In this episode of Carpools & Cannulas, Dr. Greer of Greer Plastic Surgery in Cleveland, OH, and Dr. Gallus of Restore SD Plastic Surgery in San Diego, CA discuss treatment options for brow raising results. From the Botox lift to the most extreme approach of deep plane brow lift they cover the pros and cons of each approach. Do we all really need that upward tilting brow or is it going to be another regretful trend?
Transcript
Dr. Gallus: Hi, everybody. Getting a late start, but time to do “Carpools & Cannulas.” Super excited to be talking about brows this evening. And I think Dr. Greer should be joining us shortly.
So, we’re going to talk about brow lift, although I feel like we should be talking about the merits of dry shampoo maybe this evening. Let’s see. Oh, and we have some people joining us. Just need Dr. Greer. So, we’re going to talk about the different ways that we do brow lifts, and go over the surgical and non-surgical brow lift. Because it is kind of a hot topic or popular area to address. And sometimes if you don’t address the brows, you notice them afterwards. So, that can be an issue, as well. So, hopefully she is going to join us, just trying to see who’s texting me. Okay, waiting for Dr. Greer.
Anyway. So, brow lifts. There she is. And we’ll get started in just one second. Here, let’s see. Get her on. Maybe it’s just my lousy Internet connection. There you are. Hi.
Dr. Greer: Hello. How are you?
Dr. Gallus: Good. Sorry I’m late, I was running around. Clinic got out of control, and then…
Dr. Greer: As it does.
Dr. Gallus: Yeah, it does go off the rails sometimes. And then also, it…then traffic was a beast. I don’t know, for no particular reason, like, why. It’s Wednesday, I’m not really sure. But, anyway.
So, you’re doing okay? You survived spring break, and so did I.
Dr. Greer: Okay. I’m hoping the Wi-Fi is going to hold out back here. I’m in my bedroom and it wasn’t quite as strong. But yeah, we…my kids had spring break, we were out of time, and then I moved the week we got back, because that’s fun. So.
Dr. Gallus: Yeah, moving is fun.
Dr. Greer: Yeah. Love it. Especially right after a vacation. It’s very restful.
Dr. Gallus: Yeah. Right. I know. I operated every day last week, that was my… Hi.
Dr. Greer: Wow.
Dr. Gallus: Yeah. So, I got back from spring break, and then every day I was like, “Okay, that’s a lot.”
Dr. Greer: That is a lot.
Dr. Gallus: Yeah. And then my blessed clinic set up clinic every afternoon. So, I was, like, racing to the next thing. Anyway.
So, we’re going to talk about brows today, right?
Dr. Greer: Okay. Yes, hopefully. I’m, like, getting my kid logged back into her math homework and my other kid is doing his handwriting homework, and they’re only a little bit trying to kill each other. But brow lift in the midst of that sounds fantastic.
Dr. Gallus: Okay.
Ella: Kill my brother.
Dr. Greer: Ella just said, “Kill my brother,” by the way.
Dr. Gallus: Yeah, we have sibling rivalry at our house, as well.
Dr. Greer: Yes, it happens. I have to say brow lifts are becoming one of my favorite procedures, and they used to be one of my least favorite.
Dr. Gallus: Yeah. Same. I think some of it has to do with the technique, which I think we both have changed, right?
Dr. Greer: Yes. Because I started off doing, like, the big coronal incision or the pretrichial in front of the hairline, and it was just so much work. And scalps bleed a lot, by the way, and they’re miserable to work on because just they bleed a lot. And it didn’t make, like, a very dramatic improvement for all of that.
Dr. Gallus: Right.
Dr. Greer: Which frustrated me.
Dr. Gallus: So, yeah, I was trained and did endoscopic brow lift. So, small incisions here, here, and here. And then, with the camera, go in and kind of elevate everything. But then the actual pull is a little less dramatic than I would think. And you’re just really…
Dr. Greer: Yeah.
Dr. Gallus: Yeah. Kind of…
Dr. Greer: Although, even with the open it’s not that awesome.
Dr. Gallus: Yeah, you’re just tugging back a little bit and sticking it with either a suture or a screw or a staple or something.
Dr. Greer: Yeah.
