Bags, Brows and Bad Blephs: The Best Fix for Looking Tired

Dr. G (00:00):
You want to look more refreshed. You don't want to look like someone else.

Bri (00:04):
Yeah.

Dr. G (00:05):
Unless you're a Kardashian, which you're just mutating into something else.

Bri (00:09):
Yeah, you're a new bitch every 10 years. It's fine.

Dr. G (00:14):
You're listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. Two out of three facial plastic surgeons say more patients want eyelid surgery for one reason. Tired of looking tired. Amen. I will say upper eyelid surgery or eyelid surgery is always in the top five of performed and requested procedures every year when the different societies do their annual survey of what's hot, what's not. But looking tired can have multiple different causes and some of them are easier to fix than others. So I think it's just a matter of what is the issue, what actually works and what you may or may not need to avoid looking like, I don't know, who's a celebrity that you can think of that has jacked eyes? I know Kenny Rogers is one of the OGs, but you probably don't know who that is. Is there someone more... Well, I think Jim Carrey.

Bri (01:18):
Oh, that one was brutal. Yeah. I think Jim Carrey, they kind of did dirty. I think also, I don't think it looks bad, but Jesse from the Mormon wives, I think they just overdid it and she's said so many times that she does not love it, but I think she looks great.

Dr. G (01:33):
Yes, that's true.

Bri (01:34):
Still, she looks awake. She is wide awake.

Dr. G (01:37):
Wide awake.

Bri (01:38):
I also feel like when you're being tired, my under eyes. I'm like, I need to remove some of this skin. I also think that's what she did. Maybe it was a lower one. I walk in here with my eye patches in the morning.

Dr. G (01:54):
Yeah. I do think under eyes are important as well. Speaking of faces, let's get through some important celebrity news. I guess the original 2007 Keeping Up with the Kardashians faces popped up because they had their 19th anniversary and they have their new season out.

Bri (02:15):
Did you see Kylie on the Victoria's Secret fashion show?

Dr. G (02:18):
Yes.

Bri (02:18):
She looked so good.

Dr. G (02:19):
That's the second topic, but yes.

Bri (02:21):
Oh, sorry.

Dr. G (02:22):
But they do look completely different, which we all know. It's just interesting to see them side by side.

Bri (02:28):
Yes. And I loved, I saw some memes last night and it was all these people like, "Oh my God, imagine aging like this." And they're like, "The only thing that aged was their plastic surgeon. Come on. If you actually thought that these people just grew into these looks."

Dr. G (02:44):
I know. I think a lot of times when we see what happened to this person's face kind of situation, a lot of times you're like, "Oh, well, it's not fair because we're looking at a picture of them 10 or 20 years ago. So obviously there's going to be some changes." But these ladies -

Bri (03:02):
That's crazy.

Dr. G (03:03):
Don't even look remotely the same because they've altered their faces in so many different ways that it's not really an aging thing. They're just completely different people.

Bri (03:15):
Yeah. It's so wild. Even still being skinny, it's not like they lost a bunch of weight and look different except for Chloe. They just are different people.

Dr. G (03:23):
Yeah. It's bananas. But yeah, so speaking of, Kylie was on the...

Bri (03:29):
Victoria's Secret Fashion Show.

Dr. G (03:31):
Yes. Wearing a fantasy bra that was made out of gold and diamonds only.

Bri (03:35):
It was mazing. She got to wear it. My sister loves it. It's like a holiday for her kind of, she says. She sits down and every year she watches the Victoria's Secret Fashion Show. She's done it since she was 16 and she just was obsessing over it. So that's why I hear about all of it.

Dr. G (03:53):
Well, I don't normally pay attention, but it was playing at my house because my sister came over with her son and I had to study AP bio with him. And then my sister and my daughter were watching the show live. My sister is not a fan of Kylie. She thinks she's gross.

Bri (04:14):
Erica.

Dr. G (04:15):
I know. But she definitely looks -

Bri (04:18):
Why? We're going to have to have a personal conversation about this.

Dr. G (04:22):
Confident and in charge.

Bri (04:25):
I think since she had kids, she's really changed. And then I really liked her.

Dr. G (04:32):
Okay. I think it's fair.

Bri (04:33):
I think she's a great mom.

Dr. G (04:34):
Speaking of kids, I did see on my TikTok feed last night that there were 17 mothers in the Victoria's Secret show.

Bri (04:42):
Two of them. One was either three weeks or three months postpartum and the other one was like -

Dr. G (04:48):
Six weeks.

Bri (04:49):
Six weeks. I was like, that's crazy. I'm still trying to lose baby weight 14 years later. Just kidding. I remember my mom saying that forever. She's like, "I'm still losing the baby weight." And they'd be like, "How old are your kids?" And she'd be like, "25." That was her line forever.

