Planes by Donald B. Yoo, MD; Grace Lee Peng, MD; Guy G. Massry, MD).  If you are considering blepharoplasty surgery you can visit Der. Massry online http://drmassry.com/#/home/  for more information.

24Feb/130

Blepharoplasty Surgery (Eyelid Lift) Before and After Photographs

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Blepharoplasty Surgery (Eyelid Lift) Before and After Photographs

24Jan/130

Avoiding Blepharoplasty Complications

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Poor results to blepharoplasty surgery are not uncommon and are devastating to patients.  Avoiding these complications starts with seeing the most qualified doctor assess your concerns with your eyelids. Dr. Guy Massry is an ophthalmic plastic surgeon.  This is a specialist is cosmetic eyelid (blepharoplasty) surgery. Dr. Massry is a member (fellow) of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS  http://www.asoprs.org ).  He has also edited three well-respected textbooks on the subject of cosmetic eyelid surgery (blepharoplasty) and correcting problems related to this http://www.springer.com/medicine/ophthalmology/book/978-1-4614-0066-0 , http://www.springer.com/medicine/ophthalmology/book/978-0-387-25389-3 , http://www.pr.com/press-release/459510 , and is on the editorial board of the society journal – Ophthalmic Plastic and Reconstructive Surgery – OPRS http://www.pr.com/press-release/450162 .  As Dr. Massry practices in Beverly Hills, California http://drmassry.com/blog/new-beverly-hills-office where a large amount of upper and lower blepharoplasty is performed – He tends to see many such issues.

Common problems seen after upper and lower blepharoplasty are lower eyelid retraction (pulled down), lower eyelid ectropion (turned out), inability to close the eyes, dryness, irritation, infection, poor cosmetic outcome, and the list goes on.  As stated these problems negatively impact patients often times to the point where quality of life is reduced.  Information about Dr. Massry and his scope of practice can be attained by reviewing his website http://drmassry.com .

16Sep/120

Educate Yourself Before Having Cosmetic Eyelid Surgery (Blepharoplasty )

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Blepharoplasty surgery is a unique form of specialized facial cosmetic surgery which addressed the aged eyelids.  This includes both the extra (hanging) skin of the upper eyelids, and the puffy and prominent bags of the lower eyelids.

The surgery to correct these issues is called blepharoplasty surgery.  Blepharoplasty surgery can be performed while awake, under local anesthesia injections only, sedated or asleep (under general anesthesia).  Blepharoplasty surgery is so specialized that there is a group of cosmetic physicians who only specialize in this area.  This specialty is called ophthalmic plastic surgery.  The organization which trains oculoplastic surgeons is called the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Please open this ink to find out more about ASOPRS http://asoprs.org.

Dr. Guy Massry, Beverly Hills blepharoplasty specialist is an ASOPRS member who performs hundreds of both upper and lower blepharoplasty surgeries every year.   He has particular expertise in revising surgery after poor outcomes http://www.realself.com/find/California/Los-Angeles/Oculoplastic-Surgeon/Guy-Massry ,http://www.vitals.com/doctors/Dr_Guy_Massry#reviews , http://www.ratemds.com/doctor-ratings/170637/Dr-Guy-Massry-Beverly+Hills-CA.html .  Dr. Massry’s only goal to provide an honest appraisal of what can be achieved with your blepharoplasty surgery so that you can have a realistic expectation of outcome

Please open this link to see before and after surgery examples of Dr. Massry’s work (click on before and after gallery) http://drmassry.com/#/1-3

If you have any questions regarding Dr. Massry’s work, or desire a blepharoplasty surgery consultation; Dr. Massry  can be reached at his Beverly Hills office at 310 453-8474

 

 

 

25Jul/120

How to Fix Bad Blepharoplasty Surgery

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Blepharoplasty surgery – also referred to as eyelid surgery, eyelid lift surgery, eyelid bag surgery or simply cosmetic eyelid surgery – is one of the most common facial plastic surgical procedures performed today.  Numerous surgeons from varied subspecialties perform eyelid lift surgery.  The problem is that blepharoplasty surgery is a very specialized cosmetic surgery which can easily lead to a poor outcome if not performed by the appropriate surgeon.