Dr. Gallus: And so for the amount of dissection… And honestly, it hurts a lot for… I think the patient finds it uncomfortable, don’t you? Their forehead hurts afterwards when you do an endoscopic. So.
Dr. Greer: Interesting. I wonder why. I mean, it’s all…like, you’re right above the periosteum, right?
Dr. Gallus: Yeah. I don’t know, I thought people just didn’t really enjoy it.
Dr. Greer: Fair enough.
Dr. Gallus: So…
Dr. Greer: I did…then I did the subcutaneous lateral brow lift for a while, which is just skin excision. And it gives a little lift. But skin stretches. So, not my… So, now I do the lateral brow lift that Andrew Jacono does in New York.
Dr. Gallus: Okay.
Dr. Greer: Because when I bought his facelift book to learn his deep plane facelift technique, I actually had a patient who had called for a consultation with him. She lived in New York, but then she was in town with me and she’s like, “Yeah, I called for a brow lift at his office and it was $25,000.” And I was like, “Well, I have his book, I’ll read the chapter.” And it’s actually…this is literally our conversation. Hopefully she’s on here, she’s hilarious. She’s like, “Sounds great.” And it worked beautifully.
Dr. Gallus: Oh, well, you’ll have to share it, because I do the subcu brow lift.
Dr. Greer: Yeah. Yeah. Well, his technique is actually a lot like an endoscopic. So, he makes the incision… He only does two incisions right over the temporalis muscle. Endoscopic tools and an Aufricht retractor to see.
Dr. Gallus: Okay.
Dr. Greer: Elevates here, and releases the arcuate line and the conjoint tendon, which is really the key part. And then just suspends the skin flap up a little higher on the temporalis fascia. Yeah. And it’s beautiful. Like I have actually that patient’s before and after pictures are on my Instagram and there is, like, a visible half-centimeter lift.
Dr. Gallus: That’s awesome.
Dr. Greer: And she was awake actually, too. Yeah.
Dr. Gallus: And then, so, you use the endoscope to see what you’re lifting, or no?
Dr. Greer: Just the…. Actually, I just use the endoscopic elevators.
Dr. Gallus: Elevator?
Dr. Greer: Yeah. No camera, direct vision.
Dr. Gallus: Right.
Dr. Greer: Yeah.
Dr. Gallus: And then what are you securing that lift with?
Dr. Greer: I use…
Dr. Gallus: What suture?
Dr. Greer: No, I use a Vicryl.
Dr. Gallus: Oh, okay.
Dr. Greer: Yeah.
Dr. Gallus: Yeah.
Dr. Greer: Yeah, and it’s nice. And the incision is this long.
Dr. Gallus: Right.
Dr. Greer: And you just have to elevate around so it doesn’t bunch up when you lift.
Dr. Gallus: Right.
Dr. Greer: You know, and it’s, like, a few interrupted horizontal mattress or a chromic to close. And you’re not, like, curving the incisure on the hairline. Because when we do it in front of the hairline, guys, just so you know, we make it wavy because it’s less obvious, but that is…it takes longer to close. And with this it’s just a little incision, it’s back of the hairline, it hides beautifully.
Dr. Gallus: Nice.
Dr. Greer: It is, it’s nice. It’s a nice technique, I like it. It’s very elegant.
Dr. Gallus: Well, I will have to give that some though then.
Dr. Greer: Am I freezing? I might be freezing.
Dr. Gallus: You’re… I think you’re okay.
Dr. Greer: Okay. Maybe you’re freezing, actually. Oh, Ella is giving me a thumbs up.
Dr. Gallus: Oh, she’s good.
Dr. Greer: She’s a fan of the lateral brow lift, as well.
Dr. Gallus: Oh, yeah, okay. Well, so…
Dr. Greer: It’s the preferred technique in kindergarten.
Dr. Gallus: In terms of technique, I have also seen, but I have not done, the direct right at the brow.
Dr. Greer: Yeah. I’ve seen some.
Dr. Gallus: Which, I don’t know, I guess in the right patient, maybe.
Dr. Greer: Yeah. Some people just have that really sebaceous skin that tends to leave indented scars though and I’m always afraid I’m going to get that result.
