Five Signs You Might Need An Eyelid Lift (Blepharoplasty) – SF Bay Area

Posted December 02, 2019 in Asian Eyelid Lift (Asian Blepharoplasty), Eyelid Lift (Blepharoplasty), Home

Cosmetic Eyelid Surgery is one of the most frequently performed plastic surgery procedures. By definition, it is an elective procedure, so no one strictly “needs” it; however, if you have one or more of the following Five Indications for Blepharoplasty, you might want it.

#1 – Hooded Upper Eyelids

Upper Eyelid Lift before and after pictures (Upper Blepharoplasty)

Upper Blepharoplasty – the above upper eyelid lift before and after pictures show a large amount of upper eyelid skin excess present before blepharoplasty. By removing this visor of skin, her hooding is eliminated; her eyesight is improved, and her tired appearance is erased leaving her looking alert and awake.

By far, the most common reason for eyelid surgery is Heavy Upper Eyelids. The following four features contribute to the formation of heavy upper eyelids:

  • Thick upper eyelid skin
  • Thick upper eyelid muscles
  • Excess upper eyelid fat
  • Too much skin

The patient shown in the before and after photos (above) had all four factors and wanted relief. The thickening and redundancy created a large visor of skin which hooded her eyes and blocked her vision. After Blepharoplasty, in this case an Upper Blepharoplasty, her eyes are more open. In the after photo you can see more of her eyeball; moreover, she is better able to see upward and to the side without the “blinders” of skin. She appears more alert, awake and attractive with the excess skin removed. Additionally, after Upper Blepharoplasty, she can apply upper eyelid makeup, something that her upper eyelid skin excess prevented.

#2 – A Tired Appearance

upper and lower eyelid lift before and after pictures (quad blepharoplasty)

Quad blepharoplasty before and after photos – Rejuvenating all four lids (bilateral upper and lower eyelids) is called a quad bleph for short. A quad bleph eliminates both heavy upper eyelid skin and lower eyelid bags.

Another frequent complaint I hear from patients seeking Cosmetic Eyelid Surgery is that they look tired. Even when they are well rested, their droopy eyelids and bags under eyes people might still cause people to ask if they’re tired. Well rested, alert appearing eyes are fully open and do not have bags under them. These are the goals of Blepharoplasty.

For the patient above, Upper and Lower Blepharoplasty was performed to rejuvenate her eyelids. The excess skin and fat was removed from the upper and lower eyelids to open her eyes and smooth her lower lids. The result is a happier, well rested and more youthful appearance.

#3 – Irregular Upper Eyelid Folds

Asian double eyelid surgery before and after photos

Asian double eyelid surgery is used to create a distinct upper eyelid fold when it does not exist. These Asian eyelid surgery before and after photos show the creation of a single fold on her right eyelid (where several existed) and elevation of her left eyelid fold, creating more open and alert eyes.

Sometimes, the upper eyelids do not have a well defined crease. This can happen to anyone, but is present about half the time for patients of Asian descent. Occasionally, as in the above case, one eyelid has a crease (her left), while the other is indistinct (her right). Creases can also be absent, as evidenced in the first set of photos at the top of this post. After Double Eyelid Surgery, this patient’s upper eyelids are more open and symmetrical.

#4 – Lower Eyelid Skin Laxity

Lower blepharoplasty before and after pictures

Lower blepharoplasty – these lower eyelid before and after pictures show removal of the lower eyelid bags and tightening of the lower eyelid skin – smoothing out her lower lids.

Indications for Lower Eyelid Lifts are excess skin and/or excess fat. The bright blue eyes above appear tired due to a combination of eyelid skin laxity and excess lower eyelid fat. During a short outpatient lower blepharoplasty procedure, an incision was made just below the lower eyelid lashes to remove the excess skin and fat from the lids, leaving her with smooth lower eyelids and a more youthful and rested appearance.

#5 – Lower Eyelid Bags

Lower eyelid lift before and after pictures

Lower eyelid lift – Sometimes the lower eyelids have bags even when the skin is tight. These before and after pictures show how a lower blepharoplasty can remove excess lower eyelid fat and provide a smooth lower eyelid.

Sometimes the main problem with the lower eyelids is the excess fat. By removing the excess fat, or repositioning it into the hollow beneath the eyelid bags, a smooth and youthful lower eyelid can be created. In cases when the skin is tight, the incision to remove the excess fat can be made inside the eyelid.

Blepharoplasty Consultations

When considering Eyelid Rejuvenation, be certain to seek an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area call (925) 943-6353 and schedule your private, informative consultation appointment.

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Eyelid Lifts (Blepharoplasty) Video | Walnut Creek | San Francisco Bay Area

Posted July 01, 2019 in Asian Eyelid Lift (Asian Blepharoplasty), Eyelid Lift (Blepharoplasty), Home, Videos

Today’s post reviews Eyelid Surgery and includes a Blepharoplasty Video from KRON 4’s Body Beautiful.

Indications For Eyelid Surgery

Eyelid Surgery is performed for men and women for both cosmetic and functional reasons. In the Blepharoplasty Video below, you will see Eyelid Lift Before and After Pictures and learn the indications, procedures and recovery for Blepharoplasty.

It is common for people to assume we are tired solely by the look of our eyes. Heavy, droopy upper eyelids and bags under our eyes occur when we need sleep. Unfortunately, these changes also occur with aging.

Lower Eyelid Surgery (Blepharoplasty) for Eyelid Bags - before and after pictures

Bags under the eyes contribute to the perception of being tired. Lower Blepharoplasty (Lower Eyelid Surgery) removes the fullness of the lower eyelids, thereby smoothing and tightening the lower eyelid skin and rejuvenating your appearance.