Dr. G (05:04):
Barbara Palvin walks six weeks postpartum. She was funny. I didn't actually see her on the runway, but I saw her do a little thing like most people don't get more than six weeks off for maternity leave, so it makes sense I have to go back to my job. And I'm like, "Okay, that's fair."

Bri (05:22):
They look so great. They also let that one girl, I saw it was so cute who she completely ate shit on the runway.

Dr. G (05:30):
Oh, I didn't see that.

Bri (05:30):
Yes. And then she was... No, her first walk. Yeah. And then they did her walk now and she did it so gracefully. But yeah, I feel like the show is really good.

Dr. G (05:42):
It's terrifying. Even Kylie looks a little scared. It's terrifying to walk out there.

Bri (05:46):
Yeah. That would be...

Dr. G (05:49):
Yeah.

Bri (05:50):
I could never, unless it was really dark.

Dr. G (05:53):
In those heels, unless it's in my uggs, I might be able to do it.

Bri (05:57):
And I was in sweats and no one was watching.

Dr. G (06:04):
At home.

Bri (06:05):
Yeah. Through my hallway. Okay. So we've established we won't be walking the Victoria's Secret runway show.

Dr. G (06:11):
Yeah. That's not in our lineup. Walking's hard.

Bri (06:17):
If I were uggs too high with the platform uggs, I'll almost break my ankle. You'll see me walking down the hallway and they're just like eat shit.

Dr. G (06:27):
Let's not underestimate how hard it is.

Bri (06:31):
And they say those wings, like that one girl who was like three weeks or whatever postpartum, the wings were 50 pounds.

Dr. G (06:39):
Yeah. It's like this thing that they strap on your back. That's crazy.

Bri (06:42):
Yeah. Insane. I sit up too straight for more than three minutes and my back is spasming.

Dr. G (06:47):
Yeah, you're making me tired.

Bri (06:48):
My muscles aren't strong enough.

Dr. G (06:52):
Okay. So let's talk about... So speaking of eyelid lift, Teddi Mellencamp documents her eyelid lift while still in cancer treatment. I guess that's the grab on this headline. I mean, she's being treated, I think, for breast cancer. There's nothing that precludes you from having cosmetic surgery during that time, I guess.

Bri (07:14):
I would want to do everything I can to be super hot if I was going through something. I'd be like, "I'm going through this one thing. I'm going to do everything else I can."

Dr. G (07:24):
At least she did it safely. I would say upper eyelid blepharoplasty, you can do under local anesthesia, which is what she did. She did it in between chemo runs so that nobody, like cleared with both doctors, coordinated, and it was just something that was super important to her. And then she posted about it, had when her stitches were out, that kind of thing. And so we can talk about upper bleph. That is oftentimes a very nice little procedure you can do under local anesthesia. It removes that extra eyelid skin that people complain about as it becomes a little bit more redundant. It can be hard to put on makeup and it's just this little extra crepey skin. So I think that can be really helpful and kind of like a simple tweakment.

Bri (08:20):
Yeah. I feel like all the ones I've seen you do, they all look so good and everyone's so happy. And it's like the smallest amount of skin too that you can take out and make someone so happy.

Dr. G (08:29):
Right. Yeah. It's an easy fix. And we can talk about, I would say upper eyelid lift. Generally speaking, I'm doing skin only. I just presented on this at our annual meeting and I do think it's a great fix for someone who has a good brow position, who just has upper eyelid excess, who doesn't have what we call a droopy eyelid. So eyelid ptosis, it's important to rule that out. And then yeah, you take the skin. I put a suture in that's going to pull out at five days and then you can usually wear makeup at two weeks back at it. And her little journey there is kind of indicative -

Bri (09:11):
And the scarring's not bad at all.

Dr. G (09:13):
Yeah. So the scar is designed to hide in your eyelid crease and then...

Bri (09:19):
Okay. I like that one.

Dr. G (09:21):
That's the best. She's ice packing, I guess, but I don't understand why it goes around her nose.

Bri (09:26):
I'm about to buy those for the office.

Dr. G (09:29):
Yeah. And so I do try to keep... The incision is going to stay within the tail of the brow. It hides in your eyelid crease. I do a skin only approach. I think if you want to pop up a photo of Mandy Moore, this is what happens when people take fat out and they get this hollowed out look. I mean, some people are naturally like that. I don't have a lot of fat in my upper eyelid crease, but that's how my eyes have always looked. And then you see people like Mandy Moore who had very full kind of that space between the upper eyelid crease and the brow that's kind of full that if you take the fat out, it does give this kind of hollowed skeletonized look. Susan Dell, who we talked about last time, you know how she has those eyes kind of look skeletal or...

