general anesthesia for breast augmentation

what treatment would you recommend for undereye hollows? i'd like some help with what i can do withmy under eye area. i saw a plastic surgeon the other day and he said my under eye hollowsare due to naturally hollow cheek bones so my under eye area isn't supported, also thinunder eye skin and prominent brow. he said in his opinion i would need a number of surgeriesto correct this including cheek implants, fat transfer, brow and nose shaved too. couldn'ti just have a lower bleph to correct it to bring up the lower area and so there isn'tso much thin skin thank you for your question! you submitted a photo and you described ina pretty nice detail your recent consultation

with a plastic surgeon about the puffinessand the appearance of your under eye area and interestingly, this plastic surgeon madean assessment of the relative prominence of your cheeks and the recommendations that camefrom that included cheek implants, nasal surgery etc and that’s quite a lot. and your questionof course is if you can have just a lower eyelid blepharoplasty. well assuming that you already understand,i’ll just give a brief review of what the plastic surgeon was describing. when we lookat a person’s lower eyelids, we assess why they are puffy. most commonly, they are puffybecause of lower eyelid fat prolapse. lower eyelid fat prolapse means that the fat thatis normal below your eyes, pushes forward,

creates a bulge appearance and at the sametime, a lot of people have skin discoloration. so, when we are addressing lower eyelid fatprolapse and skin discoloration, we do a combination approaches. one is to do a procedure calledtransconjunctival blepharoplasty and that’s to reduce the fat pockets from the insideof the eyelid and by doing that, we are able to reduce, reposition and do whatever proceduresnecessary in order to restore the contour. when it comes to the discoloration of theskin, just briefly, we routinely help people with a material called platelet-rich plasma.platelet-rich plasma is derived from your own blood. it is essentially a concentrationof the growth factors and the healing processes that are necessary for wound healing and wehave found that it helps people. the skin

quality improves significantly. when we do this type of procedure, what we’redoing is we’re taking away the negative that dominates your face. the negative aspectthat draws all the attention. in the field of cosmetic surgery, we look at things bothin the close-up view as well as the holistic view. when i look at the patient, i just thinkwhat’s dominant feature that is drawing the attention and is that dominant featuretaking away from the face. well, when someone has bags under their eyes, and they alwayslook tired it just affects everything in their whole face. now in terms of what the doctor was talkingabout in the cheeks, there’s something called

negative vector. it means that the cheek boneis relatively less projected compared to the eyeball or front of the cornea. now that isa set-up in certain patients for issues related to cosmetic eyelid surgery such as lower eyelidretraction and we have seen a lot of patient all over the world who unfortunately had surgeriesdone from an external approach and by doing an external approach or transcutaneous blepharoplasty,skin was removed and nothing was done to support and control the position of the lower eyelid.what eventually happens in the healing process, the lower eyelid pulls down and creates aretraction. in some cases, it actually everts and causes ectropion or the eyelid being exposedfrom the inside. so that being said, the doctor made a veryvalid assessment as to your anatomy. in our

practice, we are very sensitive to this andby doing the approach we do and doing things that are specific to my experience and expertise,we manage to avoid these types of issues 99% of the time. and so, that being said, i wouldagree with you. you may just start by first dealing with the issue on your face that isdominant and is the most negative which is the puffiness under eyes. and after that procedureis complete, you still feel that you want more cheek projection or you want other thingsdealing with your nose, then you can pursue those things. i think a lot of plastic surgeons are biasedbecause when they look at a patient, they want to address everything. and two, becausethey do everything under general anesthesia,

they want to try to do as much as they canfor that patient during that one general anesthesia session. in our practice, we don’t do generalanesthesias. we do everything from eyelids, facelift, breast augmentation, liposuction,tummy tucks, we do everything under local anesthesia with sedation and so, we are ableto give our patients a lot of flexibility, from that perspective. that being said, putting aside the anesthesiaissues, i think that trusting your own instincts about addressing the lower eyelid alone wouldprobably make a significant amount of difference for you. it is really dramatic how the wholeface can be enhanced dramatically by reducing the puffy bags under the eyes.

so at this point, meet with other cosmeticsurgeons and get some other opinions and find a doctor that you resonate with and get arealistic of your outcome and once you do that, make the decision and move forward.so i wish you the best of luck, i hope that was helpful and thank you for your question!