There are a variety of indications for Blepharoplasty. Aging is the most common reason for upper and lower blepharoplasty. Aging causes skin laxity and hooding of the upper eyelids which not only makes us look tired, but can also block upward and lateral gaze. Aging also causes elongation of the lower eyelids, thinning of the skin and atrophy of the subcutaneous fat, revealing the fat pads beneath the eyes.

There are other reasons why eyelid lifts are performed. Sometimes it is functional, like when the muscles that open the eyes are not functioning properly. This should always be checked before having Blepharoplasty. Sometimes it is cosmetic, like when Asian eyelids have a poor or absent fold. This allows the skin and fat of the upper eyelid to descend and close the eyes. When a fold is present, often it is low and indistinct, giving a sleepy appearance and blocking vision. When desired, Double Eyelid Surgery (Asian Eyelid Surgery) is used to form a clear fold to better support and open the eyelids.

Eyelid Lift Video (Blepharoplasty)

The following Eyelid Lift Video includes several examples of:

  • Upper Blepharoplasty
  • Lower Blepharoplasty
  • Double Eyelid Surgery (Asian Blepharoplasty)

This segment from Body Beautiful first aired on KRON 4, the San Francisco Bay Area’s News Station. In this video, I review Cosmetic Eyelid Lift Before and After Pictures and narrate the indications, procedure and recovery of Blepharoplasty.

Blepharoplasty for Aging Upper Eyelids

Upper blepharoplasty removes excess upper eyelid skin - before and after pictures

Excess upper eyelid skin causes heavy upper eyelids and projects a tired appearance. The upper eyelid before and after pictures above reveal the alert, interested and friendly appearance that upper blepharoplasty can provide.

As we age, the skin on our upper eyelids thins, sags and can take on the appearance of crepe paper. The skin also loses elasticity and its attachment to the muscle beneath it. As a result, the skin drops toward and sometimes in front of the eyes. Upper Blepharoplasty removes the excess upper eyelid skin and rejuvenates our appearance. If the brow also sags, it pushes additional skin down onto the eyelids. An open or endoscopic Brow Lift may be recommended to further improve facial harmony and balance.

Blepharoplasty for Aging Lower Eyelids

Lower eyelids bags can be corrected with lower eyelid surgery. See these lower blepharoplasty before and after pictures.

Lower eyelid bags can make even young eyelids look old and tired. Lower blepharoplasty (lower eyelid surgery) unstuffs those bags, smooths the lids and provides a more rested, attractive appearance.

When the lower eyelids age, they become longer and fuller. The bags that form in the lower eyelids are caused by fat “pseudoherniation.” The excess fat pushes forward and gives the overstuffed look we associate with aging. A Lower Blepharoplasty removes the excess fat and smooths out the lower lids. The result is a more rested and youthful appearance.

When the eyelid skin is wrinkled and crepey, a lower eyelid chemical peel may also be recommended to address the fine lines. The peel helps tighten the skin on the surface, and can remove excess dark pigmentation. More about alternate ways to remove wrinkles can be found on my Skin Care Page.

Blepharoplasty for Sagging Upper Eyelids

Blepharoptosis (saggy upper eyelids) is corrected with levator advancement in these eyelid surgery before and after photos.

Blepharoptosis (saggy upper eyelids) is corrected with levator advancement during blepharoplasty in the above eyelid surgery before and after photos. In the before pictures on the left, her eyelids are blocking her pupils and obstructing her vision.

Blepharoptosis can occur at any age. If present at birth it is called congenital ptosis; if it appears later in life, it is called senile ptosis. Eyelid sagging can have multiple causes, so a careful evaluation is required prior to choosing the best procedure for correction. In the case above, her eyelid sagging was caused by stretching of the tendon that opens the eyelids. During her blepharoplasty, the levator muscle tendon was shortened, allowing the eyelids to retract properly. This technique, Levator Advancement, is just one of many procedures available to help correct Eyelid Ptosis.

Blepharoplasty for Asian Eyelids

Asian Eyelids surgery (Double Eyelid Surgery) is used to create more symmetrical upper eyelid creases, as seen in the Asian Eyelid Upper Blepharoplasty before and after pictures.

Before surgery, multiple folds are seen in this patient’s right upper eyelid, and a single, low fold is present in her left upper eyelid. Asian Eyelid Surgery (Double Eyelid Surgery) was used to create more distinct, symmetrical and yet natural appearing upper eyelid creases.

Asian Eyelids may have no fold, a single low fold or multiple folds. The fold is dependent on if and how the eyelid skin is attached. Caucasian eyelids normally have a single, strong line of attachment. To form the fold in the Asian eyelid, a line of attachment is created. For the patient above, Double Eyelid Surgery was performed to correct her asymmetry, and provide her with crisp, clean eyelids folds.

Blepharoplasty Consultations

Eyelid Surgery is one of the most detail oriented procedures performed by Facial Plastic Surgeons. The key to achieving your best results is to consult with an experienced, well trained and Board Certified Plastic Surgeon. A professional who can balance achieving the ideal aesthetics with maximizing the function of your eyelids is necessary for a great result and satisfying patient experience.

People from all around the San Francisco Bay Area come to my Walnut Creek Plastic Surgery office for just that. Call (925) 943-6353 today to schedule your private consultation.