Bri (10:17):
Yeah,

Dr. G (10:17):
That is taking fat out. So because of that, I don't take fat out from the upper eyelid. I think it's a mistake. Even if you could do it, I think it doesn't age well. You're trying to decide if you need an eyelid look. Yeah. You can just see... Well, she looks bananas on a whole bunch of levels, but it's this space kind of between your medial brow and your nose. And if you take that fat pad out and you don't need it removed, it looks different and it looks a little weird, honestly.

Bri (10:46):
Yeah. It looks like -

Dr. G (10:48):
And it doesn't age well.

Bri (10:50):
Her eyes look a lot... Her brow is a lot closer to her eyeball, it looks like. I don't know. Or maybe her bras were just really thin back there.

Dr. G (10:58):
I can't get past her red lipstick. I don't know what's happening. But there was a presentation by this guy. I think his name is Dr. Derek Ford. He was on my panel and he oftentimes corrects this and puts nano fat in to kind of fill this area out or rejuvenate it. And it's kind of interesting for some patients, they don't really need an upper bluff. They just need a little fat or filler in that area. It's very interesting. I think my takeaway from being on that panel was oftentimes less is more. Doing something subtle is definitely more transformative than doing something dramatic and then having people look weird.

Bri (11:39):
Yeah. Last night on Instagram, the Mormon wives, they keep talking about Jesse Draper, but she did this whole post on how she wants to find a doctor that can remove all of her fat grafting. Can you remove fat grafting? How does that work?

Dr. G (11:54):
Yeah. I mean, let's say you put too much fat in someone's booty, you would just suction it out. So you really need -

Bri (12:00):
Like your face?

Dr. G (12:02):
Yeah. It's hard. If you remember when Jennifer Aniston looked super weird for a minute, that was like someone did her dirty with facial fat grafting and then couldn't get it out. I mean, you can try to micro cannula. You can go in there and surgically remove it. Not ideal though.

Bri (12:23):
No, not at all.

Dr. G (12:24):
It sucks because we often fat graft to the face in facial rejuvenation and 90% of the time I would say the complaint is that it doesn't last.

Bri (12:34):
Oh yeah. They're like, "I need more."

Dr. G (12:36):
Yeah. You get it in there, your face looks all full. There's a little bit of swelling and then it disappears and you're like, "Oh."

Bri (12:43):
I think she needs to wait a little while because she kind of had this done recently, but she also just said he just over grafted so much.

Dr. G (12:51):
I have seen some... There was a guy who used to present at our national meeting who was anti-fat grafting and he would show these cases of people that had been over grafted and it is a little alarming, but just like anything else. So my talk was about the upper bleph, just the simple approach, no fat removal. I don't remove muscle. I keep it simple, subtle. And then I reached out to one of our local oculoplastic surgeons, so that's somebody who is an ophthalmologist and then just does eyelid surgery literally for a living. And I was like, "Can you give me some examples of bad upper bluffs because I want to show what that looks like. Thank God I don't have any legitimate ones of my own." And he sent me five right away and I was like, "Okay, okay."

Bri (13:43):
Here. You're like, I'm good.

Dr. G (13:45):
Make it stop. But yeah, I think you have to appreciate just facial fat grafting or fat grafting around the eye can be a correction for some things, can be enhancing. More is not always better, and then that ends up creating a new problem. And so can you take too much upper eyelid skin? Absolutely. And I feel like somebody was describing -

Bri (14:08):
Where you can't even close your eyes.

Dr. G (14:11):
Yeah. Who were they looking at last night? This one woman who analyzes people's faces on TikTok, she was saying, "Well, now we can't do a brow lift because if you do take too much eyelid skin, if you think you need a brow lift, you need to do the brow lift first." Because sometimes that's the problem. Often it isn't, but if your brow is what's causing your upper eyelid to seem redundant or tired, if you take all the upper eyelid skin and then try to raise the brow, you won't be able to close your eyelid. I wish I could remember what celebrity it was, but at any rate, that person clearly doesn't have any upper eyelid skin left, and now her brow is descended. So if you try to raise her brow, it's going to look weird. Another guy on the panel talked about that in conjunction with ptosis, which is when your upper eyelid sits a little bit down on your pupil.

(15:07):
I feel like Bethany Frankel is a classic example, but anyway, he said, "If you have somebody with ptosis and you do an upper bleph and a brow without correcting the ptosis, which is also baseline, you should correct the ptosis." He's like, "They actually look drunk." I was like, "What are you talking about?" And he's like -

Bri (15:26):
We don't need none of that.

