Roger A. Dailey, MD, FACS

I struggled with the decision for years and am very happy I went through with the surgery. Given impact on field of view, insurance covered the upper lids. I elected to have the lower lids done at the same time.
Dr. Dailey and his team were great throughout the entire process - helpful consultation, responsive to questions, and excellent post operative care. I would highly recommend him.

I underwent an upper lid blepharoplasty with skin laser resurfacing. The process was seamless. Dr. Dailey and his staff made me feel comfortable, explained the procedure in depth and was always available for questions. I am very pleased with the results and plan to have him do my lower lids and brow in the future. I could not recommend a more skilled surgeon.

My procedure is scheduled for tomorrow and I wanted to add photos and information now so that others might follow along with the surgery and recovery. Müllerectomy is (apparently) done from beneath the eyelid. I have been putting off the surgery for a few years. I am now 62 (soon to be 63) and this issue came up at least 5 years ago. My surgeon has been patient with me in my hesitancy to move forward. I am photographed a fair amount (because of my profession) and over the years I've had a funny quirk...whenever a camera is around I raise my brows (thereby making my eyes look much more normal). Indeed, most photos of me have looked quite good because of this habit. Recently I was photographed without my knowledge and THAT photo tells more of the truth. I have also tried to relax my face to take another 'before' in anticipation of surgery. I'll have general anesthesia. Thanks for following along with me. :)

Updated on 25 Sep 2013:
I got to the waiting room on the early side and checked in. They came and got me right away and put me on a gurney type bed. There were other surgery patients lined up like this behind curtains. The nurses had trouble starting my IV...but that is not the first time that has happened to me. I guess my veins are small. A nurse anesthetist managed it and explained that they were not going to do a general (as I had thought)...rather, they'd do a sedation thing. He explained I'd likely be aware of things. However! as soon as he put something in my IV I was out like a light. I did not hear a beep or a word until I woke up in the same little place I'd (apparently) left from. When I woke up it was like looking through several pieces of gauze. My h who brought me told me that one eye looked far more open that the other. He photographed it for me. I told him I know from all my friends here...that we can't look at things like that. (Though I worried later wondering if my 'best' eye was somehow mixed up with my 'worst' one). Hours later...it all looks better to me. I still can't see all that well. I am just having the mullerectomy, no in-the-crease sutures..the sutures are under the lid. I do have some irritation...but it is not awful. I haven't taken pain pills--no need yet. I will upload photos tomorrow.

Updated on 26 Sep 2013:
Hello friends,

Thank goodness I am fully aware that things change.. because right after surgery my eyes looked quite asymmetrical. My h was also looking at it going...'er'....But, within hours my eyes looked much better. (It did worry me at first...that maybe my worst eye was going to stay looking as it had and the other one was going to look way open...but then I remembered the things I learned here...things like 'don't freak out'). Additionally, I have it on good authority that my surgeon is some sort of a genius...so I have an inner calm that goes with that!

Mine are under the lid sutures, so I guess I won't have the amount of bruising I have seen on other eyelid surgery photos here. (Though, it is only day one, so perhaps there is more bruising to come).

I would describe what I've felt mostly as mild discomfort..no big pain. One eye does feel like more happened to it than the other. I am enjoying rest with bad movies and two big cats. h is waiting on me.

My eyes didn't shut all the way,at first... but I was prepared for that and frozen pea bag with washrag shut out the light. Today they shut. Hooray.

No pain pills necessary. They did give me a rx for steroids, to control swelling.

I had this done lbecause my eyesight has been compromised (and I think I can already see much better--though right now, of course, everything is blurry and I don't like looking at things for very long). Any cosmetic benefits are going to be a by-product...but I think I can tell that this is going to look just fine.

All my life I've been told I have nice eyes, so when one went 'wonky' I was not happy about it...but I was also quite concerned about surgery that would make me come out looking altered.

Here are new photos. I did a side by side for comparison also. It is just day one...what do you think? better?? :)

Updated on 13 Oct 2013:
After my last update I was surprised by more changes. I developed what seemed like an extra wad of skin over both eyes (see photos). Whoa! What the what?? My first few days had been fine....good even...so what was this? It was concerning, but I thought ---well, the surgeon did say if I need further work down the road that he could do it. The plan for me had been to only do the under-the-lid Mueller (tightening the muscle) and nothing else, because I didn't have excess skin prior. (Then I 'developed' extra skin! geez! ) If you follow along with the photos you'll see the issue seems to have resolved itself with time. My eyes don't look 100% symmetrical, but I think this is such an awesome outcome I am not going to quibble. I got a little used to one eye going half-masted (see photo #1) so, a few millimeters are of no consequence to me. I'll probably do one final photo down the road with real makeup in a few weeks. If you are 'older' like me and want to do this, don't hesitate. I can now see better and I look improved!

