Boston Doctors

Hollow Dark Circles: What to Do? HA Filler, Blepharoplasty, Fat Grafting, Laser? (photo)

Hello Doctors, I have genetic dark circles. Their darkness is exacerbated further by the hollowness around my orbital bone and the indentation of my tear troughs. This is something that would be remarkable for me to fix. I've tried expensive creams w/ no luck & want tangible results. The 2-fold problem seems to only be solved by restoring volume & diminishing darkness. Should I get laser Arcus Marginalis release (transconjuctival incision), fat repositioning, laser therapy? Thank you!

There are 3 problems contributing to the Dark Circles:

1. Thin Eyelid Skin- The eyelid skin is so thin that the purple color of the muscle under the eyelid skin is transmitted through the skin-this cannot be effectively changed

2.The Arcus Deformity or Naso Jugal Fold is deep and accentuated because of a lack of normal fat around the eye and frequently there is an unusually deep depression in the bone underlying this area

3. Pigment on the upper layers of the skin.

Many many people have been severely disappointed with filler injections beneath the lower eyelid. Unless they are placed absolutely perfectly by an expert familiar with the anatomy, the contractions of the Orbicularis Muscle around the eyelid actually pushes the filler down out of the depression which makes the depression look worse. Often in inexperienced hands the filler is placed incorrectly and can create visible lumps-sometimes grey discolored lumps.

For over 15 years and in 2500 cases I have found Composite Fat Grafting through a Transconjunctival Blepharoplasty with Release of the Arcus Marginalis an excellent procedure to correct the hollow depression that you write about. It is a permanent solution which does not have to be repeated as do filler injections. It uses your own natural tissue which is an additional plus.

Pigment can be treated with topicals and if necessary the 1540 Non ablative fractional Erbium laser.

The benefits of using the CO2 laser in incisional mode have been well demonstrated in the Medical Literature repeatedly since 2000.

For details on the procedure check the link below

Brooke R. Seckel, MD

Boston Plastic Surgeon

Will I Grow into my Nose? Nose is Bigger then All my Features (photo)

My family has pretty big noses, but the difference is for them, it works with there facial features. I'm 17 and my nose isn't bumpy, it's straight. The problem is it's very WIDE at the bottom and I don't think it goes with my features. My lips are small, my eyes are small, and im not a large kid. I don't understand why my nose is so unproportional. I want to be a actor someday and I don't think ill get to if my nose looks so bad. I feel if my nose was smaller i'd look good. Help? :(

I am afraid that I don't see everything that you see.   I see a nose that is balanced with your face, and small on profile.  The width could be a little less from the front, though it is perfectly acceptable and attractive as it is.

The problem that most men have is that their skin is not  very elastic, so that changes made to the skeleton may not be followed by desirable changes in the surface--you may just lose shape. 

If you decide to go ahead, be extremely careful as you select your surgeon, and ask to see photos of noses like yours with results that you like.  Not every surgeon will be able to give you what you hope for.

Good luck!

Mark B. Constantian, MD

Nashua Plastic Surgeon

Havent Tried Implant Sizes Prior to Surgery Just Pictures, Is that Normal?

i have met with my DR for pre-op,he said he doesnt have patients try on implant sizes because it can turn out different once under the skin/muscle.i have showed him picutres on what id like to look like and told him id like a full C/D cup. he states on the day of surgery he fills it closest to what i request and also whats going to compliment my body. should i be worried about this,or is it common for DR's to not have patients try implants during pre-op/consult.

Many doctors do not place trial Breast Implants in your bra prior to Breast Augmentation because it is difficult for you to see an accurate picture of how the implant will look once it is placed into your body.

I do this because patients want to see it but I explain that doing this is not the look that they will achieve.

Photographs of patients who have had Breast Augmentation are also very helpful.

In my experience the best method for determining Breast Size or Breast Implant Size is a very simple test you can do at home. It is called the Rice Test or Rice Breast Implant Size test.

See the link below on how to do the test.

Placing Rice in a Baggy and placing it into your Bra allows the rice to move and conform to your Breast Shap. This provides a better approximation of what Breast Augmentation will look like. You can measure the volume of Rice in cc's for an approximation of what you want.

Of course, oick an experienced Board Certified Plastic Surgeon and take his/her advice.

Brooke R. Seckel, MD

Boston Plastic Surgeon