Dr. G (15:28):
He's like, "Because their brow is lifted, their eye is -

Bri (15:32):
Trying to go down.

Dr. G (15:34):
Dragging down, and they have this look where they're trying to keep their eyes open. Friday night. So you get the opposite of not looking tired. You look like you're trying to open your eyes because your brows are permanently lifted and your lid is down and there's no extra skin in there. And he showed pictures of it and I was like...

Bri (15:57):
I wonder how many times they've been pulled over and had to take a breathalyzer because of it. Just been like," You're hammered. I already know.

Dr. G (16:03):
Right? Because you had bad eye surgery?

Bri (16:06):
Yes.

Dr. G (16:06):
It's just Kenny Rogers.

Bri (16:07):
No, this is just my eye surgery. I'm not hammered, sir. It's fine. So I do need you to step out of the car.

Dr. G (16:14):
It was a good talk in terms of how all these things interrelate. And so there was a big discussion on brow position, upper excess eyelid skin, and then where your upper lid sits over your eye. And that's important. If you try to just do the same operation to everybody and don't take into account those things, that's where you start getting people who look weird. Back to Kenny Rogers, he showed the before picture of Kenny Rogers and you can see really clearly that he had eyelid ptosis, which means his upper lid came down over his colored part of his eye. And so when they corrected his eyelids, that's what gave him that super weird look because you haven't corrected the ptosis.

Bri (17:04):
Oh.

Dr. G (17:06):
But I've known he's had jacked eyes for a long time. I just thought it was more feminizing. In men, it's very tough.

Bri (17:12):
Totally different.

Dr. G (17:13):
Yeah. But see how he's trying to keep his eyes open? That's because his ptosis has not been corrected. So his poor little upper eyelids are still drooping. And then he just looks... At least he looks surprised and not drunk, but yeah.

Bri (17:31):
And if you can't close your... Do your eyes just get really dry?

Dr. G (17:33):
Yes.

Bri (17:34):
Like what happens if you can't close your eyes what you do?

Dr. G (17:36):
The pictures I presented were people who had too much upper eyelid skin removed, and so they have an incomplete blink. So when they blink, their eye doesn't close all the way and it can lead to... It's really bad for your eye, health in general, and it can be very stressful. A lot of times you need to do some sort of reconstruction for that.

Bri (17:59):
Like a little graft maybe?

Dr. G (18:02):
Take skin from somewhere and put it in.

Bri (18:03):
That doesn't sound fun.

Dr. G (18:05):
Okay. So I think you can have... Like I said, I treat mostly the basic bitch of upper eyelids. I can do a lateral brow lift if you really need it, but my preference is if you need a brow lift, you probably need a bunch of other stuff. Let's see facial plastics to do your facelift, your facial rejuvenation. But if we're doing just upper lids, just getting rid of that little bit of extra skin, make your eyes look a little bit brighter, more like you used to before. Some people are congenitally just get that extra skin earlier than most. I've done 35 year old women. They don't need a brow lift. Their brow's in great position. They don't have eyelid ptosis. They just need that extra skin removed. I'm not changing your eyelids to look like my eyelids. I have a lot of what we call upper eyelid show. That's just because my natural crease is high. And so there's variations -

Bri (18:58):
You get all the best eyeshadow.

Dr. G (19:00):
Right. There's variations in ethnicity and how... Yeah. So we're not trying to create a different look. We're trying to kind of just turn the clock back a little bit. So I think upper eyelids can be the easiest thing to do. They also can be terrible if not executed properly. So let's talk about lower eyelids because that's where you...

Bri (19:25):
Yes. Yeah. They're just so crepey. When I look at lower eyelids, I don't look at how hollow or don't have a little dark spots, but all the skin is crepey. It just needs to come out just a little bit.

Dr. G (19:42):
It's interesting because when you talk to the eye specialists, I feel like they are often reluctant to take out that skin, right?

Bri (19:51):
Yeah.

Dr. G (19:52):
I think that was the go-to for the longest time was remove that crepey skin. And I think that tends to lead to problems and what you need is to thicken that skin that solves a lot of problems or to tighten the skin, but not necessarily remove the skin. And I think that can be done in a couple of different ways. CO2 laser or some sort of erbium laser resurfacing is usually the most obvious way of just tightening and thickening that skin. I think one of the other things is you don't have this, but having dark circles under your eyes, that's generally, again, that skin is thin and translucent. And so the veins kind of show through and people feel like they have these dark circles and they just look tired. And so the issue with the dark circles is oftentimes those are people who are a little bit darker skinned.