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Eyelid Lifts and Double Eyelid Surgery Video Presentation | SF Bay Area

Posted November 07, 2018 in Asian Eyelid Lift (Asian Blepharoplasty), Eyelid Lift (Blepharoplasty), Home, Videos

Eyelid Surgery Video (Blepharoplasty)

Today’s episode of Body Beautiful discusses Eyelid Lifts including: the upper eyelid fold and skin excess and lower eyelid bags and loss of tone. Blepharoplasty can correct multiple problems with the eyelids and encompasses many specific techniques. The following Blepharoplasty Video illustrates several of these procedures and demonstrates what is possible with carefully planned Eyelid Rejuvenation Surgery.

Upper and Lower Blepharoplasty Before and After Pictures: Sagging upper eyelids, caused by excess, upper eyelid skin, leads to a tired and disinterested appearance. Blepharoplasty can open your eyes to a more youthful, bright and alert appearance.

Upper and Lower Blepharoplasty Before and After Pictures: Sagging upper eyelids, caused by excess upper eyelid skin, leads to a tired and disinterested appearance. Blepharoplasty can open your eyes to a more youthful, bright and alert appearance.

The Eyelid Lift Video segment below is from the Bay Area’s News Station, KRON 4’s, Body Beautiful. The show features the latest in Cosmetic Plastic Surgery News, and uses before and after pictures to show what is possible for actual patients.

Eyelid Lifts and Double Eyelid Surgery Video Presentation

Double Eyelid Surgery

Asian Eyelids are anatomically distinct from Caucasian eyelids. Asian eyelids often lack a distinct palpebral fold, and when the fold does exist, it may be indistinct or crease at multiple levels. An example of this is show below. The patient’s right upper eyelid has multiple folds. She has a high fold, a low fold and a third fold in between on the inner eyelid. Her left upper eyelid has a single fold, but it is low and becomes indistinct as it extends toward the nose medially.

Double Eyelid Surgery can correct low, indistinct or multiple eyelid folds. These double eyelid before and after pictures show how the folds can be raised, sharpened and made more symmetrical.

Double Eyelid Surgery can correct low, indistinct or multiple eyelid folds. These double eyelid before and after pictures show how the folds can be raised, sharpened and made more symmetrical.

Double Eyelid Surgery is the procedure used to raise the eyelid folds, reduce multiple folds and improve the symmetry of the upper eyelids. The after picture reveals improvement in all these areas. Trying to form a fold when there is none, or it is in the wrong position, is more difficult than just removing excess skin, so revisions are more common with Double Eyelid Surgery when compared to standard Upper Blepharoplasty.

Eyelid Surgery Consultations

Eyelid Surgery is one of the most meticulous of all cosmetic plastic surgery procedures. While the operation can be performed safely and reproducibly, even under local anesthesia when desired, you can improve the chances of a good result by seeking an experienced and Board Certified Plastic Surgeon or Oculoplastic Surgeon. A plastic surgeon can also address other aspects of Facial Plastic Surgery and maintain facial harmony with other rejuvenating procedures such as: Brow Lifts, Face Lifts or Neck Lifts. This is particularly important if these areas are aging at the same rate as the eyelids.

To schedule a personal, private, in-person consultation call (925) 943-6353, today. The goals, procedure and anticipated recovery, specific to your needs, will be reviewed in detail.

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Blepharoplasty Video (Eyelid Lifts)

Posted January 06, 2018 in Eyelid Lift (Blepharoplasty), Home, Videos

Saggy upper eyelids and lower eyelid bags make us look tired and add years to our face. This is why the Eyelid Lift remains one of the most popular cosmetic plastic surgery procedures which I, and other Board Certified Plastic Surgeons, perform.

Eyelid lifts can literally open our eyes, making us look more awake and alert. As the upper eyelid skin becomes more redundant, it begins to rub off upper eyelid makeup and can come to rest on the eyelashes. The result is a heavy sensation and a worn down appearance, even when we are well rested.

Eyelid lifts can literally open our eyes, making us look more awake and alert. As the upper eyelid skin becomes more redundant, it begins to rub off upper eyelid makeup and can come to rest on the eyelashes. The result is a heavy sensation and a worn down appearance, even when we are well rested.

Blepharoplasty means eyelid changing, and it can rejuvenate our appearance and recharge our persona. San Francisco Bay Are Board Certified Plastic Surgeon, Dr. Joseph A. Mele, discusses eyelid rejuvenation and narrates numerous blepharoplasty before and after pictures on this video segment taken from KRON 4’s Body Beautiful.

Blepharoplasty Video (Eyelid Lift)

The following video segment reviews Eyelid Lifts and illustrates what Blepharoplasty can do with numerous Eyelid Lift Before and After Pictures.

The preview screen on the above Blepharoplasty Video shows how excess upper eyelid skin can weigh down the upper eyelid. In the picture on the left, the upper and lateral visual fields are obstructed and the skin is resting on the eyelashes, making the normal use of eye makeup impossible. In the after picture on the right, the eye and the upper eyelid are now visible.

The Correction of Lateral Hooding

In these Blepharoplasty Before and After Pictures, the before picture on the left shows the lateral brow skin completely covering the outer eyelid. In the after picture on the right, the brow skin is elevated, giving a much cleaner, refreshed and younger look.

In these Blepharoplasty Before and After Pictures, the before picture on the left shows the lateral brow skin completely covering the outer eyelid. In the after picture on the right the brow skin is elevated, giving a much cleaner, refreshed and younger look.

Lateral Hooding occurs when the eyelid or brow skin descends past the outside of the eye opening also known as the lateral orbital rim. Skin in this position blocks the lateral gaze, like blinders do on a horse. It also impacts a sleepy and older look to our eyes. In the above example, simply removing the excess skin corrected the problem. When the brow itself sags, a Brow Lift may be recommended.

