Dr. Fagien - Before & After

Upper and Lower Blepharoplasty with Lateral Canthoplasty

When skin and muscle need to be tightened to improve the surgical result with lower blepharoplasty, a stabilizing procedure if often utilized to allow this tightening while maintaining or improving the normal shape to the lower eyelid. Dr. Fagien developed “lateral retinacular suspension”, a minimally invasive form of lateral canthoplasty, over 25 years ago as a way to improve surgical results with lower blepharoplasty. This has been published in many prestigious plastic surgery journals and Dr. Fagien has presented on his technique to his colleagues on nearly every continent. The following cases demonstrate patients that underwent both upper blepharoplasty and lower blepharoplasty with lateral canthoplasty.

Case 2- Upper and Lower Blepharoplasty with Lateral Canthoplasty

Case 3 - Upper and Lower Blepharoplasty with Lateral Canthoplasty

Case 4 - Upper and Lower Blepharoplasty with Lateral Canthoplasty

Case 5 - Upper and Lower Blepharoplasty with Lateral Canthoplasty

Case 6 - Upper and Lower Blepharoplasty with Lateral Canthoplasty

Case 7 - Upper and Lower Blepharoplasty with Lateral Canthoplasty

Case 8 - Upper and Lower Blepharoplasty with Lateral Canthoplasty

Lower Blepharoplasty with Lateral Canthoplasty

At times, patients require only lower blepharoplasty with lateral canthoplasty (don’t need an upper blepharoplasty at the same time) to improve the appearance of lower eyelid bags, hollows and skin laxity/wrinkles combined with canthoplasty.

Lower (Transconjunctival) Blepharoplasty

At times, the best surgical option is the simplest. When skin excess is not a concern for the patient that presents with lower eyelid bags or “hollows”, lower eyelid fat contouring though an internal “invisible” incision might be your best solution.

Case 2 - Lower (trans-conjunctival) Blepharoplasty

Case 3 - Lower (trans-conjunctival) Blepharoplasty

Case 4 - Lower (trans-conjunctival) Blepharoplasty

Case 5 - Lower (trans-conjunctival) Blepharoplasty

Upper Blepharoplasty

Not all upper eyelids are the same. Some patients look best while maintaining a full upper eyelid where the skin fold rests closer to the upper eyelid margin (eyelashes) while others look best when the eyelid fold is raised showing more eyelid and a larger area to apply makeup. Dr. Fagien developed Volume Preserving Upper Blepharoplasty many years ago understanding that the reduction of volume by surgery in most patients does not deliver the best or most youthful result. Dr. Fagien will discuss with you – your individual desires and preferences and make recommendations based on careful evaluation.

Upper and Lower (Transconjunctival) Blepharoplasty

Ptosis

Ptosis, or “blepharoptosis” is common and otherwise known as drooping of the upper eyelid – this drooping is commonly asymmetric and can partially or completely cover the pupil, resulting in a tired appearance. This procedure is performed using an incision on the inside of the upper eyelid (no visible incision) to help increase the apparent size of the eye.

Medial Canthal Web Reduction

A medial canthal web, or “epicanthal fold” is a skin fold that either partially or completely covers the inner corner of the eye. This is more common in patients of Asian ancestry but can also be present in patients of different ethnicities. Dr. Fagien developed a technique that avoids placing a scar over the inner corner of the eye – this can be performed at the same time as an upper blepharoplasty to raise the upper eyelid fold and reveal a larger area to apply makeup.

Injectibles

Myomodulation – Fillers + Neuromodulators

Case 1 – Chin Filler, Lips and NLF: Chin augmentation can be beneficial for those who lack chin projection, have irregular surface contours or both as shown here. Using a combination of fillers and neuromodulators, a smoother and more aesthetically pleasing chin contour can be achieved.

Case 2 – Forehead line filling with reconstituted hyaluronic acid gel for long – term improvement. It requires precise technique developed by Dr. Fagien. The results are not only natural but can last well beyond a year.

Case 3 – Dr. Fagien pioneered the use of fine-line fillers to treat deep forehead lines as shown here. Unlike with neuromodulators alone, this treatment does not adversely affect the position of the eyebrows and can last up to 2 years.

Case 4 – Dr. Fagien pioneered the use of fine-line fillers to treat deep forehead lines as shown here. Unlike with neuromodulators alone, this treatment does not adversely affect the position of the eyebrows and can last up to 2 years.

Case 5 – Dr. Fagien pioneered the use of fine-line fillers to treat deep forehead lines as shown here. Unlike with neuromodulators alone, this treatment does not adversely affect the position of the eyebrows and can last up to 2 years.

Case 6 – Crows feet treatment with filler and Botox®. Her left droopy eyelid (i.e., ptosis) was also treated with Botox®.