Dr. Dailey and his team are incredible. During my consultation he took my concerns seriously and immediately put me at ease, so I decided to go with him for my surgery. Weeks prior to surgery I was pretty nervous, but as soon as I was being prepared for surgery Dr. Dailey, the anesthesiologist and the rest of the staff were so comforting that I wasn't nervous in the least, I felt that I was in good capable hands. I am very happy with my results and am glad I chose Dr. Dailey for my procedure.

Stay away. Doctor Dailey also claimed, like another patient on here, that my undereye filler was not uneven but it clearly was and he tried to make me out to look like a fool after spending a huge chunk of money he should have known to inject the filler deeper. I have to now get the filler dissolved and refilled with another doctor deeper into my skin so it doesn't look swollen and green and inflamed like it does now.

What a hassle and waste of time.

I was overfilled with Restylane under the eyes and went to another doctor -- Dr. Dailey -- to have it removed with Vitrase. I specifically asked him if there was any chance that the Vitrase would permanently dissolve my own tissue. He was emphatic in saying no. So I agreed to have him inject the Vitrase.
In the first month, some of the filler dissolved and some did not... More horribly, tissue in my cheek -- well below where the filler went, but where the Vitrase poured into -- began to dissolve! At two months, I went to see Dr. Dailey and showed him the outcome. There was a clear depression, surrounded by a less noticeable settling/depression of the tissue. At first, he feigned that he could see nothing, then conceded there was a depression but blamed the dissipated filler. When I reminded him that there was no filler in my cheek where the hole now stood, he said it was impossible for the Vitrase to be responsible, as he uses "gallons and gallons" of it in his eye surgery practice. He began to get up to leave the room, saying to come back in a few months. He added for good measure that I was "fine, look great... I have no idea why you're here."
For a sanity check, I went to a dermatologist who readily acknowledged the depression and increased redness of the area. She sent me to a new plastic surgeon, who saw me right away. He confirmed that Vitrase DOES in fact dissolve our body's natural HA along with the filler. In most people, the body quickly replaces it (matter of hours to days). However, in rare cases, the natural tissue never grows back or takes a very long time! Now I am left with an obvious indentation on my cheek with uncertain prospects that it'll ever fill back in. I'm mortified, and embarrassed, as this directly impacts my ability to earn income.
Dr. Dailey may well use "gallons and gallons" of Vitrase but he does his patients a profound disservice of 1) not warning them of the rare complication and 2) conducting some degree of testing on a patient's skin to make sure they are not one of the unlucky folks such as myself. Now that I am reading of other surgeons on RealSelf confirming this potential outcome, I am livid that Dr. Dailey was so dismissive of my initial question and subsequent follow up.
Updated on 23 Dec 2017:
With temporary dermal fillers becoming more and more common, so too are poor outcomes -- from asymmetry to dangerous blood vessel compromise. Doctors using hyaluronic acid-based (HA) fillers (Restylane, Boltero, Perlane, Juvederm, etc) tell patients to rest easy, as they have a potent weapon to "erase" any of these bad outcomes: hyaluronidase (HYAL). The following gives an overview of this poorly understood HYAL drug, clarifying not just the benefits of using such but also the known and suspected devastating outcomes of using it. More importantly, my hope is that this overview will serve as a clearinghouse for patients who've had bad experiences with the drug and offer up ways to mitigate the damage it has caused.

