Ask Dr. Seckel » Unhappy Results

I recently had a Radiesse injection under my right eyebrow at a Medical Spa. I didn’t have one under the left one. The RN that injected under the brow said that it would lift the brow and even it out with the other one. Now I have one swollen eyebrow and one naturally flat one. I have been massaging it and considering a correction. However, after reading some of your replies to people who are considering correcting Radiesse, I am hesitant to do so. I don’t know why I allowed her to do this to me, but it seemed logical at the time. I have never gone to a Medical Spa and should have left when I found out a doctor would not be performing the procedure. I am now considering having a small amount of filler added to the other eye, however using something more temporary than Radiesse. Would you recommend a little filler on the other eye in order to even out my appearance if it’s done by a physician? Sincerely, Debra, Eagle Pass, Texas

Dr. Seckel — Fri, 29 Feb 2008 10:55:18 +0000

Dear Debra,

I am sorry to hear of your problem following a filler injection in a Medical Spa. I have received many similar emails from other people with similar problems following soft tissue filler injections in Medical Spa’s by unlicensed or inexperienced licensed people. Check my archives under “unhappy results” to read of some serious complications.

I suggest you not have additional filler placed in the opposite eyebrow. This could compound your problem. I suggest you continue to massage the Radiesse. It will dissolve slowly over 6-9 months.

I have been doing filler injections for 26 years and am up to date on all of the new fillers. I have never heard of attempting a brow lift with a filler. It sounds like an idea thought up by the soft tissue filler salesman. There have been serious complications including blindness reported in England following soft tissue filler around the eyes.

The supraorbital nerve could easily be injured by injecting a filler beneath the eyebrow, I am happy this did not happen to you. The issue of invasive procedures being performed in Medical Spa’s with no physician on site is a controversial one. I assume this controversy will be resolved by legislation and by the liability insurers refusal to write insurance for Medical Spa’s who do not have on site physician supervision.

Why anyone would trust their face to any one other than a board certified Plastic Surgeon or Dermatologist whjo specializes in facial rejuvenation is hard for me to understand.

Be patient, continue your massage, you will be OK. Next time see a board certified Plastic Surgeon or Dermatologist, your chances of having a “happy result” will be better. Read Save Your Face to inform yourself about facial rejuvenation techniques, and sign up for my newsletter to keep current on changing technology.

Dr Seckel

Concord, Massachusetts,

Boston, Massachusetts

978-369-4499

Dear Dr. Seckel, I had a face lift 4 months ago. Now my upper right lip doesn’t move properly. When I try to pucker my lips the right upper lip doesn’t pucker. When I press my upper lip to my lower lip and put pressure on it the middle of my upper lip moves to the left quite a bit which does not look very good. It is difficult for me to eat. My upper right lip will move upwards and my smile is fine. My surgeon told me that he may have damaged my orbicularis oris muscle during the surgery. He explained to me that he separated my skin from the corner of my mouth up to my ear to allow him to try to minimize a wrinkle that was at the corner of my mouth. I saw some improvement in my upper lip during the first couple of months but have not seen any improvement for over a month. The right side of my face is still numb in several places. Will my upper lip improve with more time? Can this condition be permanent? Thank you in advance for your reply. Sherri, Dana Point, CA

Dr. Seckel — Sun, 27 Jan 2008 21:09:13 +0000

Dear Sheri,

Most likely the buccal branch of the facial nerve was injured during your face lift.

Fortunately buccal branch injuries recover because of generous additional nerve branches in the cheek area, however recovery can take many months. This creates a problem because the inactive muscle around the lip undergoes atrophy and when the new nerve branches reach the muscle, the muscle cannot respond to the regenerated nerve.

To keep the muscle healthy while waiting for the nerve to re grow I use DC (direct current) electrical stimulation. I use a hand held device which the patient uses at home to make the muscle contract 2-3 times a day.

If you would like to learn more about this therapy please call my office at 978-369-4499.

