For years when patients came to see cosmetic surgeons they were counseled on how surgery could remove the excess skin and bags and get rid of wrinkles. The thinking was that gravity made the eyelids and face sag and that cutting out skin and fat and lifting tissue was the answer. Well we have found that often times this kind of surgery made patients look funny, gaunt, pulled and “done.” It just doesn’t look natural. Why is this? In the last decade or so we have learned that
one of the main reasons we look aged and tired is loss of volume (fat) from our faces. This causes skin and muscle to fall and collapse. It is the same thing that happens to grapes as they turn into raisins. With this in mind we have concentrated very hard on techniques which replace volume in the face whether they be gel fillers (Restylane, Perlane, Juvaderm) , or our own fat (fat grafting). This has revolutionized how we approach cosmetic surgery. We no longer emphasize subtractive surgery (where all we do is remove tissue); but rather focus on replacing what is lost.

This concept of volume loss with age is most apparent around the eyes. The upper and lower lids are supported by muscle, fat and bone. With age the fat shrinks, the muscle weakens and bone is resorbed (lost like bone loss in the body with osteoporosis). With this tissue loss the lids lose support and sag. This leads to bags, dark circles, puffiness, hollows, and wrinkles. The sun damage to the skin
accentuates the appearance by causing the skin to lose collagen and elastin (the stretchy material in the skin that allows it to snap back into place like a rubber band).

We now believe that replacing this lost volume is the most important feature of restoring youth. Rather than tissue reduction we emphasize tissue addition.

Dr. Massry has specific expertise in volume preservation and replacement in cosmetic eyelid surgery. Please refer to his photo gallery for examples of fat repositioning and fat grafting procedures which maintain facial and eyelid fat. Dr. Massry’s contact information is on the home page of this website. He would be happy to discuss these new concepts in eyelid surgery with you at length at your convenience.