(20:48):
They tend to have different ethnicity. And so you really shouldn't be resurfacing their eyes with laser because that tends to hyperpigmentation, then you have new problems. So an aggressive periocular laser is maybe not the right option for them. It's kind of a bummer. But you, we've done it, right? We've zapped your -

Bri (21:09):
We've done it once. You need to do it again.

Dr. G (21:11):
We can do a little bit of Botox to keep that... So what's causing it is the obicularis oculi muscle is just bunching there. Just some people have a really active one and you can put a tiny little bit of Botox there and there and it keeps it from bunching up. So that can help.

Bri (21:29):
That's fine. I'll put myself on the schedule for today.

Dr. G (21:33):
Right, because it's so wide open.

Bri (21:35):
You'd have to do it in the bathroom on a bathroom break for me to get it done.

Dr. G (21:38):
That's right. For those that can't do laser resurfacing, I think, or aren't great candidates for it. We do like doing PRP.

Bri (21:47):
Yes. I've done that twice now.

Dr. G (21:49):
That can be very helpful. It's also helping to rejuvenate that skin to make it thicker. You can do nano fat under there. So taking fat and really, really making it almost into a slurry to kind of layer it in there. I think what's important to understand between PRP and nano fat is that we're not adding volume there. We're not doing whatever Jesse Draper had. We're adding kind of like a substance to sort of rejuvenate and thicken that skin.

Bri (22:19):
Which you're injecting, right?

Dr. G (22:20):
Yes. Both of those are being injected. So PRP is just your spun down plasma, right? And we're just going to inject this, what looks like a kind of a straw colored fluid. So we draw your blood, spin it down and pull it up into a teeny tiny needle syringe and inject approximately a CC underneath each eyelid. It is rejuvenating. It isn't like a magic eraser. You need to do it, generally speaking, a few times to get a nice result. So we recommend -

Bri (22:51):
I think we have a couple videos of me doing the whole actual process of it on our Instagram. Oh yeah. I'm pretty sure.

Dr. G (22:59):
I mean, you can get bruising.

Bri (23:01):
I didn't bruise very much though, but you can. I remember you've done it once and you got real bruised.

Dr. G (23:05):
I've done it twice. Both times it's been... One time I was training somebody to do it, I got hella bruised, whatever. It looked like a punched in the face.

Bri (23:14):
It's fine.

Dr. G (23:15):
It's fine. And then the other time we had extra. So if you remember, Dr. Chao injected me with three ccs under each eyelid and it took forever to heal.

Bri (23:28):
Oh yeah. I usually

Dr. G (23:29):
Don't recommended

Bri (23:29):
Done it was just one and one.

Dr. G (23:31):
One CC is all you need.

Bri (23:32):
Three is kind of crazy.

Dr. G (23:32):
More, again, it's not better. Three was crazy. And then I think unlike PRP or nanofat, under eye filler is generally a no. I feel like it has to be the very rare patient that needs that at this day and age. It was super popular and trendy to do, and now most people have decided it's not a great idea.

Bri (23:57):
Yeah.

Dr. G (23:58):
It migrates. If it gets too superficial, it can create your skin to have this bluish, what we call a tyndall effect. Did I mention it migrate?

Bri (24:09):
I've had a couple girlfriends that have seen it done because I've wanted it done and they're like, "I just have a hard ball. If you don't do it right, it just..."

Dr. G (24:18):
I mean, ideally it sits right on the bone and stays there, but if any product gets in the muscle, and we're talking...

Bri (24:26):
You

Dr. G (24:26):
Have millimeters of space in here to work with. It just gets balled up along the muscle. And then it also, I think the more you're injecting what's supposed to be not a permanent product, it's supposed to dissolve with time, but it does stick around for a really long time. It interferes with the lymphatics. And so if you are prone to have puffy under eyelids, if you're prone to have kind of a puffy upper cheekbone area, all of that's going to make it worse. So nobody wants that. That's why I think the nano fat and the PRP are great options. And if you can do it, I think...

Bri (25:05):
I'll be lasering my eyeballs.

Dr. G (25:06):
Laser is the way to go.

Bri (25:08):
Yeah.

Dr. G (25:09):
I think it's really effective. All right. So back to Jesse and maybe Emma Stone, what's a telltale set sign of these ladies looking overdone?

Bri (25:23):
Their Instagram stories on how much they hate it.

Dr. G (25:28):
Ongoing rants about how much you hate your surgery. I really don't think that she looks that...

Bri (25:33):
I don't either. I think she's still so pretty. I think it's just for her when you're looking at your face every day for years and then you get something done. And I think honestly, if all these people weren't commenting on how ugly she looked and how different and she destroyed her, she might actually love it and be like, "Oh, I'm more confident having fat in my face or I look good." But I think just because everybody is telling her she looks terrible, she's like, "I look terrible."

