B (2:44)

She's looking wide awake these days, guys. Dr. Maleki comes to us with over 15 years experience in practice right here in Toronto and he has performed a staggering 20,000 plus procedures. And now he's sitting right here and we got him for a whole hour on the hot seat and he's going to tell us everything, you know, he wished patients really knew about eyelid procedures. What? Maybe you're wasting your money on what is a good investment and maybe what the Internet isn't telling you. And what's behind all those before and after photos.

A (3:12)

Plus we're spilling the tea on how to avoid aggressive hollow looking eyes you may have seen on the interwebs this year. And we're also going beyond eyelid surgery too. If you're kind of surgery shy, we're going to be talking about med spa procedures like Sculptra, PRP, PRF, CO2 lasers.

B (3:31)

So welcome to Breaking Beauty, Dr. Maleki.

C (3:34)

Well, thank you for having me.

B (3:35)

I can't believe that we get a whole hour of your time today. This man is in high demand, so I'm excited. So, first question, like I mentioned, some people may have heard the word blepharoplasty, but they don't even know what it is. So what is it? What's your elevator pitch?

C (3:50)

Yeah. So blepharoplasty is a procedure that is going to alter the appearance of the eyelids. And it may involve removal of skin, it may involve removal of fat, it may involve repositioning of fat or adding fat. So it's basically reshaping the eyelids. That's in essence what the blepharoplasty is.

B (4:11)

Okay.

A (4:11)

But you can have upper or lower, so maybe you could like distinguish between those.

C (4:16)

Yeah. So upper lid blepharoplasty typically classically involves removing excess skin or excess fat from the upper eyelids. Lower lip blepharoplasty involves removing sometimes excess skin, sometimes excess fat, and sometimes correcting the hollows underneath the eyes with your own fat.

A (4:35)

That's additive blepharoplasty.

C (4:38)

Yeah. So modern techniques in blepharoplasty are trying to Replace the volume that you've lost and not remove too much fat. Because when you remove too much fat, then you get into trouble in terms of making people look very hollow. And recently we've had a couple of examples of that in the media of people looking very, very hollow, and it makes them look a lot more age. So modern techniques for blepharoplasty really is about preservation of tissue and repurposing tissue to make you look more youthful.

A (5:07)

Yeah.

B (5:08)

Why is it called blepharoplasty? What are we talking, Latin? It's Greek.

C (5:11)

Yeah.

B (5:13)

All Greek.

C (5:13)

Yeah. Blepharo means lid, and plasti means to reshape.

A (5:16)

Yeah, right.

B (5:17)

Oh, okay. I didn't know that. From your perspective as a surgeon, how many people get both upper and lower?

C (5:23)

Oh, it's pretty common. It depends on if. So it depends on how people are aging. So it's interesting, some people, when you see them, their upper lids look. Get puffy and get full and get heavy, and other ones, it's their lower lids, they get puffy or hollow. If a patient has both upper and lower lid aging changes, then oftentimes they'll do them together. But some patients, we only see it in the upper lids or lower lids. So I would say in my practice, probably like 70 of patients will do upper and lower list together. But we certainly have a lot of patients who only need an upper lid blepharoplasty. Don't really need to lower the blepharoplasty or vice versa.

A (6:01)

And I mean, let's talk about. Let's just go there, because you mentioned the hollows, right. That look. And I mean, Bradley Cooper, I'm. He's haunting me on social media right now. I'm seeing this all the time. And, you know, people are speculating like, is, is his career over? People are like, he's lost his smolder.

C (6:22)

Yeah.

A (6:22)

So what happened there?

C (6:25)

So, I mean, obviously we don't know exactly what happened because, you know, we don't know his medical history. Speculating is that. Is that he had an upper lid blepharoplasty and that he may have had overly excessive skin and probably fat removal, which made him look too hollow. So it's really important when you're doing an upper lip blepharoplasty specifically and lower lids, too, that preserve the fat. And if you're. You don't have enough fat that we augment that fat. So the. The preservation of the fat is critical. And modern techniques in blepharoplasty, certainly in terms of Surgeons who do this type of procedure regularly, everyone is trying to preserve fat in the upper eyelid and not remove too much fat. So I'm not exactly sure what happened in this particular case, why this happened, but certainly amongst the circles of surgeons that. That I work with and we. And we. We discuss in conferences, modern upper blepharoplasty techniques are all about preservation of tissue.

A (7:22)

Yeah.