Correcting Upper Eyelid Hooding

In the upper (before) shows severe hooding of the entire upper eyelid. After her blepharoplasty, her upper eyelids are now visible, and a smooth upper eyelid crease has been created.

The upper (before) photo shows severe hooding of the entire upper eyelid. After her blepharoplasty, her upper eyelids are now visible, and a smooth upper eyelid crease has been created.

Sometimes the upper eyelid skin is so excessive that the entire upper lid is hooded. Wearing upper eyelid makeup properly is short lived at best. By removing the excess skin, the upper eyelid and lashes are revealed, and a natural eyelid crease is created.

Blepharoplasty Consultations

If you would like to schedule a personalized consultation appointment, give me a call at (925) 943-6353. There is no substitute for an in-person eyelid consultation with an experienced and qualified, Board Certified Plastic Surgeon. A brief exam and medical history are needed to be sure the procedure is right for you. Safety and predictability are the most important aspects of any surgery, but this is especially true of elective plastic surgery.

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Ralph Millard, Cleft Lips, Double Eyelid Surgery & Korean Plastic Surgery

Posted January 27, 2017 in Asian Eyelid Lift (Asian Blepharoplasty), Eyelid Lift (Blepharoplasty), Facial Augmentation, Home, Nasal Augmentation

As of the time of this post, South Koreans have more plastic surgery per capita than any other country on earth. The United States is much larger, so more plastic surgery procedures are done in the United States; however, a higher percentage of the South Koreans have Plastic Surgery than Americans. Moreover, Dr. Millard may be at least partially to blame.

in 1954, Dr. Millard was recalled to active duty during the Korean War as Chief Plastic Surgeon to the U.S. Marine Corps during the Korean War. During his time in Korea, he took care of injured soldiers, but he also came into contact with many children born with cleft lips and palates.

Above - Dr. D. Ralph Millard reviewing before and after pictures of Cleft Lip and Palate surgery. His contribution of the rotation-advancement flap repair remains one of the most significant advancements in the field of congenital lip deformity correction.

Above – Dr. D. Ralph Millard reviewing before and after pictures of Cleft Lip and Palate surgery. His contribution of the rotation-advancement flap repair remains one of the most significant advancements in the field of congenital lip deformity correction.

The incidence of Cleft Lips and Palates is twice as high in Asian populations (1 in 500 births) as it is in the Caucasian population (1 in 1000 births), and four times as high as in the African population (1 in 2000 births). After studying photos of these defects, he developed the rotation-advancement flap cleft lip repair. He performed the first such procedure during the war, and it is now perhaps the procedure for which he is best know. His signature cleft lip repair is currently used around the world as one of the most versatile and predictable cleft lip repairs we Plastic Surgeons have in our arsenal.

From Cleft Lips to KPOP

During his year in Korea, Dr. Millard performed hundreds of reconstructive procedures for victims of war, most of whom were Korean. And like most plastic surgeons, he was not idol when the war lulled. In addition to cleft lip surgery, he also advanced “double eyelid surgery.”

Asian Eyelid Surgery can include refining an ill-defined eyelid crease in addition to removing upper eyelid skin redundancy and lower eyelid bags. The double eyelid before and after pictures above are of one of my patients, and show the improved, yet natural appearing results that are possible with Dr. Millard's techniques.

Asian Eyelid Surgery can include refining an ill-defined eyelid crease in addition to removing upper eyelid skin redundancy and lower eyelid bags. The double eyelid before and after pictures above are of one of my patients, and show the improved, yet natural appearing results that are possible with Dr. Millard’s techniques.

It is believed that Double Eyelid Surgery or Asian Blepharoplasty was first introduced in late 19th-century Japan; however, it was during the Korean War that the operation became popular in Asia.

Why Change the Shape of the Eyelid?

There have been many heated debates about what drives us to have plastic surgery. Why double eyelid surgery is performed is no exception. In many Asian Eyelids, the upper eyelid fold, the superior palpebral fold, is absent or poorly formed. This leads to increased fullness of the lid, increased upper eyelid weight from less support for the eyelid fat, increased upper eyelid sagging, more visual obstruction, an epicanthic fold, and according to Dr. Millard, a more stoic expression.

The stereotypical Asian eyelid has a single fold at the bottom. The eyelid skin flows smoothly to the margin of the lid. The Caucasian eyelid is a double eyelid. One above the crease and one below the crease. Or if you rather, one inside and one outside. But like most stereotypes, it is not that simple. Not all Caucasians have well defined eyelid creases, while half of all Asians do.

K-Pop is short for Korean Pop, and can mean the performers or the music. Much like in the U.S., K-pop stats exemplify the ideal standard of beauty in South Korea. As the K-Pop phenomenon grows, so too does the Korean plastic surgery industry.

K-Pop is short for Korean Pop, and can mean the performers or the music. Much like in the U.S., K-pop stats exemplify the ideal standard of beauty in South Korea. As the K-Pop phenomenon grows, so too does the Korean plastic surgery industry.

The goal of double eyelid surgery is to form a natural crease that is beautiful. Heavy upper eyelids are not considered attractive, especially for women. Heavy eyelids are more masculine, but also may be a sign of fatigue or inattention. Others respond to us better when we look like we are paying attention to them. Open, alert eyes are a visual cue signaling interest.

Most Asians, like everyone else undergoing eyelid surgery, are looking for improvement. Sometimes it is purely functional, but even then there is also an improvement in appearance. Last year, a million and a half people had double eyelid surgery. This accounts for about 15% of all the cosmetic plastic surgeries performed around the globe.

Why Korea?