Dr. Gallus: True. And then I saw somebody… I was considering doing it for somebody, but he ended up waiting, who had a brow lift done elsewhere. And they did, they did a lateral brow lift, direct excision, right above the brow. And it healed and it, of course, got the desired lift, but he’s a man. So, he had this, like, nice arched brow. And I was like, “Oh, that’s weird looking.” So, then he needed his medial brow, so…
Dr. Greer: So that it was straight and not arched.
Dr. Gallus: Yeah. So, we were talking about doing that, but he was going to try with Botox for a little bit. And then I was like, you know, “It might relax, too.” And… But I don’t know why. I guess that person did… So, that’s the downside, right? Of doing the same operation on everybody, whether or not they’re male or female.
Dr. Greer: Yeah.
Dr. Gallus: You don’t want the, you know, Bella Hadid eyebrow in a guy.
Dr. Greer: Right.
Dr. Gallus: It’s just weird. And so men’s brows…
Dr. Greer: It feminizes, yeah.
Dr. Gallus: …drape across. Yeah. So, I think…
Dr. Greer: Like mine. I have Bella Hadid eyebrows.
Dr. Gallus: Yours is not straight at all.
Dr. Greer: Mine are very… Do you see these eyebrows? I need a lateral brow lift. Do a vacation in San Diego.
Dr. Gallus: Well, I’ll open that chapter, and then you can come to San Diego and we can do it.
Dr. Greer: You know what? I’ll bring the book. You can read up, it will be fine. Be a fun weekend. Okay.
Dr. Gallus: Yeah. So, did you do the brow lift under just sedation or local, or what did you do for this patient?
Dr. Greer: The couple of times I’ve done it I’ll usually give like 2 of Versed and 50 of fentanyl. So, they’re still wide awake, but they care a little bit less. And, obviously, I have to numb a little extra above the supratrochlear and supraorbital nerves because that’s tender. And I tell them they have to be okay with scraping sounds. I’ve had a couple people opt to do it under local, and I’ve had more do it under general. But, yeah, it’s doable.
Dr. Gallus: Cool. Yeah, I think lately the ones I’ve done have been in combination with a facelift, so.
Dr. Greer: Yeah. So, they’re under general.
Dr. Gallus: Maybe upper and lower lids. And so you’re just going to be under anyway, so it’s fine.
Dr. Greer: Yes.
Dr. Gallus: Yeah. What about…how do you feel about the Botox brow lift? Do you like doing that? Do you use Botox?
Dr. Greer: I do it, yeah. I mean, I tell people, like, “You’re going to get a little…a millimeter.” But it does help, I think, in a lot of people. Although often they’ll come in and they’ll want their whole forehead frozen, and then they want a brow lift. And then you’re explaining, like, “The forehead lifts the brow. And if the forehead is not moving…”
Dr. Gallus: Yeah. You just want to, like, for certain people, just, like, Botox right centrally so that when they lift their eyebrow, it goes out. But it looks crazy.
Dr. Greer: Oh, yeah, it’s the Spock brow. Yeah, it’s like this. It’s not a good look. I’ve also had patients who really hate the horizontal lines, but the brow gets really heavy with Botox. And I’m like, “Let’s do a lateral brow lift, and then you can freeze it to your heart’s content.”
Dr. Gallus: Nice. That’s true.
Dr. Greer: And that works, yeah. Yeah. Because that’s the thing, people always think brow lifts are going to smooth the horizontal lines. And, like, the frontalis muscle, guys, is a really thing sheet of muscle over your whole forehead. That stays. Like, brow lifts are not going to affect that. But they do let you use as much Botox as you want then without dropping your eyebrow. So.
Dr. Gallus: Right. Yeah. It’s not going anywhere. So, that’s smart. Yeah, I do like the corner brow lift. I usually, even when I do it, I sneak it up there just so that, you know, it keeps it from pulling down at least.
Dr. Greer: Yeah.
Dr. Gallus: But yeah, it’s definitely balancing that out with what’s going on above the brow. And, yeah, that is a hard concept, I think, for people to understand. That as much as we hate forehead wrinkles, the purpose of that muscle that you’re paralyzing with Botox is to raise your eyebrows. So, if you take it out of commission, then you can’t raise your eyebrows. And a lot of us walk around with our brows raised kind of baseline without…
Dr. Greer: All the time.
