Tag Archives: blepheroplasty

Under Eye Circles and Bags

16 May

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).


Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have. I’ve done multiple surgeries with Dr. Russo. He does an amazing job, and it’s definitely one of my favorites to assist in!!!

Least Invasive to Most Invasive

  1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
  2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
  3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
  4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
  5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
  6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:

Before: I look tired. And old. Ew. Taken November 2011.

After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.


(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31


Thinking about a NoseJob/Breast Aug/Lipo/Tummy Tuck? … Butt Implants?

15 Dec

I go with a lot of my clients to their consultations and watch a lot of procedures with Dr. Russo.  My wonderful friend called me at 8 this morning to ask me what she should ask at her consult (apparently she forgot I am NOT a morning person).  I jumped out of bed though, because I remembered I had a lists!  I love lists ALMOST as much as I love white boards!

I know Plastic Surgery isn’t for everyone, but I think if you are contemplating it, you should be prepared from the beginning; starting with the right surgeon can make all the difference in the world!  (I am very partial to Dr. Russo, who, by the way, gave me this list).

Plastic Surgery:  Making the Best Decision

Brief important plastic surgeon qualifications

Please check out www.plasticsurgery.org to see if your surgeon is ASPS accredited.  If they are ASPS accredited you are in good hands.

Each ASPS member must meet the following:

  • At least five years of surgical training and a minimum of two years of plastic surgery training.
  • Board certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
  • Trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
  • Peer-reviewed for safety and ethical standards prior to attaining the honor of active membership.
  • Only operates in accredited facilities.

When making the choice:

  • Use your head not your heart in making the selection.
  • Bring before and after photos, if possible, to show what you want.
  • Research the doctor, call other patients for recommendations.
  • Get a recommendation from your bariatric surgeon.
  • Meet the doctor and get to know him or her; you trust yourself to his or her care, so you need to feel comfortable with the person.
  • Use the term “reconstructive surgery” with your insurance company, since “plastic surgery” is often considered to be “cosmetic” or “elective” and hence is not covered.

Questions to ask:

1.  Are you an ASPS member surgeon? If he or she answers “yes” you can rest assured that your surgeon is board certified in plastic surgery, has hospital privileges and only performs surgery in accredited facilities.
2.  Are you board certified by the American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada?
3.  Do you have hospital privileges to perform this procedure?   If so, at what hospital? Is the surgical facility accredited?
4.  Am I a good candidate for this procedure?
5.  What will be expected of me to get optimal results?
6.  What are the risks involved with my procedure?
7.  Will I need to take time off work?  If so, how long?

What you should ask about the procedure

8.  What is the simplest and safest surgery to help me achieve my goals?
9.  How is the surgery performed?
10.  What is the expected length of operation?
11.  Are other options available?
12.  What results can I expect, and how long do the typical results last?
13.  Where will scars be located, and how noticeable will they be?

What you should ask about your surgeon’s experience

14.  How many times has the surgeon performed this procedure?
15.  How long has the surgeon been performing this procedure?
16.  How many times per year does the surgeon perform the procedure?
17.  How many patients have required re-operation or touch-ups?
18.  What complications may occur?
19.  How frequently do these complications occur?

What you should ask about logistical matters

20.  What preparation is required the day before and morning of surgery?
21.  Should my regular medications be taken on the morning of surgery?
22.  What time should I arrive at the surgery location?
23.  Should someone drive me?
24.  Should someone wait at the surgery location or come back later?


What should you ask about emergency plans

25.  What emergency plan and equipment are in place to provide for my needs in the event of an emergency?
26.  Are the surgeon and staff certified in Advances Cardiac Life Support? (ACLS)?
27.  Does the surgeon have admitting privileges at a local hospital should problems arise during my office surgery? (Call the hospital to confirm)
28.  How would I be transported to this facility?
29.  Has an adverse event ever occurred in the past?

What should you ask about the recovery process

30.  What kind of care will I require?
31.  When will I be able to go home? Is an overnight stay required, or is one available if I prefer?
32.  Who will attend me in the case of an overnight stay?
33.  Will I need someone to drive me home?
34.  If a problem arises after I go home, who answers calls after hours and on weekends?
35.  If I need to be seen after hours, where will this occur?

36.  If I need help in my home, is a private duty nurse available?  At what cost?

37.  Are any special garments, medications, or diets required during the recovery period?
38.  How much pain/swelling/bruising is to be expected? How long are these likely to last?
39.  How long does the entire healing process last?
40.  How many follow-up visits are necessary?
41.  Who performs the skin care/post-operative follow-up/suture removal?
42.  When can I wear makeup?
43.  When may I return to exercise/bathing/driving/normal activities/work?
44.  At what point will I feel comfortable in a social setting?
45.  What if I am dissatisfied with the results or with the degree of changes achieved?
46.  If touch-ups are necessary when would that be performed?

What about fees

47.  Does the cost depend on where my surgery is performed?
48.   Will I need to see another physician prior to surgery for examination or testing because of a preexisting medical condition?

49.  Who pays this cost? Will my regular family doctor suffice?
50.  If a complication causes me to be transported to a hospital or stay overnight, who pays for this additional cost?
51.  If I request multiple procedures, can they be performed at the same time? What are the cost savings?

52.  What options are available for payment?

53.  Does the office accept credit cards?
54.  Is a payment plan available to patients?
55.  What is the refund policy should I change my mind after paying in full?
56.  Is my surgery covered by my insurance plan?

After discussing all of the factors involved with your proposed procedure with the surgeon, you should have a sense of whether or not the surgeon is right to you.  Take note of and consider whether the surgeon:

  • Listen and understand your priorities, opinions, and requests?
  • Communicate concern, compassion, request and honesty?
  • Instill confidence in you?
  • Display confidence in his or her ability to care for you?
  • Seem distracted, or come across as arrogant or curt?
  • Seem patient and willing to spend time to answer all your questions and discuses your concerns?
  • Condescend; talk down or under estimate your intelligence?
  • Make eye contact or continually jot down notes in the chart as you spoke?
  • Display positive body language?
  • Confuse you or offer clear explanations?
  • Appear to be selling you the procedure?
  • Adequately discuss any preexisting medical conditions you might have?
  • Encourage your family to participate in the consultation and decision-making process?

Do you:

  • Feel that you have established forthright communication and a positive rapport with the surgeon?
  • Trust your life to this surgeon?
  • Feel the Surgeon is acting in your best interest?
Remember, Aesthetic Augmentation is no one’s decision but yours. 
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