Back to Dr. Millard. So why is he responsible for the disproportionate number of Plastic Surgeries performed in South Korea well after his time there? Dr. Millard was well known for developing his cleft-lip repair during his time in Korea; however, his other equally groundbreaking work was the advancement and popularization of the double-eyelid surgery.

His initial work on the eyelids was done for reconstruction after injury. Reconstructive surgery is both humbling and educational. The exposure of the underlying anatomy can be as daunting for the reconstructive surgery as it can be enlightening. Methods that work well for reconstruction, can also be adopted to enhance otherwise normal anatomy, too.

Above are the before and after pictures of the Korean translator who approached Dr. Millard. Notice the changes in the eyelids and nose. Do you think he looks less stoic?

Above are the actual before and after pictures of the Korean translator who approached Dr. Millard. Notice the dramatic changes in the eyelids and nose. Do you think he looks less stoic?

The story goes, during his time in Korea, a Korean translator approached him and asked to be “made into a round-eye.” He felt that because of the closed appearance of his eyes, Americans could not tell what he was thinking and consequently did not trust him. Millard later wrote. “As this was partly true, I consented to do what I could.”

Understand, racial intolerance in the U.S. was greater then than it is now. Although the War Brides Act in 1945 enabled American soldiers stationed overseas to bring home wives of a different race, interracial marriages were illegal in parts of the U.S. until the early 1960s, leading to more distrust and a desire to reduce racial features in order to blend in and avoid conflict. The world has evolved a little, but is still not a perfect place.

Dr. Millards’s Double Eyelid Surgery

Dr. Millard was aware that surgeons in Japan, Hong Kong, and even Korea were already performing double-eyelid procedures for both medical and cosmetic reasons. He was unable to find any publications about the surgery that were written in English, so he devised his own operations.

Dr. Millard decided to raise the nasal bridge and widen the eyes. He transplanted cartilage to the nose for Nasal Augmentation and performed Z-plasties to the inner fold of the eyelid to flatten it and open the inner aspect of the eye opening. He also removed fat resting above the eye and sutured folds of skin to the deeper structures, creating the attachment seen in double eyelids.

The results were pleasing to the translator, and like his cleft lip repair, the techniques are still used today in Korea and throughout the world. The combination of safe, predictable and functional results, aligned with an improved cosmetic appearance has caught-on in Korean pop culture, and Dr. Millard’s techniques seem to have been the catalyst.

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Plastic Surgery Principles – Changes Over The Last 500 Years

Posted January 22, 2017 in Asian Eyelid Lift (Asian Blepharoplasty), Eyelid Lift (Blepharoplasty), Facial Augmentation, Home, Nasal Augmentation, Patient Safety

Dr. Ralph Millard, Jr. (June 4, 1919 – June 19, 2011) as I remember him. He was described as “the most brilliant and creative plastic surgeon alive” at the time.

Dr. Ralph Millard, Jr. (June 4, 1919 – June 19, 2011) as I remember him. He was described as “the most brilliant and creative plastic surgeon alive” at the time.

In the April 2000 issue of Plastic Surgery News, David Ralph Millard, Jr. (June 4, 1919 – June 19, 2011) was described as “the most brilliant and creative plastic surgeon we have alive.” He is perhaps best known for his versatile and widely-used technique for repairing cleft lips, but his contributions to Plastic Surgery, especially reconstructive Facial Plastic Surgery are too many to list. Dr. Millard may also be the person most responsible for the current explosion of K-Pop Plastic Surgery in South Korea, but more on that in the next week.

Dr. D. Ralph Millard

Dr. Millard's portrait from 1937, as it appears on the Asheville Prep School's notable alumni page. He is one of the 10 surgeons nominated “Plastic Surgeons of the Millennium” in 2000 by the American Society of Plastic Surgery.

Dr. Millard’s portrait from 1937, as it appears on the Asheville Prep School’s notable alumni page. He is one of the 10 surgeons nominated “Plastic Surgeons of the Millennium” in 2000 by the American Society of Plastic Surgery.

Though his given name is David Ralph Millard, Jr., Dr. Millard went by his middle name, Ralph. I would only call him Dr. Millard. I read a later edition of his 1957 tome, The Principles and Art of Plastic Surgery Vol I and II, cover to cover, several times during my residency. It remains one of the foundations of modern plastic surgery. Co-authored with another World Famous Plastic Surgeon, Sir Harold Gillies (1882-1960), the first edition originally sold for $35, and is offered today on Amazon for $2500, used.

The Principles and Art of Plastic Surgery

The Principles and Art of Plastic Surgery began in 1564, with famous French barber surgeon Ambroise Paré. Yes, surgeons are descendant from barbers, not physicians, but that’s another story. Ambroise Paré Surgical Principles numbered five:

  1. Take away what is superfluous
  2. Restore to their places things which are displaced
  3. Separate those things which are joined together
  4. Join those which are separated
  5. Supply the defects of the nature

The Ten Commandments of Plastic Surgery

In 1950, Dr. Millard published Sir Harold Gillies’ Principles, also known as the ten commandments of Plastic Surgery:

  1. Thou shalt make a plan
  2. Thou shalt have a style
  3. Thou shalt honor that which is normal and return it to normal position
  4. Thou shalt not throw away a living thing
  5. Thou shalt not bear false witness against thy defect
  6. Thou shalt treat the primary defect before worrying about the secondary one
  7. Thou shalt provide thyself with a lifeboat
  8. Thou shalt not do today what you canst put off until tomorrow
  9. Thou shalt not have a routine
  10. Thou shalt not covet thy neighbor’s plastic unit, handmaidens, forehead flaps, Thiersch graft, ox cartilage nor anything that is thy neighbor’s

These principles can be applied to most of life’s pursuits. Elaboration on how the commandments are applied to skating for example, is available in this publication from the Archives of Plastic Surgery entitled, “Plastic Surgery and Aggressive Skating: Can Business Mix with Pleasure?” The Articles from Archives of Plastic Surgery appears on the National Center for Biotechnology Information website and was collected from PubMed Central (PMC) as part of US National Library of Medicine and the National Institutes of Health. Interestingly, the footnote states, “Articles from Archives of Plastic Surgery are provided here courtesy of Korean Society of Plastic and Reconstructive Surgeons.” However, it is still not time to talk about Korean Plastic Surgery.