Dr. Gallus: Yeah. Because…
Dr. Greer: Yeah. I notice when I haven’t been getting my Dysport regularly, and then I do it, like, my eyebrows, suddenly I’m, like, fighting to raise them when it kicks in. So, I must be, you know, very skeptical most of the time.
Dr. Gallus: Yes. Yeah, and you usually get used to it. And it’s nice to…it’s just nice to find that balance, the amount of Botox that you need that lets there be a little bit of movement, but nice, smooth forehead, right? So.
Dr. Greer: Exactly. Yeah, and it’s different for everybody because they all have different frontalis muscles. You know, I only get like one little line here and here, and then other people are like a whole row of lines all the way across.
Dr. Gallus: Yeah. I haven’t gone without Botox in my forehead so long. I guess mine goes all the way across. It’s never fully moving. But yeah, and it goes…it’s just, like, a long wavy line across.
Dr. Greer: Yeah.
Dr. Gallus: But yeah, you see people who have, like, a line across, and then it jumps up. Right? And then it…
Dr. Greer: Yeah.
Dr. Gallus: Like, almost like a square in the middle of their forehead, like it comes up this way. So, I think it’s important to pay attention. I’m training my nurse now to do Botox and we’ve spent a lot of time, like, looking at how people’s muscle works and what you’re naturally doing. Because, yeah, if you treat everybody the same, then it ends up looking weird.
Dr. Greer: It does not work, yeah. And that’s part of why Botox is still fun after, you know, being a surgeon for 10-plus years, because everybody’s muscles are a little different.
Dr. Gallus: Yeah.
Dr. Greer: And, you know, I will actually, for some patients where, like, they’re asymmetric or they’ve had results they didn’t like before, I’ll draw marks on with the white eyeliner. I don’t know who uses that for eyeliner, but we use it for marking for Botox. And I’ll take a picture for their chart, and then we can tweak it.
Dr. Gallus: Right.
Dr. Greer: And that helps. Or my nurse injectors will bring a picture of somebody they’ve marked and be like, “Okay, is this where I”…you know, “Do you agree with this? Do I need to make tweaks?” So, it’s a subtle art.
Dr. Gallus: Yeah, for sure. Because otherwise it just… Yeah. I do find that if somebody has a stronger brow on one side, if it’s the first time I’m seeing them, I will put the same amount on both sides just to see. Because I think sometimes if you chase it, I don’t know, there’s, like…
Dr. Greer: It gets worse.
Dr. Gallus: Yeah. Compensatory problem once you paralyze it. Like, it takes a while for the face to figure out what’s going on. So, I usually say, “Hey, I’m going to start even-steven. And then, in two weeks, let’s see where you’re at, and then we can add a little bit, or not, depending on how your body responds to not being able to move it.” They’ll always need more.
Dr. Greer: And that’s where I always tell my patients, “It’s like finding somebody who understands your hair and how to cut it. When you find an injector who gets the results you want, you really have to stick with them. Because if you’re, like, Groupon hopping, you’re not getting those little tweaks from time to time that make your result consistent and perfect.
Dr. Gallus: Yeah, for sure. Definitely, for sure. So, okay. What’s your most…what would you say you do your brow lift in conjunction with the most? What’s your most…
Dr. Greer: Probably upper eye lift.
Dr. Gallus: Yeah.
Dr. Greer: Because there are so many people who have extra skin on their upper eyes, and half of it is just their brow is dropped.
Dr. Gallus: Right.
Dr. Greer: So, yeah. How about you?
Dr. Gallus: Same, same.
Dr. Greer: Yeah.
Dr. Gallus: Yeah. I mean, and I think a lot of people can do upper lids without doing brow. I think they’re over…it’s an overcall. Like you’ll run into… Like I think there are some, probably, people in town who every time somebody comes in for an upper eyelid lift, they’re also telling them that they need a brow lift. Which maybe they do, maybe they don’t. But, yeah, there’s definitely people who do better with both in combination.
And then I feel like this was a resident-level question, but, like, which one do you do first?
Dr. Greer: Yes.