Dr. G (26:02):
Emma Stone, on the other hand, looks whack.

Bri (26:06):
I don't know what she's...

Dr. G (26:08):
She actually falls into... What's that lady's name? Renee.

Bri (26:14):
She looks so awake right there. So awake.

Dr. G (26:19):
I will have to say her outfit slays. That color is so good.

Bri (26:25):
I kind of like it actually. She looks very different and she looks like she has that fox eye, like she's got some threads being pulled.

Dr. G (26:32):
Yeah. It's like the lateral brow is way up there.

Bri (26:35):
But she looks kind of youthful.

Dr. G (26:37):
I don't know. She looks... It's really not about... If you never seen her before, you're like, "Okay. Yeah, she's pretty." But I think the problem is when you start to change how someone's face looks, it makes everybody crazy.

Bri (26:54):
She does look totally different.

Dr. G (26:55):
You know?

Bri (26:56):
Yeah.

Dr. G (26:57):
Her brow was never that high, so why are we changing the position of her brow? And she didn't have that much eyelid show, so now she has more eyelid show. And so it definitely changes your appearance in a way that makes people go, "Huh, that's not how she used to look like." It's not that it's bad per se, it's just different. And I think that's the issue with Jesse too.

Bri (27:21):
Yeah. It's just different.

Dr. G (27:22):
It's kind of like when you get a nice result on someone and then they don't like it, you're like, "Okay, but..."

Bri (27:28):
Yeah. I actually think Jesse looks good. I think she's a little hard on herself.

Dr. G (27:34):
I feel bad for her plastic surgeon who was like, "This is a nice result. Calm down."

Bri (27:39):
Right. Yeah. Everyone's going to talk shit.

Dr. G (27:44):
Yes. So the upper eyelids, I think, especially in men and male celebrities, when it gets done wrong - Yeah, she looks weird. And changes their appearance. Everyone notices. For women, it's an often did she or didn't see she, but in certain patients, in certain celebrities, when it changes their overall appearance, which it is really easy to do with subtle eye stuff, people notice. That's not what you want. You want to look more refreshed. You don't want to look like someone else.

Bri (28:16):
Yeah.

Dr. G (28:17):
Unless you're a Kardashian, which you're just mutating into something else.

Bri (28:21):
Yeah, you're a new bitch every 10 years. It's fine.

Dr. G (28:24):
It's fine.

Bri (28:25):
So when you're doing -

Dr. G (28:26):
And you're all morphing to look the same.

Bri (28:28):
And you all look the same. We don't even know who's who. So when you're doing a lower bleph, where is the scar?

Dr. G (28:37):
Okay. So the traditional lower bleph is a scar that goes right underneath your lash line that generally involves... It's an anterior approach. It generally involves removing skin and a little bit of muscle. So that's a very old school, aggressive way of doing it. And then I would say the trend or more common approach now is to go in through the inside of the lid. So what we call a transconjunctival...

Bri (29:06):
Conjunctivitis? Conjunctiva?

Dr. G (29:09):
No. Transcon. No.

Bri (29:12):
Conjunctiv?

Dr. G (29:13):
Yeah, conjunctiva. Anyway, so the inside of your eyelid is, everyone knows, that white on the inside. So go in through there. So it's a scarless incision because you don't have an outer scar, but you're creating scar anytime you make an incision. So the scar's on the inside, and then through there, you're often addressing the fat pads. And so that's what often makes people look tired, are bags under their eyes. So I feel like the two things that make people feel tired are hollowed out under eyes. And I think it's a little bit of genetics and your ethnicity and stuff that kind of decide which way you go. Some people are more prone to big bags under their eyes. You can think of Bill Clinton or somebody that has just big bags under their eyes versus that kind of hollowed outlook, the deep dark circles sunken in, that's sort of how I would trend.

(30:07):
But some people do develop big bags. So big bags I think are the easiest to fix because they're just going in through the lower lid and then removing or transposing those fat pads and then you look so much better. And then tighten the skin either with a small skin pinch or with some laser resurfacing, something like that. If you have the hollow eyes, then I really do think, again, less is more, some nano fat grafting or something like that to kind of anti-age the eyes and not necessarily add volume, but help rejuvenate that area or very, very, very subtle volume.

Bri (30:49):
Yeah.

Dr. G (30:50):
Yeah.

Bri (30:51):
I just keep staring at my little beady eyes this whole podcast.

Dr. G (30:56):
I mean, after I was on that panel, I was like, I'm pretty sure I just need a ptosis repair. But again, I think it would change how I look because I've always had the same lid position. So I think if somebody did something dramatic like that, then people would be like, what happened to you?

Bri (31:12):
I don't feel like you need it though.

