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

 

13Mar/130

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

Posted by admin

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.

7Jan/130

New Beverly Hills Office

Posted by admin

Dr. Guy Massry – Ophthalmic Plastic Surgery – Beverly Hills, California – is proud to introduce the opening of his new office.  Dr. Massry’s new office address is:

150 North Robertson Blvd

Beverly Hills, California 90211

Ph (310) 657-4302

FAX (310) 6574322

Cosmetic-Eyelid-Surgery-Dr-Guy-Massry-150-North-Robertson-Blvd-Beverly-Hills-CA-90211-1 Cosmetic-Eyelid-Surgery-Dr-Guy-Massry-150-North-Robertson-Blvd-Beverly-Hills-CA-90211-2 Cosmetic-Eyelid-Surgery-Dr-Guy-Massry-150-North-Robertson-Blvd-Beverly-Hills-CA-90211-3 Cosmetic-Eyelid-Surgery-Dr-Guy-Massry-150-North-Robertson-Blvd-Beverly-Hills-CA-90211-4 Cosmetic-Eyelid-Surgery-Dr-Guy-Massry-150-North-Robertson-Blvd-Beverly-Hills-CA-90211-5 Cosmetic-Eyelid-Surgery-Dr-Guy-Massry-150-North-Robertson-Blvd-Beverly-Hills-CA-90211-6

16Sep/120

Educate Yourself Before Having Cosmetic Eyelid Surgery (Blepharoplasty )

Posted by admin

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

 

 

 

18Jun/120

Closed Canthoplasty – A New Surgical Option

Posted by admin

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)

 

26Feb/120

Eyelid Filler Injections with the Microcannula

Posted by admin

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

25Feb/120

Lower Eyelid Blepahroplasty with Fat Transfer (Repositioning or Grafting)

Posted by admin

Blepharoplasty is a form of eyelid surgery whereby eyelid “bags” are removed.This can include upper or lower eyelid blepharoplasty, or both upper and lower eyelid blepahroplasty (four lid blepharoplasty).In a subset of lower eyelid blepharoplasty patients eyelid fat can be preserved, rather then excised.The fat bags are still removed from where they are excessive (BAGS), but the fat rather transferred or repositioned to areas of adjacent eyelid hollows or depressions.

This is called lower eyelid blepharoplasty with fat repositioning

This is an advanced form of lower eyelid blepharoplasty, performed only by eyelid surgery specialists (experts).

Below is an example of a woman who presented with lower lid bags and an associated depression (tear trough).Dr. Massry performed lower lid blepharoplasty with fat repositioning on her to reduce the eyelid bags and the hollow.On the right is her after picture.

 

29May/110

Fat Repositioning In Lower Eyelid Blepharoplasty

Posted by admin

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.