Dr. Gallus: You do the brow first.
Dr. Greer: And this is important people, we always do the brow first. Because otherwise you end up not being able to close your eyes because we’ve taken too much skin off the upper lift, which is not awesome. Yeah.
Dr. Gallus: I’ve actually been called to the OR for that before, where they did the brow first. It wasn’t…they weren’t plastic surgery residents, I won’t mention what service it was. But, anyway, they were doing cosmetic surgery. And so they did the bleph first.
Dr. Greer: Bleph first.
Dr. Gallus: Which I don’t know how you take two… Anyway. And then a brow. So, it would still have to be a pretty heavy brow, and, you know, it would have to be a pretty aggressive bleph to realize that you’ve taken a little too much skin, and then now can’t close the eyelid. I mean, the answer in that question is to just put the brow back.
Dr. Greer: Yes, leave it be.
Dr. Gallus: Yeah.
Dr. Greer: And then come back later.
Dr. Gallus: Yeah. But that is… Yeah. So, you don’t want to… You know, you want to make sure the brow position is stable before you start taking eyelid skin.
Dr. Greer: Yeah. And for the people who are always like, “But I don’t want to get a brow lift,” it will pull your brow down lower just doing a bleph.
Dr. Gallus: Yes.
Dr. Greer: Ask me how I know. I didn’t actually do this, but I saw a patient who had just an upper bleph and needed a brow lift. And, like, she saw me in consultation, went somewhere else, got just the bleph, came back and now her eyebrow is way too low.
Dr. Gallus: Oh, because it was pulling it down.
Dr. Greer: Yeah.
Dr. Gallus: That is a bummer.
Dr. Greer: That is a bummer.
Dr. Gallus: And then I’ve just had my annual eye examine on Monday. And we were talking about…speaking of eyes and opening of the eyes, which can be…it can be a lot of things going on, right? So, it can be a heavy brow, and then you’re trying to raise your brow and open your eye. But the…my eye doctor was talking to me about Upneeq. Have you seen that, the drop?
Dr. Greer: I’ve heard of it. Yeah. It’s basically… What is it now? To get your Muller’s muscle to contract and make your eyes look more awake. That’s what… So, it’s basically what you would give after Botox creates a ptosis.
Dr. Gallus: Right.
Dr. Greer: Hey, Wyatt, dude, I’m on Instagram Live. What you need, bud?
Wyatt: [proceeds to talk about a Netflix show he is enjoying]
Dr. Greer: Okay. Go watch it, that sounds great. He’s telling me about a Netflix show. I’m like, “That’s critical information at this time, at 9:00 p.m.”
Dr. Gallus: “We’re not burning the house down? Good, okay, moving on.”
Dr. Greer: Yeah. Yeah. Well, one time I was on a Zoom meeting and I was like, “Don’t come in unless you’re bleeding.” Ella comes in, “Wyatt is bleeding.” I’m like, “Yeah, but is it a lot?” She’s like, “No.” I’m like, “Okay, then go.” The people I’m meeting with are like, “Is everything okay?” I’m like, “They’re fine, they’re totally fine.”
Dr. Gallus: “Everything is good.”
Dr. Greer: “It’s fine.”
Dr. Gallus: Everyone in my house is currently on a screen, so it’s only a Christmas miracle that that’s even working online, that I’m not, you know…the bandwidth is still strong enough, right?
Dr. Greer: I know. When I got Internet at my new house, I was like, “Yeah, we need the highest speed. Yeah.” Now that all the TVs stream, like, yeah.
Dr. Gallus: 100%. Okay. So, Upneeq. So, we were talking about it. Yes, it opens your eyes. I’m not… She was just telling me the hilariousness of the conference that she was at where they were…you know, the company was promoting this. Because it’s very temporary. So, you would have to use it… I can’t remember exactly how many hours it lasts. But maybe once or twice a day. Like, it’s not a… It’s at least once a day, and maybe if you have an event for something that evening and you need to use it again. But it is a good… So, it is a good… [laughs at a comment about Internet in the chat] They do not have it in my area. So, there. But when it comes, I’m definitely switching over. But thanks. We could have a whole topic on, like, how Internet runs our world.