Dr. G (31:13):
I feel like Bethany Frankel is a classic example of someone whose lid position's a little bit low. It's always bothered me. We can pop up a picture, but she's kind of heavy lidded. And I think if somebody fixed that, people would go crazy. And then I use this in my talk. The audience, which was packed, had no idea what I was talking about because of the average age maybe, but I use Chase Stokes from Outer Banks.

Bri (31:44):
No one in that room is going to know who that is. Do you watch OBX?

Dr. G (31:50):
I was like, anybody ever heard of OBX? And we're all like, deafening silence. Thanks. Anyway, if you look at Chase Stokes, the entire five seasons of OBX Outer Banks that I endured, I was like, are you for reals with this guy? He has two different eyes. They are completely different eyes. One is more open. The whole eye complex is different. And the face develops. It actually merges together in the center, this middle line. So just like breasts, just like everything else, you're going to be asymmetrical. It's just the degree of asymmetry is different. And he has one little eye and one large eye.

Bri (32:32):
That's a good picture to pull up.

Dr. G (32:35):
We love that.

Bri (32:35):
Now we're talking.

Dr. G (32:37):
But I think in 20 years, if he decides to get eyelid surgery and someone changes that, it would be just aghast. No one would like that because he also often raises one eye. He accentuates it even when he's posing for the camera or whatever, where the more open eye, he has the raised eyebrow. And then he has a little squinty eye on the other side.

Bri (33:05):
He's got a look.

Dr. G (33:06):
Yeah, he definitely has a look. But I think if somebody went and did anti-aging surgery on him down the road, you would be like, just keep the eyes the way they are. Rejuvenate each independently because that's his look. And if you tried to correct that now, it would be alarming to everyone.

Bri (33:28):
I feel like that's just every celebrity though.

Dr. G (33:31):
I feel like a lot of celebrities-

Bri (33:32):
Have a look. You change it and it's just - Don't change it.

Dr. G (33:40):
I mean, whoever did Brad Pitt's facelift, T, because he looks exactly the same, just better.

Bri (33:48):
What movie was he just in that I watched?

Dr. G (33:51):
I don't know. Has he been in anything recently?

Bri (33:54):
Oh, The Dog. Wait, The Dog. No, it's about a dog. I cried my little heart out in theaters. It's him and a dog.

Dr. G (34:02):
What?

Bri (34:03):
I watched it last weekend in theaters. Hold on.

Dr. G (34:06):
Are you sure?

Bri (34:08):
I haven't finished my coffee, but he just did a movie, Brad Pitt movie, dog. Heart of the Beast. Yep. It just came out.

Dr. G (34:19):
Okay.

Bri (34:20):
That was him in it.

Dr. G (34:21):
Got zero buzz.

Bri (34:23):
Yeah.

Dr. G (34:24):
Oh, okay. Interesting.

Bri (34:26):
Yeah. If you guys want a really good cry.

Dr. G (34:31):
It's just him and a dog?

Bri (34:32):
Him and a dog get in a plane crash and it's them surviving the whole time in the forest. And then at the very end, this is a spoiler alert. Don't watch it.

Dr. G (34:40):
Dog dies.

Bri (34:41):
Yeah. No, he dies and then the dog goes off to get another owner. All of it is so sad. There were like war marine dog. They went through all this stuff in Iraq together and I'm just sitting there bawling my eyes out in a packed theater, couldn't stop crying. It was so sad.

Dr. G (35:00):
At least the dog didn't die. Jesus.

Bri (35:02):
Yeah, it was terrible. The dog got sucked out of an airplane. It was like one bad thing after another. It was... I'm about to tear up.

Dr. G (35:15):
Okay. Anyway, he looks great.

Bri (35:18):
Yes, he still aged gracefully.

Dr. G (35:19):
That was the point. With his eyes was the moral of that story. I went on a little tangent there. Okay. All right. Should we do myth versus reality?

Bri (35:30):
Yes. Okay. So actually I want to talk about the first myth versus reality. Eye cream can get rid of under eye bags.

Dr. G (35:39):
I feel like not permanently, but temporarily 100% it can.

Bri (35:43):
So what is eye cream? Should everybody use it? What is it doing here?

Dr. G (35:50):
I feel like that's controversial. So I think a good eye cream is designed... The skin under your lower lid and on your upper lid is thinner than the rest of your facial skin. And I think a good eye cream is designed for that specific area so that it's gentle and hydrating, but not too hydrating because it also is prone to getting little accumulations. You can get little milia there if you put too much stuff around your eyes. But I do think babying the eye area is important. I do remember we used to get into it when I had a different aesthetician. She was like, "You don't need a separate eye cream. You just need to wipe up whatever you're putting on your face and sweep it up. Why do you need a separate one?" I'm like, "I don't know. It's an extra step." But I do think certain eye creams are designed for the under eye.