Quick Backgrounder: When choosing a filler, you're also implicitly choosing a path to remove it. There are a multitude of reasons for having to remove filler, including benign (don't like the aesthetic look of the doctor's placement) to emergency (filler was accidentally injected into a blood vessel, resulting in near-term necrosis / death of tissue). There are other reasons too, like hypersensitivity reactions, development of nodules / granulomas, and biofilm infections. Lesson--> You should understand the risks of not only the HA dermal filler but HYAL too. Patients are rarely if ever told this by most doctors. Types of HYAL: Unfortunately, there's no clear standard for what you're likely to be injected with when it comes to HYAL. There are certainly three distinct groups from which HYAL is produced (mammalian, bacterial, and leeches/crustaceans/parasites), of which two well known brands have been mostly used (Vitrase and Hylenex). Lesson--> Ask your doctor which brand he/she plans to use and why. Dosage: Even with the well established drugs of Vitrase and Hylenex (both have been used for years in eye surgeries), there are no protocols for how much to use, whether to dilute it with other substances, etc when it comes to dermal fillers. Papers with NIH and PubMed show some HA compounds respond much faster to HYAL than others based on how they're chemically manufactured (degree of crosslink). Said differently, some HA fillers are designed to last longer by resisting degrading more than other fillers. Not surprisingly, they will thus take more HYAL to totally dissolve the product. For instance, studies show that Restylane dissolves the fastest and most complete when exposed to HYAL, while Boltero is one of the slowest and least complete. That would suggest, then, that Restylane would require less HYAL than Boltero, all things being equal. Yet most doctors have no idea that such medical study has been done on suggested dosing. Instead, most providers just inject HYAL at the same amounts regardless. Indeed, literature suggests that a "normal" dose is 150 IU of HYAL -- or 75 IU on each side of the face. Yet an injection of Restylane in the tear troughs, for instance, likely wouldn't need that amount; literature suggests no more than 75 IU total, or 37.5 IU on each side of the face. This has profound implications when considering the possible side effects related to HYAL injections... You want to inject as little of the drug as possible. --> Lesson: Ask your doctor if they are aware of the above and how much HYAL they'd inject if there were a problem. If you're not comfortable with their answer, go elsewhere. Complications - Allergic Reaction to HYAL: If you have an allergy to bee stings, you should never use HYAL, as you could have a death-enducing anaphylactic reaction. That also means you should never have HA fillers to begin with, as you must have a way to remove the filler before it's ever injected. Very few doctors ever tell patients this. Also, depending on the group of HYAL used (eg - mammalian, bacterial), you may also have an immune reaction and should thus never have HA fillers. Lesson--> Demand skin testing of both Vitrase and Hylenex before having filler placed to make sure you don't have allergic or immune reactions. Complications - Dissolving Native HA / Loss of Tissue: If you explore RealSelf, you'll see patients asking about whether HYAL can dissolve native HA. In other words, can HYAL melt away your healthy tissue and cause denting or skin damage? Many of the clinical answers on RealSelf will claim it cannot. Indeed, many well regarded doctors are both adamant and dismissive of any claims to the contrary. However, papers in NIH and PubMed make clear that they are wrong. In fact, HYAL absolutely does degrade your native HA (Pls search the internet for, "Complications of Injectable Fillers, Part I;" Aesthetic Surgery Journal, Volume 33, Issue 4, 1 May 2013, Pages 561-575; Dr. Claudio DeLorenzi). Indeed, the reason HYAL was manufactured in the first place was to assist in surgeries where doctors needed to separate skin / tissue to disperse other drugs more quickly. The question, then, is for how long HYAL will degrade natural HA, how much tissue is affected, and for what percentage of people who are injected with it? To answer these questions, a bit of background is helpful. Your body naturally makes HYAL enzymes every day, dissolving and rebuilding natural HA that's in your skin, joints, etc. Manufactured HYAL does much the same, but in superconcentrated formulas. In other words, HYALs -- both natural and manufactured -- degrade both natural HA and crosslinked HA dermal fillers. Obviously, that's why many people are attracted to HA dermal fillers... they're temporary, as the body (natural HYAL) will eventually break them down and new injections will be necessary after 6 - 18 months. NIH and PubMed papers make clear that Vitrase / Hylenex dissolve natural HA within seconds of exposure. Because of crosslinking, dermal fillers take longer than natural HA. In other words, whatever result you see within a few hours of injection is likely and almost exclusively your natural HA, not the dermal filler. Regardless, final results are seen within a day to two. The HA dermal filler obviously won't come back after a HYAL injection. But what about the natural HA that was dissolved along side the filler? What most doctors won't tell you is that medical science doesn't fully understand how the body creates its own HA and later remodels it with natural HYAL. (Pls see above source for further details. To quote from the text: "The biology of HA metabolism is far from being completely understood in animal models, let alone in humans.") Consequently, it stands to reason that manufactured HYAL could have unintentional damaging effects, depending on each body's unique process of naturally creating, destroying, and rebuilding HA. We know this to be true because Vitrase/Hylenex are both used off label for the dissolving of dermal fillers, meaning there are no known studies to clarify the risk these drugs pose for filler removal. Contrary to most doctors' advice, a lack of knowledge about risk does NOT equal no risk. This likely explains why, in so many reviews of Vitrase and Hylenex, you'll see some doctors use qualifying language when asked whether the HYAL drugs permanently destroy native HA. For example, "We don't believe..." or "It would be unusual," or "I've never heard of...". And it likely explains why a clear number of patients claim that they have, in fact, been damaged by the two drugs. In recent years, there is increasing concern in the medical community about the permanent impact of HYAL on native tissue. My private conversations with derms and PSs reveal carefully worded statements of, "I'm hearing more of this issue at conferences," or "I've not seen it at my practice but I'm frankly not surprised," or "Colleagues have claimed this but I don't think it's true." Their candid reactions are alarming as they are absent from feedback seen in places like RealSelf, leaving patients at some degree of risk. The Damage: Patients damaged by HYAL report 1) dents or hollowness (cavitation) even where no filler has been; 2) surrounding tissue that's soft or lacking firmness, with an ease of reaching bone underneath; 3) skin redness; 4) increased size of pores; 5) stratification of the epidermis (layers of the visible skin collapsing or peeling back); and 6) pain. Some of these effects may be caused by other things (eg - needle damage, scar tissue deep within the dermis, infection, etc), but a clear number of people are reporting these six complications to varying degrees. The Fix: This is where patients must help each other. Because medical science has rushed ahead with HA dermal fillers without fulling studying HYAL's effect on native HA, complications from using HYAL injections are usually dismissed by doctors. The result for patients is often frustration, anger, and despondency depending on the severity of HYAL's impact. In the comments section below, please offer your reflections on what might be helpful to address and fix the damage. Some solutions could include: --Supplements of hydrolyzed collagen, HA capsules, and anti-inflammatories (garlic, tumeric, etc). --Creams with human fibroblast conditioned media. --Anti-inflammatory doses of doxycyline (SDD 20mg 2xday; doxycycline monohydrate 40mg 1xday). --PRP injections. --Fat injections. Upshot: I would strongly encourage patients to avoid using fillers until the issues around HYAL is addressed. Instead, consider PRP injections or growing old with grace.