Dr. Greer: Yes. It does.
Dr. Gallus: And you’re, like, beholden to your signal. Although nothing… Just… You know I love to talk about Afghanistan. When I was deployed in Afghanistan, the Internet would go down whenever it rained, which was a fun little fact, because we were in the middle of nowhere. Mine didn’t either, but just did. Okay, yeah. I will keep checking. Yeah, it was whatever. Anyway.
So, yeah. So, the Upneeq opens up your eyes. And then it’s really, as far as my optometrist was concerned, it’s for people who maybe have eyelid ptosisand are considering surgery. Like, “Is it significant enough for you to do that?” And she played around with it. Like, usually, everybody’s eyes are asymmetrical a little bit. So, you can, like, you know, put a drop in the eye that you think is a little bit more closed and see, you know, how that affects the other eye, whether you need it in both eyes. I just don’t really understand the commercial appeal to the average consumer, that’s the part I don’t get.
Dr. Greer: Yeah. I mean, it’s not something…
Dr. Gallus: It’s not Botox. Like, I think it got marketed…
Dr. Greer: I don’t know if I would notice my eyes. Yeah.
Dr. Gallus: I mean, I tried out the drops that they had that were popular for a while, I’ve forgotten when they’re called, that made your eyes brighter and whiter.
Dr. Greer: Lumigan or something? Was it Lumigan? I don’t remember.
Dr. Gallus: Yeah, I think it was something like that. But, I mean, it was fine, but it’s like, “Okay, yay, my eyes look whiter and brighter.” Like, I don’t know. If that’s the one thing that’s bothering you, then I am in a good place.
Dr. Greer: You could combine them, and then your eyes will be, like, glow in the dark.
Dr. Gallus: White and large.
Dr. Greer: Super wide.
Dr. Gallus: Okay. Well, there’s one more eye drop that was available that she said that was getting pushed at the conference which basically gave you miosis, so contracted your pupil, this is interesting, so that perhaps you wouldn’t need readers temporarily.
Dr. Greer: Oh, I heard of that. Yeah, I don’t get that either.
Dr. Gallus: Yeah. She was wondering the utility of that, as well. So…
Dr. Greer: I feel like pharmaceutical companies, they’re like, “Here’s a side effect of this. How can we market this?”
Dr. Gallus: Yes, “How can we”… I mean, you should have just… Latisse was the win, just, you know…
Dr. Greer: And Viagra. Don’t forget Viagra.
Dr. Gallus: That’s right.
Dr. Greer: That was the ultimate win. Because it was a blood pressure medication, people, and it had an unfortunate side effect.
Dr. Gallus: Right. Yeah. That was probably… There’s Viagra here, and then Latisse.
Dr. Greer: Latisse immediately below. Yeah. And now you’ve got… Oh, well, like Qwo, that was made by Xiaflex, the collagenase that was used for Dupuytren’s contracture, which is…it’s a contracture of your hand and it dissolves the bands. So, they’re like, “Oh, maybe we can use this for cellulite.” But so far, from what I’ve heard, it’s just a whole lot of bruising.
Dr. Gallus: Right, yes. I feel like the results have been underwhelming. So, let’s just stick with Viagra and Latisse. And Upneeq, I guess, if you have a problem. But I think if I had a complication where I dropped someone’s…I don’t even want to talk about it, but dropped someone’s upper eyelid with Botox. And knock on wood, I haven’t done that. You can have them use basically nasal ephrine, you know, drops, decongestant drops.
Dr. Greer: Right.
Dr. Gallus: They don’t need the Upneeq. But I do think…I do occasionally… So, what made me originally start this conversation thread was that occasionally I see people who are coming in for either a brow lift or an upper lid lift and you notice that one eyelid is like lower than the other. And that’s eyelid ptosis, which is a whole different problem and could be related to a couple of different things. It can be, you know, just how you were born, it’s usually an age-related problem. And I don’t do ptosis repair.
Dr. Greer: I don’t either. I don’t either. It’s just it’s a little more involvement with the upper eyelid anatomy than I’m comfortable with and it’s very…it’s a lot of finesse. I send them all to my friend who’s oculoplastics and she’s fabulous.