C (7:22)

And not removing excess. Too much excess tissue.

A (7:25)

Well, this is the thing that I think shocks the public is because you know that Bradley Cooper has more money than God.

C (7:33)

Right.

A (7:33)

And so he obviously has access to. You can't say this is an inexperienced surgeon that he went to. Right. Like, he's obviously getting referrals from people. He's going to the tippy, tippy top. So you have to kind of question why this happened. And I saw one person who was weighing in on it, who's in the field, and she had an interesting perspective. And I don't know if you will agree with this, but that the shape that they did on him was. He used to have, like a narrow shape.

C (8:04)

Right.

A (8:05)

And then they made it too round. So I don't know if that's because they did a lift in addition to the blephone. And you could maybe speak on that again, speculating. But they were like. Her point was that you can feminize eyes or masculinize eyes or take away from that, depending on your approach. So we're speaking about anatomy, guys, not how you identify, Right? Yes.

B (8:31)

To make that point, too.

C (8:33)

So in terms of anatomy, if you look at male eyes, typically they have fuller upper eyelids, the brows are set a little bit lower, and so they tend to have a longer eye in terms of the horizontal length and not too much of the vertical length. In female eyes, typically, we have a greater distance between the eyebrow and the eyelid, and there's a slightly more rounder shape. And so there are some differences. Of course, these are general kind of statements and within each category. But if you look at most aesthetically pleasing male actors who have nice eyes, they typically have typically a narrower upper eyelid in terms of the aperture, but also in terms of the space between the eyelashes and the brows.

A (9:18)

Yeah.

C (9:18)

Whereas in women, they tend to have slightly more open eyes and. And that's considered a more attractive feature.

A (9:24)

Yeah. Because that. That's when you look at the before and after, it's like he kind of lost that smolder.

C (9:31)

Absolutely.

A (9:32)

And so it's hard to imagine that opening up the eye area could potentially make someone less conventionally attractive. But Some people are saying that's. That's the case. So what do you do? Can that be reversed?

C (9:47)

It can, actually.

A (9:48)

Really?

C (9:49)

Yeah, it can. So. And I've. And I've encountered this, you know, a number of times in my practice with patients having had surgery elsewhere.

A (9:56)

Yeah.

C (9:56)

And they come back and they say, listen, my. The shape of my eye has changed. The. The character of my eyes change. Because it's really important to maintain a person's character in their eyes. Right. And so in a case like this, I was to see that I would probably recommend doing some fat grafting to the upper eyelid.

A (10:12)

Yeah.

C (10:12)

And to regain some of that volume and then reshape the eyelids so it kind of. She can regain that. Now, this is a highly, highly technical kind of procedure to do, especially in the upper eyelids.

A (10:23)

Yeah.

C (10:24)

And requires somebody who does a lot of this type of procedure. So it's not a. I wouldn't say it's a simple procedure, but it is certainly doable in terms of reversing some.

B (10:32)

Of the aging changes.

A (10:33)

I wonder if that will happen. Well, this is why I went to an oculoplastic surgeon. You specifically, versus anybody, because other types of physicians will do. Other types of surgeons will do blepharoplasty. Right. But I was like, I want somebody who does it all day long.

C (10:50)

Oculoplastic surgeons typically are surgeons who have trained after medical school, who have done training in ophthalmology, who've done eye surgery. So they've learned everything in terms of the anatomy of the eye, how the eye functions, and then they do additional training and plastic surgery of the eyelids, so upper lids, lower lids, brows, as compared to, for example, a plastic surgeon who's done also medical school and then does five years or of residency in plastic surgery and then starts practicing and does surgery on all parts of the body, from the abdomen to the breast to the face. And then there are also facial plastic surgeons who have become very well known, and facial plastics also do eyelid surgery. So facial plastic surgeons would be people who've done medical school and then do an ENT residency program. So they'd learn everything about the ears, nose, and throat, and then they do fellowship training in facial plastics. So they would be more specialized in things like rhinoplasty. Right. So the main difference would be in terms of the training and also the frequency in terms of doing it. So as an oculoplastic surgeon myself, if I would be doing blepharoplasty every day, multiple times per day, you can imagine that that experience accumulates over months, years.

A (12:03)

Totally agree.

A (12:18)

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B (14:07)

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A (16:16)

The changes, the challenges, the joy and the freedom in this season.

B (16:21)

Here you're going to find, honestly, conversations where we might laugh and cry all in the same hour. Let's flourish together in mind, body and spirit. Nothing's off the table. New episodes every Monday, wherever you watch or listen.

