Mid-30s RN, Tear Trough Deformity - Lower Blepharoplasty with Tear Trough Implants/ Fat Redraping

I had been considering tear trough implants for several years, having checked out a number of surgeons online, and told by my local skin MD that he was gunning to place fillers under my eyes for the past three +/- years. I've also gone back to school, gone through a divorce, and been doing the single parent thing-- along with working full time as a pediatric nurse in critical care/ higher risk peds. Frankly, I *am* tired, but tired of looking it, too! After finding some very nice pics here at RealSelf, and doing additional legwork online, I settled on Dr. Louis Apostalakis out of Austin, TX. He's done over a thousand of these procedures, and give the results I saw, was my best bet for a very nice outcome.

I started emailing with Nancy, in Dr. Apostalakis's office, about the feasibility of traveling for surgery, as I would be specifically coming to Texas for the procedure. Nancy was sweet, patient, encouraging, and professional, and ultimately, urged me to talk to Dr. A firsthand. His consult fee is $50/ 1 hour by phone, and after some initial hesitation, I called Carolyn in Dr. A's office to discuss appointments, surgical windows, and logistics.

Carolyn and Nancy are both dolls: they will know you by name, laugh with you, and make you not feel like a ridiculous, bruised monster when you return to their office for follow-ups. I could not ask for more out of Dr. Apostalakis's support staff! Missy, his surgical assistant, is so kind and perfectly beautiful you'll hate her the moment you meet her, but can't help but love her every time she's in the room. She, too, is amazingly helpful, patient, and eager to answer your questions. I cannot say enough positive things about the office and clinical staff with this practice!

I did an initial phone consult with Dr. A in late August 2016-- for this, you fill out a medical history and intake form, and send a set of about 8 pictures so he can get a good idea regarding bone structure and what's going on with your face. We scheduled surgery for Sept. 13, 2016: I would fly into Austin on the morning of the 12th, meet with Dr. A face-to-face for an in-person consult on that same afternoon, and we scheduled my procedure for the next morning.

I flew to Austin with a girlfriend of mine, as Carolyn let me know I absolutely had to be supervised for 24 hours after surgery and anesthesia. There is no Uber or Lyft in Austin, folks, and there's no getting around needing a driver/ babysitter. At the office, Missy, the surgical assistant, met with me within about 5 minutes of check-in, led me to the back, and took another series of photos. Missy then escorted me back to the waiting room, we did wait an excessive period-- probably 30 minutes-- for my first meeting with Dr. A. Dr. Apostalakis is quirky, with a strictly business-like presentation and dry sense of humor, and it seemed to take a few tries to get him to open up and relax into casual conversation, rather than being all business through the entirety of our consult. However, when doing something like this, my belief is you'd much rather have someone so focused on the outcome, rather than being the "fun doc" the whole time, so consider his artistry and professionalism as high positives if your experience is similar. I was given two prescriptions (an anti-nausea med and pain killer) to have filled that evening, which in retrospect, would have been more handy to have sent to a local pharmacy here at home, because the Texas did not file/ recognize any of my insurance benefits there locally. Unfortunately, the cost was 100% out of pocket for those two meds. I was also given a bag of post-op items to bring back the next day, which included my antibiotic, an anti-anxiety medication, gauze, some starter eye drops, and cotton swabs. I brought two gel ice masks with me to Austin, as well as a memory foam neck pillow to keep my head propped up post-operatively.

The next morning, I arrived at Dr. A's office at 8:30 a.m., and was taken back immediately by Missy. Missy had me change into a surgical gown, pull my hair back, then wash my face with a surgical prep, and rinse my mouth with a medical-grade mouthwash. From there, I met with the surgical nurse, who was fun, kind, and personable, as well. She sat me down and began drawing blood for the platelet-rich plasma suspension used during the operation. After this, she skillfully inserted my IV, and I was instructed to take a small cup of medicine, with a cocktail of one antibiotic, one anxiety med, and three prednisone (anti-inflammatory) tablets. I walked to the operating suite, and was secured onto the table. Dr. Apostalakis came in, confirmed my identity and our procedure, and began administering sedatives through the IV-- this was the last thing I remember before waking up with an achy face!