Case 7 – Fine-line treatment with fillers can be applied to most areas of the face where neuromodulation is insufficient. Shown here, fine-line filling with hyaluronic acid injectable was used in conjunction with neuromodulation (with products like Botox®, can have a dramatic smoothing effect on the skin appearance.

Case 8 – The lips were augmented and the fine lines around the mouth treated with a combination of hyaluronic acid fillers in conjunction with Botox®.

Fillers

Case 1 – This 66-year-old female presented for non-surgical improvement of the lower face. Injectable Hyaluronic acid gel was applied to her nasolabial folds, oral commissures and jowls.

Case 2 – Loss of lip volume is common, as is the desire for enhancement in already beautiful lips. Subtle enhancements can provide a more pleasing shape to lips without being over-done.

Case 3 – Cheek augmentation in combination with treatment of the nasolabial fold, chin cleft (horizontal line between the lower lip and chin) and oral commissures (corners of the mouth) can provide a subtle and more pleasing appearance reversing the appearance / perception of unhappiness.

Case 4 – Many times the appearance of deeper nasolabial folds is seen in conjunction with reduced lip volume. Subtle enhancement with lip and nasolabial fold filler (more often with a single syringe of “filler”) can provide dramatic aesthetic improvement.

Case 5 – Wrinkles and folds of the cheek are common and a partly due to the excessive “wear and tear” of the movement of facial muscles that remain strong against a weakened skin with age. Fine-line filling, pioneered by Dr. Fagien, restores the youthful balance.

Case 6 – Wrinkles and folds of the cheek are common and a partly due to the excessive “wear and tear” of the movement of facial muscles that remain strong against a weakened skin with age. Fine-line filling, pioneered by Dr. Fagien, restores the youthful balance.

Neuromodulators

Case 1 – Patients more often present with either existing frown lines or to prevent inevitable frown lines with neuro-toxin treatment to the glabella (between the eyebrows) region. Treating this area can both give a smoother appearance and shape the eyebrow while also given this region a more glowing effect on the skin appearance.

Case 2a – Glabellar Frown Lines: Patients more often present with either existing frown lines or to prevent inevitable frown lines with neuro-toxin treatment to the glabella (between the eyebrows) region. Treating this area can both give a smoother appearance and shape the eyebrow while also given this region a more glowing effect on the skin appearance

Case 2b – Forehead Lines: Patients usually present for treatment with neurotoxins in several areas of the face and another common area to treat are the horizontal forehead lines. The effects can be dramatic, and the position and contour of the eyebrow can be improved. This area can be tricky with understanding the balance of line reduction while preserving or improving eyebrow shape but understanding the patient’s unique anatomy

Case 2c – Lateral Canthal Lines (Crow’s Feet): Patients usually present for treatment with neurotoxins in several areas of the face and the second most common area to treat are the areas on the outer part of the eye called Lateral Canthal Lines (or Crow’s feet). Treating this area can also reduce or eliminate lines in these areas as well as shape the eyebrow.

Case 3a – Glabellar Frown Lines: Patients more often present with either existing frown lines or to prevent inevitable frown lines with neuro-toxin treatment to the glabella (between the eyebrows) region. Treating this area can both give a smoother appearance and shape the eyebrow while also given this region a more glowing effect on the skin appearance

Case 3b – Forehead Lines: Patients usually present for treatment with neurotoxins in several areas of the face and another common area to treat are the horizontal forehead lines. The effects can be dramatic, and the position and contour of the eyebrow can be improved. This area can be tricky with understanding the balance of line reduction while preserving or improving eyebrow shape but understanding the patient’s unique anatomy

Case 3c – Lateral Canthal Lines (Crow’s Feet): Patients usually present for treatment with neurotoxins in several areas of the face and the second most common area to treat are the areas on the outer part of the eye called Lateral Canthal Lines (or Crow’s feet). Treating this area can also reduce or eliminate lines in these areas as well as shape the eyebrow.

Case 4 – Big eye – small eye (upper eyelid): Dr. Fagien pioneered the use of neuromodulators to treat eye asymmetries such as this patient with a significant degree of left upper eyelid drooping (ptosis) and was not a candidate for surgery. By using precise small quantities of neuromodulators (Botox®) you can achieve a dramatic improvement of eye symmetry with a single injection.

Latisse

Dr. Fagien was a pioneer in the use of Latisse® and was on the development team of the drug and was a clinical investigator for the FDA approval of Latisse®. Below are patients of Dr. Fagien that have the “before” treatment with Latisse® (bimatoprost ophthalmic solution 0.3%) on the left and “after” 2 months of applying Latisse® to the upper eyelid/lashes on the right. These are not from the company (Allergan®/Abbvie®) website and are actual patients of Dr. Fagien.

Case 1