You may also learn more about facial nerve injury during face lift by reading my book “Facial Danger Zones”.

You may read more about the face lift procedure on my website or by reading Save Your Face.

Dr Seckel

Concord, Massaxchusetts

Boston, Massachusetts

Dear Dr. Seckel, I had a face lift 4 months ago. Now my upper right lip doesn’t move properly. When I try to pucker my lips the right upper lip doesn’t pucker. When I press my upper lip to my lower lip and put pressure on it the middle of my upper lip moves to the left quite a bit which does not look very good. It is difficult for me to eat. My upper right lip will move upwards and my smile is fine. My surgeon told me that he may have damaged my orbicularis oris muscle during the surgery. He explained to me that he separated my skin from the corner of my mouth up to my ear to allow him to try to minimize a wrinkle that was at the corner of my mouth. I saw some improvement in my upper lip during the first couple of months but have not seen any improvement for over a month. The right side of my face is still numb in several places. Will my upper lip improve with more time? Can this condition be permanent? Thank you in advance for your reply. Sherri, Dana Point, CA

Dr. Seckel — Sun, 27 Jan 2008 16:59:30 +0000

Dear Sheri,

Most likely the buccal branch of the facial nerve was injured during the surgery.

Buccal branch nerve injuries usually recover because there are many other branches of the nerve in this region that can take over the function.

The problem is that it is important to maintain the viability and function of the muscle while it is waiting for the nerve to grow back.

I am also a neurologist and these types of injuries are usually referred to me in the Boston Area.

My policy is to treat the paralyzed muscle with DC (direct Current)

muscle stimulation which causes the muscle to contract and keeps it

functioning while the nerve is growing back.

I can send you a muscle stimulator with instructions on its use if you

wish since you do not live near Boston.

If you would like to arrange this please call my practice manager Kathleen Burke at 978-369-4499. I am copying her this email above.

If you would like to learn more about this injury you may read my book

"Facial Danger Zones" which is available from Quality Medical Publishers:

You may also read more about the face lift by visiting my website or reading Save Your Face.

Thank you,

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, I had a face lift 4 months ago. Now my upper right lip doesn’t move properly. When I try to pucker my lips the right upper lip doesn’t pucker. When I press my upper lip to my lower lip and put pressure on it the middle of my upper lip moves to the left quite a bit which does not look very good. It is difficult for me to eat. My upper right lip will move upwards and my smile is fine. My surgeon told me that he may have damaged my orbicularis oris muscle during the surgery. He explained to me that he separated my skin from the corner of my mouth up to my ear to allow him to try to minimize a wrinkle that was at the corner of my mouth. I saw some improvement in my upper lip during the first couple of months but have not seen any improvement for over a month. The right side of my face is still numb in several places. Will my upper lip improve with more time? Can this condition be permanent? Thank you in advance for your reply. Sherri, Dana Point, CA

Dr. Seckel — Sun, 27 Jan 2008 16:52:28 +0000

Dear Sheri,

Most likely the buccal branch of the facial nerve was injured during the surgery.

Buccal branch nerve injuries usually recover because there are many other branches of the nerve in this

region that can take over the function.

The problem is that it is important to maintain the viability and function of the muscle while it is

waiting for the nerve to grow back.

I am also a neurologist and these types of injuries are usually referred to me in the Boston Area.

My policy is to treat the paralyzed muscle with DC (direct Current)

muscle stimulation which causes the muscle to contract and keeps it

functioning while the nerve is growing back.

I can send you a muscle stimulator with instructions on its use if you

wish since you do not live near Boston.

If you would like to arrange this please call my practice manager Kathleen Burke at 978-369-4499. I am copying her this email above.

If you would like to learn more about this injury you may read my book

"Facial Danger Zones" which is available from Quality Medical Publishers:

You may also read more about the face lift by visiting my website or reading Save Your Face.