Dr. Gallus: Right. And so that’s what I was saying, was that I do send patients like that to oculoplastics. And so maybe I lose the ability to do their upper bleph, but I think it’s important for them to get their, you know, eyelid ptosis exactly right. A lot of times it involves, you know, hitching the levator where it needs to be if that’s dehiscent. And I have done that in the past, but, like I said, I don’t do it anymore. But you’re one millimeter or two millimeters, it’s a very precise operation and it needs to be done ideally with the patient awake. I mean, I think that’s probably the best way to do it. But, also, you can do a Mullerectomy, which I’ve never trained on and don’t feel comfortable doing. And it’s…
Dr. Greer: Where they’re just, like, cutting off the back of the eyelid? Yeah, I know, I’ve seen the pictures. I’m like, “I don’t…it’s, like, in a clam.” That level of eye surgery freaks me out. Anything in the eyeball, really, back of the eyelid, yeah. I’ll stay on the skin surface.
Dr. Gallus: Yes. So, yeah. So… But I would say that if somebody had a ptosis issue, you could offer them Upneeq just to see if they like the correction or not, and then, like…and then kind of push them along to somebody who does ptosis repair. But yeah, I do try to stay away from that now because I just saw somebody and her upper lid crease was just weirdly high on one side. So, ooh, Sally Goyal is joining.
Dr. Greer: Yeah.
Dr. Gallus: So, yeah. So, I was like, “Yeah, I’m going to need you to see somebody about that, and we can talk about the other things in the meantime.” So, that’s my… So, I guess my moral of the story is that the eyelid, the eyebrow, your forehead muscle are all, you know…
Dr. Greer: There’s a lot going on.
Dr. Gallus: Yeah. They’re all together.
Dr. Greer: It’s very intricate anatomy.
Dr. Gallus: Yeah. And so you can’t do things in isolation these days, you really need to pay attention to the whole anatomy of the upper third of your face.
Dr. Greer: Yeah.
Dr. Gallus: So, any other tips for brows?
Dr. Greer: I don’t have any. I mean, what do you think about microblading?
Dr. Gallus: That’s what I was going to say.
Dr. Greer: Oh, was it?
Dr. Gallus: Yeah. So, let’s talk about the actual eyebrow. I think that has been the greatest thing ever to hit the beauty industry, or the aesthetician industry. Because I have my brows microbladed and it’s fantastic. I’ve never… I don’t know… I should have done it sooner, honestly, it’s so amazing. It’s…
Dr. Greer: And it fades faster, right? It’s not like the tattooing that would, like, change colors weirdly, and then you have these, like, gray eyebrows in your 80s.
Dr. Gallus: So, yeah. So, I have a… So, there are different styles, and I feel like my person could probably break it down a lot easier. But she did a combination. So, microblading does not last as long. They’re making little cuts into the skin, and then smearing the ink on there. And then there’s tattooing. Which I think the original tattooing was pretty, you know, crude in terms of what options they had. But now they can do nano brushing and all these different little techniques to kind of create what looks like eyebrows, the individual hairs and whatnot.
So, I think that… I keep getting, like, spam texted. I think that… Yeah, I think that it’s probably best to do it in a combination. But, yeah, if you’re a little bit concerned, maybe do microblading because it won’t last as long. But I had…I just trusted my brow girl to do what she thought was best and she did a combination of different shading techniques, microshading, and then microblading, and it’s been amazing.
Dr. Greer: They look very natural.
Dr. Gallus: Yeah. I’ve really been happy and I don’t have to do anything with them. The worst part was, you know, keeping it dry for seven days. Yeah.
Dr. Greer: That’s tough.
Dr. Gallus: And, yeah, that’s not fun.
Dr. Greer: No. Which it makes me think of… Talking forehead and eyebrow. So, when I used to do skin cancer reconstructions, anything on the forehead, you know, you risk pulling one eyebrow up. And that’s something we, as plastic surgeons, really focus on. I had a lovely patient one time who I was going through the pre-op consent and warning her, she’s like, “I just draw them on anyway. I’ll draw them on even.” Great. Like, she had this big defect here, she’s like, “I’ll just draw them on even, it doesn’t matter.” She had, like, no eyebrow hair to speak of. She was fabulous.