Updated on 17 Jan 2020:
Over the past many years, I have tried more fixes than I can count. Mostly for volume loss, skin degradation (loose skin, wrinkling), redness, and pain. I've seen a wide swath of dermatologists, plastic surgeons, general docs, and neurologists. I've gotten an equally wide set of diagnosis, some admitting it was vitrase that caused the damage.
Treatments I've tried include:
1) Fat Grafting (for volume loss)
2) Excel V laser (for redness)
3) Peptide therapy (BPC-157 injections for pain and skin healing)
4) Multiple PRP / PRF injections (for volume and skin healing, esp subdermal)
5) Dermrollers with and without serums (for skin texture)
6) Assorted serums (w and w/out fibroblasts), incl copper-infused products to (for skin texture)
7) Hyperbaric treatments (for skin healing, esp subdermal)
8) Vitamin drips
9) Collagen powder and HA pills (general skin health)
10) Anti-inflammatory diet (general skin health)
11) Antibiotic treatments (for the possibility of rosacea)
12) Exercise with lots of sweat (for general skin health)
13) Resurfacing laser (for wrinkles and skin texture)
The result? The fat grafting helped for volume loss, though was not as effective in the areas badly damaged by hyaluronidase. Next, the Excel V helped for redness, though one treatment would have been better than the two I received. Finally, the general skin health stuff I suppose was marginally helpful. But the rest did absolutely nothing (#4-8, 11) while one (#13) made it temporarily worse and caused six months of effort to repair. The truth is that even the rest of it has returned me to normal. As you can see from the pictures, the skin is still damaged. Unfortunately, it's getting worse over time. And it just feels affected / damaged, especially the right cheek (which received the most hyaluronidase).
Bottom line: this damage is permanent. The best you can do is adjust your head to that fact and conceal as you can. The peptide therapy has helped with pain somewhat, so that's a blessing. But my upper cheeks are permanently damaged. For women, y'all might be able to conceal it with makeup. But not so for guys.
Such a foolish decision to trust my doc that vitrase wouldn't damage my native HA and dermis/sub-dermal tissue. It can and does, certainly for an undefined and unpredictable segment of people.
If I could turn back time, I would have left the filler alone and let it dissolve over time. Or used PRP to dissolve the filler, as smart doctors are now doing rather than using vitrase.
I wish everybody good luck and healing. This chemical is devastating. Until the medical community recognizing how dangerous hyaluronidase is and study different modalities to heal people, those of us who've been damaged are left to our own devices to suffer alone or in hope with others to find solutions.

Updated on 22 Jan 2020:
This was my left cheek at nearly its worst. Just before fat grafting with Dr. Law of Raleigh, NC.
I had severe pain in the infraorbital nerve region, loss of volume, wrinkling, redness, and skin that just felt affected. What's incredible and horrifying is that the area that was so badly damaged had absolutely no filler. The vitrase just drained lower from where it was injected (via gravity, I would assume) and into nearby tissue (mostly cheeks).