Thank you,

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

Dear Dr. Seckel, I recently (3 months ago) had tear trough implants placed to correct dark circles under my eyes. I now have a lump which looks like the end of the implant protruding from my right cheek and I can see the outline and it looks as though the right implant is crooked. On both sides the dark circle under my eyes near my nose, which is what I wanted to correct is still visible. Can this be corrected? Thank you, Beth, London, UK

Dr. Seckel — Mon, 14 Jan 2008 14:16:12 +0000

Dear Beth,

I am sorry to hear of your problem. I do not use tear trough implants to correct dark circles under eyes any longer because of these types of difficulties and the risk of complications.

I find that the tear trough implants are often displaced by the contraction of the overlying orbicularis occuli muscles. These are muscles which control the lower eyelid and when they tighten with smiling they squeeze and can displace the tear trough implant toward the side of the cheek away from the dark circle near the nose.

The tear trough deformity for which the tear trough implant was designed is very different from the arcus marginalis deformity which causes dark circles under the eyes and in my experience the tear trough implant frequently does not correct the dark circles under eyes or arcus deformity.

The procedure I now use to correct dark circles under eyes or the arcus deformity is the transconjunctival arcus marginalis release with fat grafting or fat repositioning. Through this approach I can place the fat graft beneath the dark circle under the eyes where it begins, near the nose, and all along the dark circle under the eye as it runs toward the side of the face. In my hands this procedure gives a better reult tan the tear trough implant. In older patients who have a tear trough deformity, and in some patients who have a particular “hollow eye deformity” I will still use the tear trough implant usually in combination with a fat graft.

The displacement of the tear trough implant that you describe is common when it is used to correct dark eyelid circles, and I fear the implant may need to be removed or repositioned. Of course you need to consult your surgeon about this and ask him/her if an arcus release and fat grafting can be done.

In the meantime if you were my patient I would have you begin massaging the lump and the implant to see if you can improve the position of the tear trough implant-after 3 months this should be safe to do, but ask your doctor first. For more information on dark circles under the eyes contact me or read Save Your Face. Be sure to sign up for my free email newsletter.

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

978-369-4499

Dear Dr. Seckel, I have had 2 blepharoplasty surgeries (all four eyelids) and still Look tired as my lower lids hang way down and I feel for lack of better word my eyes look like a basset hound. I had the scalpel blepharoplasty with the visible scar on my lower eyelids, I did not have the transconjunctival blepharoplasty you write about and I did not have the arcus marginalis release. I also did not have the laser. First surgery was with plastic surgeon, second was with occuloplastic surgeon, went back to a third plastic surgeon and he mentioned I should have had a canthoplasty instead. Does suturing the ligament to the bone cause eventual sagging because of weight of the cheek and gravity over time? Thank you for your time, Renée, Minneapolis,

Dr. Seckel — Sun, 11 Mar 2007 04:37:09 +0000

Dear Renee,

The look you describe, also called the sad eyed look, hound dog eyes, ectropion, or scleral show, is the most common problem after traditional scalpel blepharoplasty of the lower eyelid. Modern Blepharoplasty usually avoids these problems. During the traditional lower eyelid blepharoplasty when the incision is made on the outside of the lower eyelid and through the supporting muscles, the support for the lower eyelid is damaged and frequently the lower eyelid turns down and creates the “sad eyed look” or “hound dog eyes” you write about.

There are several new techniques which, when combined together, I call the “modern blepharoplasty” which avoid the sad eyed look or hound dog eyes after blepharoplasty.

First, I use the transconjunctival laser lower blepharoplasty approach. I make my lower eyelid incision on the inside of the eyelid, the pink conjunctiva instead of on the outside, thus I do not cut through the muscles and supporting structures of the lower eyelid. This avoids damage to the support of the eyelid caused by the external incision and helps prevent the sad eyed look, technically called an ectropion.