(36:44):
I think the ones that get rid of under eye circles are ones that have caffeine in it or some other thing that's causing constriction of the vessels underneath. Those can temporarily be used to make under eye bags go away. That's what that's doing. Is it solving your problem? No. Once the caffeine wears off and you go back to vasodilation, then you're back to where you started. I think it's a common beauty pageant trick to put preparation H under your eyes because the ingredients in that shrink the tissues. So same thing, you're just -

Bri (37:17):
Is that temporary?

Dr. G (37:18):
Yes.

Bri (37:18):
Damn it.

Dr. G (37:19):
It's also good for cellulite and all that. Yeah, but temporary.

Bri (37:22):
Why haven't I heard this before? All right. I'll be getting that in my Amazon cart today. When you're looking for an eye cream though, because there's so many and there's vitamin C and caffeine, all different ones. Is there any specific ingredients that this would be great for a long term or is it all just more of a gimmicky, just throw some...

Dr. G (37:41):
I think vitamin C is helpful because you usually want to brighten that area and then something with a peptide or something that's collagen. I mean, if you can tolerate a little retinol under there, that's really what's going to kind of kickstart your skin and make it thicker and be beneficial.

Bri (37:57):
Okay. You heard it there. Preparation H for everyone. Okay. So myth or reality, dark circles always mean you're not getting enough sleep.

Dr. G (38:08):
We all know that's not true. It can definitely be genetic and it can also just be as your lower eyelid skin gets thinner, it's just you can see vessels more clearly.

Bri (38:20):
Eyelid surgery leaves an obvious scar.

Dr. G (38:23):
That should not be true.

Bri (38:25):
Once you've had an eyelid lift, you'll never need another one.

Dr. G (38:28):
That's not true. So the one I presented at my conference was somebody who had an eyelid lift and then lost 40 pounds. So GLP-1s, once again, here to people who think they're at their lifetime set point and then -

Bri (38:41):
Everything.

Dr. G (38:42):
Yeah.

Bri (38:42):
The labia and the eyelids.

Dr. G (38:44):
Yeah. Both -

Bri (38:45):
Doing you dirty all over from head to toe.

Dr. G (38:48):
Head to toe. So yeah, it is not uncommon to have a second surgery, but you're not definitely going to need one.

Bri (38:56):
Under eye filler dissolves on its own in six months.

Dr. G (38:59):
No, that should last. At least 12 months. Do not stack over it. And I think a lot of people are coming back to have it dissolved.

Bri (39:07):
It's easy to dissolve under eye filler, just the same as dissolving anything else.

Dr. G (39:11):
Yeah. It just hurts.

Bri (39:14):
Insurance will pay for eyelid surgery.

Dr. G (39:16):
Insurance will pay for upper eyelid surgery if the amount of upper lid excess is so excessive that it rests on your upper lash line. So it's a lot. If you're already there, then those are people who have really, really heavy upper lids, so you'll let it go. Or men. I feel like it's pretty common. My husband needs it, but he's too much of a wuss. He could probably get it covered by insurance because his upper eyelid skin is redundant and now it's sitting on his lashes.

Bri (39:48):
You just do it for free.

Dr. G (39:50):
I know, but he's just a baby.

Bri (39:51):
Men, swear to God.

Dr. G (39:53):
Then it can make your eyes feel heavy or you have trouble opening your eyes at the end of the day. I think sometimes in those older patients, I'm talking like 70s and they're presenting with this over... The eyelid skin, you've seen them in the really old men and they can't barely open their eyes. You do have to double check that you don't have also ptosis because you can get that with age so you can get the muscle there starts to weaken or separate with age. And if you have that combination and all you do is take the skin out, you will not solve the problem. But in those insurance cases, they're often seeing somebody who specializes in that and they're looking for all those things.

Bri (40:31):
Slay.

Dr. G (40:33):
Slay. So if you're listening today and you have questions about upper lid surgery or lower lid surgery, go ahead and reach out and we'd be happy to chat some more about it and go put on some eye patches.

Bri (40:45):
Eye patches and eye cream and prep H.

Dr. G (40:48):
Preparation H for the win.

Bri (40:49):
I'm very excited. I'm about to rub that all over my body, all over.

Dr. G (40:56):
All right. We're going to scrub in.

Bri (40:57):
And scrub out. I'm like, "Can I get it by the gallon?"

Dr. G (41:01):
I don't think so. We're good. If you're listening today and have questions, need info about scheduling, financing, reviews or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. Learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @RestoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the Bs on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.