I'm not going to lie-- the first few days are a bit of a daze. I slept more than anything else, and the pain meds I was given did little for the pain (Extra strength Tylenol worked better), and a lot for just making me drowsy and irritable. I was extremely swollen the first three pre-op days: my friend and her family had a lot of fun with renaming me "Cabbage Patch" and "Cowardly Lion" (as in, Wizard of Oz) those initial days! As far as medical oversight, you'll have an immediate post-op follow-up with Dr. A the day after surgery, and for me, with having flown in, I had one more my last day before leaving town. Our total time in Austin was a Monday of one week, through Sunday of the next.

Even when you get home, you'll probably want to still take it easy (or take off work entirely if possible) those first few days. I'm still healing, and am only two weeks post-op at this point. The swelling has only JUST gone down the last two to three days, and I'm bruised enough that makeup is a must. That being said, I'm a light-skinned caucasian gal with auburn hair and anemia, so these are also considerations for bruising. I was very careful to avoid NSAIDs (ibuprofen, naproxen) and fish oil leading up to surgery, though, and if you take aspirin, you'll need to talk to Dr. A about risks vs. benefits.

From what I can tell, it *looks like* the outcome will be subtle and nice, but I still have a bit of healing left to go. I'll post more pics as time goes on, so you guys will have a more real-time sense of how the surgery results are evolving! Hope this helps!

Hi folks!
Well, I'm at week 3... was going to wait until week 4 to post again, but thought I'd throw a picture up here after having worked a full day, with no makeup, to give a better idea of the healing process! I'm still a little puffy in the cheeks, and admittedly slightly bruised, but even though I'm dead tired right now, don't think I *look* as tired as I did pre-surgery.
Oh, if you're considering this procedure, one of the hardest aspects of recovery is the loss of feeling in the lower half of your face afterwards (entirely normal). Initially, it will be both cheeks, your nose, and the upper lip area. At this point, I've regained feeling in both lips and both cheeks, but my nose and nasolabial area (smile lines) remain numb. It seems like the nerves are healing, though, as I do have intermittent itching, tingling, and occasional sharp burning sensations in my upper cheeks where the nerve exits the bone within the operative site. I've also struggled with an intermittent foreign body sensation under my right eye this week (in the conjunctiva, or pink part under the eye), but find it well-managed with OTC allergy meds (Zyrtec for me), allergy eye drops, and the lubricating gel provided by Dr. Apostalakis's office prior to surgery. If it persists, I'll email or call Dr. A's office again.
I will say, I've sent weekly photos down to Texas for review, and the office staff and/ or Dr. Apostalakis himself have both been highly responsive, usually providing feedback within half a day of my updates. I've been very happy with their attentiveness and follow up, and do plan to wait until 4 weeks to send my next check-in... unless my right eye keeps feeling a little dry and squirrelly.
Thank you again for all your kind words and compliments-- when you don't "look like" yourself for a while, it does start to weigh on your self-confidence a bit. :0)

Hi guys,
Just wanted to drop a few more pics of my progress:
First of all, the feeling has come back to the majority of my face! You WILL go through an itchy period, and a round of uncomfortable sensations (burning, stabbing-- especially if you're smiling or laughing a lot!), but as of now, I can feel both cheeks, pretty much everything except one ~1cm spot above my top lip, and a large portion of my nose (nostrils and tip are still fairly numb).

A lot of the swelling has gone down, and black eyes subsided, but now I have bruise-like rings under my eyes. I'm a nurse and talked to a couple of folks-- my understanding is it's a fairly common side effect in lighter-skinned individuals when they use blood product for facial/ dermatological procedures. What I was told was the blood components oxidize in place, effectively causing a bruise effect that's more visible (through your skin) the lighter your skin tone is. Dr. A explained this does occur in "fairer skinned" patients sometimes, but everything I've read or heard suggests it should begin to fade at about 3-4 mths post-operation.

Lastly, the attached pics are in natural lighting, with no makeup excepting brow filler and lip base/ liner. This is where I am with things right now-- hoping for some more formal pics when things progress another few weeks along.

Hope this helps!! XOX