So who performs eyelid lift surgery?

  1. Oculoplastic or ophthalmic plastic surgeons.  These specialists are first trained in eyes (ophthalmology) and then further trained is eye plastic surgery.
  2. Facial plastic surgeons.  These are ear nose and throat trained surgeons who do further training in facial cosmetic surgery.
  3. General plastic surgeons.  These are surgeons trained only in plastic surgery – but of the entire body (head to toe).
  4. A variety of other surgeons without any specific training in plastic surgery.

Clearly the best trained and most experienced surgeons for your eyelid bag surgery are oculoplastic surgeons http://drmassry.com/#/6-0 , http://drmassry.com/blog/?p=116 .  All other fields do not have the depth of training in surgery of this very complex area of the face.

Cosmetic oculoplastic surgeons specialize in blepharoplasty (eyelid or eyelid bag surgery) http://drmassry.com/blog/?p=754http://drmassry.com/blog/?p=603, http://drmassry.com/blog/?p=546 , http://drmassry.com/blog/?p=531 .  They also specialize in fixing surgery that has turned out poorly.  No other field in cosmetic surgery has this form of training.  If you have had a poor outcome to your eyelid bag surgery – please see only an oculoplastic surgeon to correct the problem.  This is the best way to ensure a good outcome to your redo (revisional ) procedure.

Common problems encountered after poor result eyelid lift surgery are inability to close the eyes, pulled down lower lids, problems with the canthus (outer corner of the eyelids), residual puffiness, and a slew of other issues.

These problems can be corrected in many cases.  However, to do so, only a specialist in the field should be seen.

 

 

 

 

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.

 

29May/110

Fat Repositioning In Lower Eyelid Blepharoplasty

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Lower eyelid blepharoplasty has traditionally consisted of the excision of excess skin/muscle and fat from the lower eyelids.  What was identified over time is that tissue removal – especially fat - eventually led to a gaunt or hollowed appearance which actually accelerated the aging process rather than re-creating youth.  Over the last decade a paradigm shift has occurred among cosmetic eyelid surgeons (ophthalmic plastic surgeons or oculoplastic surgeons).  This shift is towards preserving eyelid fat rather than removing it.  Actually a better word is redistributing eyelid fat from areas of excess to areas of deficit.  This has allowed not only the reduction of  prominent  lower eyelid “bags,” but also the simultaneous filling of lower eyelid depressions or grooves (typically under the bags) with this fat.

A major groove which causes concern to many patients is the tear trough (or nasojugal groove).  It is present under the lower eyelid fat bag near the nose (on the inner part of the lower eyelid/cheek junction).  This depression cannot be corrected by fat removal only.  This is one of the areas of the lower eyelid which can be filled with Restylane or Jevederm if surgery is not desired (see link http://drmassry.com/blog/?p=176) .

In fat repositioning lower blepharoplasty the lower eyelid fat pads are shifted into the tear trough under the skin to fill the depression.  The fat acts like a filler but is one’s own tissue.  It does not dissolve over time like the fillers we inject.  The surgery is more complex and delicate than normal fat excision lower eyelid blepharoplasty – but the results are superior.

I believe that facial/eyelid fat is precious and should be preserved as much as possible to prevent long term hollowing of the eyelids (a very unattractive appearance).  Sometimes fat does have to be trimmed a bit, but more often than not, there are as many areas of depression which need this fat as there are areas of fat excess.  Typically fat repositioning (shifting) redistributes the fat appropriately to significantly improve eyelid contour.

Below is an example of a young woman who presented with lower lid fat prominence and an associated depression below (tear trough or nasojugal groove).  She underwent lower blepharoplasty with fat repositioning by me in addition to a midface (cheek) lift.  Note the significant improvement is lower lid appearance after surgery with reduction of lower lid bag and filling of associated tear trough (depression below bag).

Before My Surgery          After My Surgery

Lower lid blepharoplasty with fat repositioning is an intricate procedure which should only be performed by a cosmetic eyelid specialist.