Dr. Gallus: Oh my god. Yeah, no, I highly recommend it. Despite the, like, seven-day of keeping them dry, it was worth it.
Dr. Greer: It’s doable.
Dr. Gallus: For sure, yeah. Highly recommend it. And my sister got it done, too, in the last year and she really likes the way it looked, too. She went with more microblading, which is probably… Hey, Quinn. Is probably a better way to go. She usually instantly hates everything she does if it’s a big change. Like, is one of those people who researches it all, then gets the procedure, and then has instant regret. And you’re like, “Okay.” So, but then she’s come around and she likes it. So, but it isn’t as long-lasting as some of the other techniques, so it’s…I think it’s a good way to go.
Okay. So, now my dog is trying to join in. Perfect.
Dr. Greer: Oh, yeah. My… I’ve been actually petting my dog with my feet this whole time so that he will stay still. He’s not very happy about it.
Dr. Gallus: So, yeah. So, we should come up with another topic.
Dr. Greer: I know. What do you guys want to hear about next time?
Dr. Gallus: I know.
Dr. Greer: What have we not talked about in a while?
Dr. Gallus: DM us with ideas and we can talk about some things. Oh, maybe my sister was listening to me, because I just got a text.
Dr. Greer: She’s like, “Don’t you talk about my eyebrows on Instagram. I’m watching you.”
Dr. Gallus: “That’s personal, it’s protected health information.” Ooh, facelift. Oh, yeah, we can do that. Yeah.
Dr. Greer: Yeah, we haven’t talked about that. Good idea.
Dr. Gallus: I feel like we haven’t covered that.
Dr. Greer: Thank you.
Dr. Gallus: That’s awesome. Yeah, we can definitely cover that. And soft tissue support. So, Quinn might work for a company that does Galatea. We can do that, we’ll add that to our list.
Dr. Greer: Oh, funny. I use quite a bit of GalaFLEX, actually.
Dr. Gallus: Dr. Greer is a big fan, yeah.
Dr. Greer: In fact, I just did a breast lift with GalaFLEX and fat grafting on Monday, which was lovely.
Dr. Gallus: Oh, yeah. We should talk…we could talk about soft tissue support and fat grafting at the same time. Because I just saw two people today that were told…they were told that the, you know, surgeons didn’t do fat transfer cosmetically to the breasts. And I’m like, “Why?” I mean, I don’t really understand.
Yay. And then…
Dr. Greer: Well, yeah. So, facelift is a good thing to talk about, yeah.
Dr. Gallus: Yes. Okay, yeah, let’s talk about that. All right. So, we’ll set that up for a couple weeks from now, and then we will also put GalaFLEX soft tissue support and maybe some fat transfer at the same time. We can talk about fat transfer with the face, too.
Dr. Greer: All good topics. Nice.
Dr. Gallus: All right. Have a great weekend.
Dr. Greer: Yeah, we can, and the badness that can happen.
Dr. Gallus: Oh, yeah.
Dr. Greer: Cool.
Dr. Gallus: Yes.
Dr. Greer: You too. See you in a couple weeks.
Dr. Gallus: Okay. All right. Bye.
Dr. Greer: Bye.
About Restore SD & Dr. Katerina Gallus
As the Director of Restore SD Plastic Surgery, board certified female plastic surgeon Dr. Katerina Gallus has over 15 years of experience helping San Diego women enjoy head to toe rejuvenation with face, breast and body procedures. After a successful career as a Navy plastic surgeon, Dr. Gallus founded Restore SD Plastic Surgery with the intention of creating a welcoming space for anyone seeking cosmetic enhancement.
Restore SD Plastic Surgery offers popular facial rejuvenation procedures like facelift & neck lift, facial fat grafting, and eyelid lift; breast augmentation with implants, breast lifts or breast reduction; body contouring procedures such as tummy tuck, liposuction, mommy makeover, and Brazilian butt lift (BBL), as well as aesthetician services, BOTOX, injectable fillers, and laser treatments.
Dr. Gallus and her highly-experienced aesthetics team are here to help you look and feel your best! To schedule a personal consultation, please contact us online or call our San Diego office at (858) 224-2281 today.