But Wait, There’s More

The Principles And Art Of Plastic Surgery -Sir Harold Gillies, CBE, FRCS, and D. Ralph Millard, Jr., MD, Assistant Clinical Professor of Plastic Surgery, University of Miami, Florida. Little, Brown and Company, 34 Beacon Street, Boston, 1957. In Two Volumes, Boxed. 690 pages, 2472 illustrations, 122 in color. Original price $35.00 new. Current Amazon price over $2500 used.

The Principles And Art Of Plastic Surgery -Sir Harold Gillies, CBE, FRCS, and D. Ralph Millard, Jr., MD, Assistant Clinical Professor of Plastic Surgery, University of Miami, Florida. Little, Brown and Company, 34 Beacon Street, Boston, 1957. In Two Volumes, Boxed. 690 pages, 2472 illustrations, 122 in color. Original price $35.00 new. Current Amazon price over $2500 used.

In 1957, six more principles were added in the book mentioned above, The Principles and Art of Plastic Surgery. Through the course of his life, eventually these became Dr. Millard’s 33 Commandments of Plastic Surgery. Most are aligned with the more fundamental and self deprecating KISS principle: Keep It Simple Stupid. The complete list can be found on the Internet Scientific Publication Website.

You Can’t Go Wrong With Good Principles

To me, these simple guiding principles are Dr. Millard’s greatest contribution to Plastic Surgery. Others will argue that one or another of the specific techniques he adapted or improved are more important, but commandments two, nine and ten say to me: Plastic Surgeons should keep evolving and not solely rely on the past or a technique. The commandments are a simple and yet effective framework with which to refine current techniques and to evolve the future of Plastic Surgery.

So What About South Korea?

Two of Dr. Millard’s most famous techniques are the rotation-advancement flap for the correction of the Cleft Lip and Palate Deformities, and the Double Eyelid Surgery or as it is called in the US, Asian Blepharoplasty. Both of these were developed while he was Chief Plastic Surgeon to the U.S. Marine Corps during the Korean War. How this led to the boom in Korean Plastic Surgery 60 years later is the subject our next San Francisco Plastic Surgery Blog post.

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Bogus Plastic Surgeons – Buyer Beware

Posted November 28, 2016 in Board Certification, Breast Augmentation, Eyelid Lift (Blepharoplasty), Home, Liposuction, Patient Safety, Rhinoplasty (Nasal Surgery)

Miami Skyline

Miami, Florida, seems to be hot bed for Deceptive Plastic Surgery Practices, and is giving good Miami Plastic Surgeons a bad name. The most recent incident to make the national news is a Botched Brazilian Butt Lift at Encore Plastic Surgery. The clinic is linked to a chain that focuses on cheap plastic surgery for medical tourists visiting Florida for a procedure and a vacation.

Fake San Francisco Plastic Surgery

San Francisco Skyline

Miami is not unique, however. This year, Carlos Guzmangarza was sentenced to 20 years in prison for performing illegal plastic surgery out of his fake San Francisco, California “plastic surgery” clinic. His Mission District clinic preyed on many Central American immigrants. Allegations include: smoking a cigar during surgery, flushing Liposuction fat down the toilet, sexual assault, the injection of unknown skin fillers and leaving a four inch needle in a patient’s buttocks. Eventually, he was convicted of thirty-three felonies and eight misdemeanors.

Caveat Emptor – Let the Buyer Beware

Caveat Emptor

In most cases, there are clues that everything is not up to the usual standard of care. In the case of Mr. Guzmangarza, not only was he not a Board Certified Plastic Surgeon, he was not a doctor. He did not have a medical license, and that’s something that anyone could check.

Check the Medical License

California Medical License

Notice the medical license is for a “Physician and Surgeon.” California, like all states, does not differentiate.

Medical Licenses are issued by the state in which the doctor practices. Simply google your state’s medical board to use their free online look-up service. If you are in California, click here to check your doctors medical license and any disciplinary actions.

Check For Plastic Surgery Board Certification

American Board of Plastic Surgery MOC

I am Certified by the American Board of Plastic Surgery. The only ABMS recognized board for Plastic Surgery.

The American Board of Plastic Surgery offers a free, online certification lookup. Click here to see if your doctor is certified by the American Board of Plastic Surgery. Most doctors claiming the title “Plastic Surgeon” are not certified by the American Board of Plastic Surgery. In fact, it is estimated that only one in twelve practitioners practicing plastic surgery are Certified by the American Board of Plastic Surgery. Does your doctor have the best training?

Check For Other Board for Certifications

American Board of Surgery MOC

I am also certified by the American Board of Surgery, because I completed a residency in General Surgery, too.

If your doctor is not certified by the American Board of Plastic Surgery, who are they certified by? Click here to see if your doctor has any board certifications.

If your doctor is certified by the American Board of Ophthalmology, they are trained in surgery of the eyes. So if you are having Eyelid Surgery, they should have had the appropriate training. On the other hand, if you are having Liposuction, buyer beware.