The other maneuvers I use during a modern blepharoplsty are called a canthoplasty and an orbiculopexy. Canthoplasty involves tightening the supporting ligament of the lower eyelid, the canthal ligament by suturing it to the bone of the orbit or eye socket during the blepharoplasty. This tightens the lower eyelid and restores the natural youthful shape of the lower eyelid. A smaller procedure called a canthopexy can be used in many cases.

The orbiculopexy is a procedure which tightens the eyelid muscle which overlies the cheek and actually tightens and lifts the cheek during the blepharoplasty. Both the canthoplasty and orbiculopexy are done through the upper eyelid incision of the upper blepharoplasty, which is done to remove hooding of the upper eyelid or eye hoods.

These maneuvers comprising the modern laser blepharoplasty create a youthful eyelid appearance, removing eyelid bags, loose skin, dark circles under the eyes, and eyelid hooding, while preserving the beautiful eyelid shape and avoiding the sad eyed look or hound dog eyes.

The canthoplasty, if done correctly by an experienced blepharoplasty surgeon, should correct the basset hound look you complain of. The canthoplasty should tighten the lid and should not be pulled down by the cheek. It is a strong repair and done properly is a permanent correction.

Thank you for your question.

For more information on blepharoplasty eyelid rejuvenation,and plastic surgery read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Dear Dr. Seckel, I live in Brussels (Belgium) where I had a blepharoplasty (both eyelids) end march 2006, and I am not happy with the result. The ‘bags’ of the lower eyelids disappeared, and the scars are not too visible, but my eyes look very hollow with dark circles under the eyes, under both eyes (more in the right eye) I have now real visible hollow eyes with dark circles under the eyes. That makes the eye look rounder; mostly in the extern corners of the eye, like sad eyes, like dropping. I think you call it the sad eyed look or hound dog eyes. In the upper eyelid, the line of the eyelid is very high now (more in the right eye than in the left), it looks artificial, and now also my brows look lower than before. A lot of people say to me: “you look tired”, or “you lost a lot of weight, didn’t you?” It gives a tired, not-healthy look. I thought I would get used to it, or the result would be better after a few months, but no. I begin to search information on internet, see what can be done, it seems it is not easy to remedy, I don’t find real specialists of that problem in my country, and now I want to be very careful, I don’t want to risk a worse result. A plastic surgeon I went to here spoke about another operation, but he would open the skin again, I hesitate… I read your site and thought you could give me a good advice about what to do, or perhaps an idea of where or who here in Europe I could see. Thank you very much for information and apologize my approximate English! Thank you, Georgette, Brussels, Belgium

Dr. Seckel — Mon, 05 Feb 2007 11:27:31 +0000

Dear Georgette,

I am sorry to hear of your experience following the eyelid rejuvenation procedure called blepharoplasty to correct bags and dark circles under the eyes. The problems you mention, hollow eyes, dark circles under the eyes, and the sad eyed look are problems that do occur after the old style incisional blepharoplasty in which an incision is made on the lower eyelid and lower eyelid skin is removed.

There are two main problems that can cause the appearance of hollow eyes, dark circles, and the sad eyed look following blepharoplasty.

First, when too much fat is removed from the lower eyelid the lower eyelid develops the hollow eye appearance. Second, when an incision is made on the lower eyelid the support of the lower eyelid is lost and the lower eyelid droops giving the sad eyed or tired eyes appearance which is technically called an ectropion.

To correct the hollow eye appearance I remove fat from the area around the umbilicus or belly button and transplant the fat into the lower eyelid to plump the hollow appearance. I use an incision on the inside of the eyelid, through the conjunctiva, with a laser, called a transconjunctival laser blepharoplasty. I DO NOT do fat injection with a needle-it is dangerous and does not always work.

I transplant the fat through a tiny laser incision on the inside of the eyelid thus there is no visible scar and the support of the eyelid is not further damaged.

To correct the sad eyed look I do a procedure called the canthopexy, which tightens and restores the ligament, which supports the lower eyelid. This tightens or pulls the lower eyelid back up to a more natural position.

These are complex Oculoplastic procedures and I do not know anyone to refer you to. If you would like to come to Boston, please contact me.

If you would like more information on blepharoplasty, dark circles and eyelid rejuvenmation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Dear Dr. Seckel, How can I get rid of the thread lift procedure dimple?

Dr. Seckel — Sat, 03 Feb 2007 12:54:50 +0000

Dear Kathryn,

Dimples or depressions in the skin are one of the complications of the plastic surgery thread lift procedure, the modified face lift procedure for facial rejuvenation and tightening. Dimples like this do not happen when a traditional face lift is done. This happens when the one of the small “barbs” on the thread hooks the skin and pulls the on the skin and creates a dimple when the thread is tightened to pull the facial skin upward. Whether the thread lift dimple can be corrected easily depends on where the dimple is located. If it is near the hairline the attachment could be released with a scissor. If it is in mid face and the thread lift dimple cannot be reached from above the hairline, direct release would require an incision on the face and would leave a scar. In this circumstance it may need to be removed via an incision above the hairline or inside the lip. I will be happy to review your photo confidentially.

For more information on thread lift,plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Dear Dr Seckel, I hope you can shed some light to my dilemma. Exactly 30 days ago, My Doctor recommended Restylane injections under my eyes to create fullness under my eyes and correct the dark circles under my eyes. He and I expected 7-10 days to heal. It took 28 days for the swelling and the bruising to diminish completely. However, I have a new problem due to the Restylane, I have one dark circle under my right eye while my left is back to normal coloring. I have tried skin lightener, Vitamin K, gels, etc. and to no avail. I am asking for your Professional opinion as to what I can do to remove the dark circle. I am forced to hide with heavy Concealers. HELP. Is this a permanent condition, or is there something I can do? Thank you, Margaret, Sugarland, Texas

Dr. Seckel — Thu, 04 Jan 2007 11:02:19 +0000

Dear Margaret,

I am sorry to hear of your problem following Restylane injection around the eye for eyelid rejuvenation and to treat dark circles under the eyes. As you know from reading my blogs I do not do Restylane injection around the eye because I believe there are many risks to the eye and the companies that make the fillers do not recommend soft tissue filler injections around the eyes.

If the dark color is simply residual bruising it should eventually go away. Bruising, especially bruising around the eye can take 6-8 weeks to resolve so I would give it more time and use a concealer like Covermark or Dermablend.

Another possibility is that the Restylane was injected too superficially near the surface of the skin. When this happens a dark discoloration can occur. I do not know how long this type of discoloration can last. If this has happened to you all you can do is wait until the Restylane dissolves completely which can take up to 6 months. I do not know if this type of discoloration is permanent-I just have not seen this, have only heard about it.

I also recommend that you visit the very informative website devoted specifically to dark circles under the eyes where you will find many helpful suggestions.

Please feel free to email me your photos and I will try to give you a more informed opinion.

For more information on dark circles under the eyes, eyelid rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

Dear Dr. Seckel, I have had Botox injected successfuly twice. This time I went to someone else and the Botox didn’t take. What could cause this? Thank you, Alitha, Longville, GA

Dr. Seckel — Mon, 27 Nov 2006 01:13:56 +0000

Dear Alitha,
It is hard to say-my first thought would be outdated Botox. After dilution Botox is good for 2 weeks only. The other thought is that not enough was used; some Doctors dilute Botox too much so they can treat more patients with one bottle. Alternatively the Doctor may have missed the muscle and placed the Botox too deep.

For more information on Botox and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

CONFIDENTIAL: This communication is intended only for the party to
whom it is addressed. If you are not that party, disregard all
contents and delete this message.

DISCLAIMER: This communication is for general reference use only
and is neither represented as nor intended to serve as medical
diagnosis, specific advice, and/or treatment. If you are
experiencing a medical problem, see your physician.