If your doctor is certified by the American Board of Otolaryngology, the are trained in ear, nose and throat surgery, so Facial Plastic Surgery is within the scope of their training. If you are having Rhinoplasty, this is an appropriate board for certification. If you are having Breast Augmentation, buyer beware.

Non-Surgical Board Certification

The non-plastic surgery boards listed above are at least surgical boards. Some “cosmetic surgeons” have non-surgical board certifications. Certification by Family Practice and Internal Medicine Boards is not reassuring if you are having a surgical procedure. Proof of additional surgical training should be made available, and it should be years or training, not a weekend course.

Do Your Homework

A well trained, experienced practitioner will be up-front and honest about their training and abilities, but those who are not honest may be even more convincing. You need to do your homework. Use the links above to confirm what you are being told. If it does not fit, do not commit.

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Asian Eyelid Surgery | SF Bay Area Blepharoplasty

Posted October 01, 2016 in Asian Eyelid Lift (Asian Blepharoplasty), Eyelid Lift (Blepharoplasty), Home, Videos

Eyelid Surgery, aka Blepharoplasty, remains one of the most popular Cosmetic Plastic Surgery procedures. Last year, according to the American Society for Aesthetic Plastic Surgery (ASPAS), it ranked number four, ahead of Breast Lifts, and behind Liposuction, Breast Augmentation and Tummy Tucks. The statistics do not break down the number of Occidental vs. Asian Eyelid Surgeries performed, but here in the San Francisco Bay Area, the Asian Blepharoplasty accounts for a significant percentage of all the Eyelid Surgery Performed.

Asian Blepharoplasty

You don’t have to be a Board Certified Plastic Surgeon to see that the Asian and Occidental eyelids have different shapes. These differences are directly related to ethnic changes found in the Eyelid Anatomy. While the goals of Blepharoplasty are the same, the techniques to achieve these goals must be modified for differences in the anatomy between Occidental and Asian Eyelids.

Asian Eyelid Surgery Video (Asian Blepharoplasty)

Below is a segment from my latest KRON 4, Body Beautiful show. Several Asian Eyelid Surgery Before and After Pictures are included, and narrated, to help illustrate what Asian Blepharoplasty has to offer.

Asian Eyelid Surgery Goals

The goals for Asian Eyelid Surgery depend on whether the problem is congenital or acquired. Congenital Eyelid Problems we are born with, and these are often caused by deficiencies in the eyelid’s anatomy. The most common problem is poor connections between the upper eyelid skin and the tarsus, causing a poorly formed eyelid crease and the skin to drop into the eye’s visual field. Acquired Eyelid Problems we earn over time and are caused by aging and relaxation of the soft tissues that protect the eye. Protecting the eye is the primary goal for both types of eyelid surgery. Plastic Surgeons aim to restore the normal anatomy and to provide you with eyelids that look good while they are doing their job.

Asian Eyelid Surgery

If you are considering Asian Blepharoplasty, be certain to choose an experienced and Board Certified surgeon who understands, and knows how to repair, your specific eyelid anatomy and achieve your goals. In the San Francisco Bay Area call (925) 943-6353, to schedule a personalized and private consultation appointment.

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Body Beautiful On KRON4 Wednesday At Noon – Live

Posted September 04, 2016 in Asian Eyelid Lift (Asian Blepharoplasty), Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Breast Reduction (Men), Capsular Contracture, Ear Pinning, Ear Shaping (Otoplasty), Eyelid Lift (Blepharoplasty), Home

Attention Plastic Surgery Television viewers. Body Beautiful will be broadcast live on KRON4 this Wednesday, September 7, 2016, At Noon – Live. So tune-in to get the latest Plastic Surgery News, and see if I get it right on the first take.

Plastic Surgery Topics Will Include…

This week’s show will be thirty minutes packed with what’s new in Cosmetic Plastic Surgery. Topics will some of the most popular procedures here in the San Francisco Bay Area including:

  • Breast Augmentation Revision for…
    • Breast Implant Deflation
    • Breast Implant Exposure (Skin Erosion)
    • Capsular Contracture
    • Symmastia
    • Breast Implant Malposition
    • Breast Asymmetry
    • Breast Implants too small
  • Gynecomastia Reduction (Male Breast Reduction)
  • Otoplasty (Ear Pinning for Prominent Ears)
  • Asian Blepharoplasty (Asian Eyelid Surgery)

There will be plenty of discussion and Before and After Pictures for illustration. Below is a sneak peek.

Breast Augmentation Revision

The patient below had a rare, but serious Breast Augmentation Complication, requiring staged Breast Augmentation Revision Surgery. Her breast implant nearly eroded through the skin on the bottom of her left breast. Oversized Breast Implants in small breasts with poor soft-tissue coverage are at greater risk. This is more commonly seen after Breast Reconstruction when the breast has been radiated to treat breast cancer. It is unlikely to occur in a young, otherwise healthy woman, but it did.

Breast Implant Revision: Sometimes breast implant revision is urgent. The square shape sticking out of the bottom of this patient's left breast is her breast implant, and it's about to fall out.

Breast Implant Revision: Sometimes breast implant revision is urgent. The square shape sticking out of the bottom of this patient’s left breast is her breast implant, and it’s about to fall out.

Breast Augmentation Revision Stage I – The Salvage Operation

The top row of photos are the before and after photos from the first stage of her Breast Implant Revision Surgery. The upper left photo shows that the patient’s left Breast Implant is eroding through the skin of the lower breast. It’s about to fall out, and the current breast implant needs to be removed, urgently. If the Breast Implant becomes exposed, infection quickly follows. After careful discussion, it was decided to proceed with Breast Implant Removal on both sides.

Breast Augmentation Revision - Stage I was urgent removal of the left breast implant, which had nearly eroded its way through the lower pole of the breast. It was elected to remove both implants during stage I, because replacing the original saline breast implants with smaller silicone gel filled breast implants was part of the plan to decrease the risk of recurrence.

Breast Augmentation Revision – Stage I was urgent removal of the left breast implant, which had nearly eroded its way through the lower pole of the breast. It was elected to remove both implants during stage I, because replacing the original saline breast implants with smaller silicone gel filled breast implants was part of the plan to decrease the risk of recurrence.

Having one implant in and one implant out was an option, but would have left her with an almost undisguisable amount of asymmetry. Moreover, the plan was to use smaller replacement implants, to decrease the risk of another breast implant erosion. Leaving both implants out forever would also treat this problem, and completely eliminate any chance of it happening again.

Breast Augmentation Revision Stage II – Asymmetric Breast Augmentation

While the nearly Exposed Breast Implant problem was solved, there were two new problems: 1) obvious breast asymmetry and 2) breasts which are too small for my patient’s preferences. The Breast Asymmetry is two fold. The left breast is smaller than the right, and the left breast is higher and tighter on the chest wall.

Breast Augmentation Revision Surgery - Stage II. The second stage entailed lowering the left implant pocket, expanding the lower, contracted pole of the left breast and asymmetrically augmenting the breasts to decrease the size difference.

Breast Augmentation Revision Surgery – Stage II. The second stage entailed lowering the left implant pocket, expanding the lower, contracted pole of the left breast and asymmetrically augmenting the breasts to decrease the size difference.

Breast Implant Revision Surgery was performed to asymmetrically increase the size of the breasts, and to lower the left breast to match the right. The initial results are shown above, just one week after surgery. An alternative approach would be to raise the right side with a Breast Lift; however, this would require additional, external scars on the right breast.

As time marched on, the results improved. No additional surgery was performed after stage two. While initially the skin stretched well, the muscle was tight. Over several months the muscle relaxed and the symmetry improved, as expected.

Breast Augmentation Revision Surgery – Stage II and a patient patient. As time marched on, the results improved. No additional surgery was performed after stage II. While initially the skin stretched well, the muscle was tight. Over several months the muscle relaxed and the symmetry improved, as expected.

The Breast Revision Before and After Photos above show the results after new, smaller Silicone Breast Implants were placed, and the breasts were allowed to heal. The left picture is one week after surgery. In this photo, the left breast mound is firmer, higher and more projecting, as would be expected when more stuffing is placed in a smaller pillow case.

As the breasts heal, the left breast skin and muscle relax, the left breast implant descends and her results improve. The right, after photo shows the results after a few months. A larger breast implant was used on the left, to correct the asymmetry, and while initially it may seem like her Breast Implant Problems are not completely corrected, over time, it settles down. It is a good deal better than the potentially life-threatening complication she presented with originally, as shown below.

Breast Implant Revision Before and After Photos - the left picture is how the patient initially presented. The second picture is a few months after completion of both stages (breast implant removal and breast implant replacement with pocket modifications).

Breast Implant Revision Before and After Photos – the left picture is how the patient initially presented. The second picture is a few months after completion of both stages (breast implant removal and breast implant replacement with pocket modifications).

Breast Augmentation Revision Consultations

Breast Augmentation Revision is considerably more complicated than primary Breast Augmentation. If you have problems with your Breast Implants, seek an experienced and Board Certified Plastic Surgeon for your revision surgery. If you are in the San Francisco Bay Area and would like to schedule a personalized consultation appointment call (925) 943-6353, today.

PS – Don’t forget to watch Body Beautiful live at noon, this Wednesday, September 7, 2016, on KRON4, the Bay Area’s New Station.

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Eyelid Lifts SF Bay Area (Blepharoplasty)

Posted April 02, 2016 in Eyelid Lift (Blepharoplasty), Home, Videos

Eyelid Lifts or Blepharoplasty, is always a top five Cosmetic Plastic Surgery procedure. In 2015, Cosmetic Eyelid Surgery ranked fourth after Liposuction, Breast Augmentation, Tummy Tuck and ahead of Breast Lift.

Blepharoplasty Means Eyelid Changing

Blepharoplasty is the plastic surgery term for an Eyelid Lift. It literally means eyelid changing. For upper eyelids, the change is most often the removal of excess skin, which can make you look tired or block your vision. For the lower eyelid, the most common change is the removal of lower eyelid bags. Since the eyelids normally swell when we are overtired, the fullness caused by the fat under the eyes makes us look like we need a nap.

Eyelid Surgery on KRON 4’s Body Beautiful

Over the years, I have appeared on television many times to answer the frequently asked questions about cosmetic plastic surgery. Most recently, I had the opportunity to discuss Eyelid Rejuvenation on the San Francisco Bay Area’s News Station, KRON 4. The show is Body Beautiful, and over a hundred video segments covering many types of cosmetic plastic surgery can be found here on the San Francisco Plastic Surgery Blog. Just click on “videos” under the heading “Categories” in the column for a complete listing. Below is the most recent Blepharoplasty Video. You can also find them on my YouTube channel.

Blepharoplasty Video (Eyelid Lift)

Eyelid Surgery Consultations

An in-person consultation is the best way to get accurate medical advice about your eyelids. A brief exam and medical history are needed to be sure the procedure is right for you. Safety and predictability are the most important aspects of any surgery, but this is especially true of elective plastic surgery. If you would like to schedule a personalized consultation appointment, give me a call at (925) 943-6353.

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