A (16:46)

Why do you think that blepharoplasty overtook liposuction for the number one cosmetic surgery this year? Why do you think it's so huge?

C (16:54)

It's hugely impactful. You can see the difference right away and, like, relative to cost also. Yeah.

A (17:02)

So in terms of bang for your buck, I feel like this is the poor man's facelift.

C (17:07)

It's the biggest.

A (17:08)

Speaking for myself, for sure, like, I'd love to get a facelift, but I can't afford one, so. But the eye surgery I could afford and I think a lot of people do want to know, like, the cost. So what would you be paying ballpark U.S. canadian for? Yes versus facelift.

C (17:25)

Yeah. So for blepharoplasty, it can range anywhere from 5,000usd to up 10,000usd. That's a kind of a broader range.

A (17:33)

Yeah.

C (17:33)

And then if you're looking at facelifts, typically you're in the range of like 15 to 20 USD to up to a hundred thousand, 150 depending on.

A (17:43)

Yeah. For sure.

C (17:45)

Who you go to and, but, but.

A (17:47)

But it's a fraction. It's a fraction really. And then for the results that you get and full disclosure, guys, I had a media discount when I came to you. Yeah. Which I appreciate. But yeah, you're looking at probably around 10,000 if you want to get a good blepharoplasty. And so yeah, the comparison. But then your, when your eyes are lifted, like it's such a crucial facet of aging that you really can look like 10 years younger just by having your eyes more open.

C (18:19)

Definitely.

A (18:19)

So that's why I was, that's why I think it's completely taken off because people are so used to seeing these transformations on social media and it's like accessible.

B (18:29)

I think you made a really good point about the distinction in your training and being an oculoplastic surgeon. Because Carlene, a big part of this like you were talking about is you needed. You had ptosis.

A (18:39)

That's true.

B (18:40)

So let's talk about that part.

A (18:41)

Yeah, so I, you know, as much as I would love to just have more open, you know, younger looking eyes, I really had an issue with one eye in particular that was drooping.

C (18:52)

Yeah.

A (18:53)

And I started note, I remember the day that I saw it on my, on my social media because I was posting and I was like, what is up with my eye? It seemed like it kind of happened overnight. And in fact I happened to go on vacation. This was just pre Covid with my mom, Eastern European. She's going to tell you right away if something's different. And she's like, what's going on with your eye? Like it's drooping.

C (19:16)

She brought it up.

A (19:17)

Is there something wrong with your eye? And I thought actually I noticed that and then I noticed it in pictures. And then I actually went to get Botox and I said, should I get it? Because I noticed this is drooping. And they were like, you know what, don't I think you need to get it checked out, make sure there's nothing going on. It was a big journey for me. I went to an ophthalmologist, a specialist. They did like a CT scan, they did mri, all kinds of things just.

C (19:46)

To rule out some serious thing, rule out stuff.

A (19:49)

And then eventually the diagnosis was ptosis. And I was like, okay, so what causes ptosis medically? Do you. Is it common?

C (20:01)

Ptosis is very common, actually. I was just at a meeting last night and we were just talking about that. So ptosis in the general population between the ages of 18 to about 60, 65 is about 11%. So 1/10 of the general population has some degree of ptosis. So what is ptosis? Ptosis basically means a drooping of the eyelid. And that means that if you look at someone's eyes, if you're looking at the iris, the color part of the eye, one eye or both eyes appear smaller. So the lid has come down like a curtain that you pull down and it kind of covers part of the window. The eyelid is like the curtain of your eye. If the eyelid is coming down, it's going to partially kind of block the iris, the color part of the eye. In terms of causes, there are lots of different causes for ptosis. You could be born with a ptosis. You can have a congenital ptosis, like a weak muscle. It can be an acquired ptosis, meaning that it happens as you age. So the second most common cause of ptosis is aging, age related. So if you look at people over the age of 65, about 30% of them have ptosis. So it's a very, very common problem.

A (21:04)

I'm seeing it now because I'm sensitive to it. So I'll notice it on people, but.

C (21:09)

In a younger person. So as someone who's in their 20s and 30s who are just noticing ptosis, typically it's related to dry eyes or contact lens use. So anything that's any inflammatory problem of the eye can cause the muscle of the eyelid to slip and the lid will drop. So most of my patients who come to see me who are in their 30s, 40s, and 50s, when I ask them about any history, either there's a history of trauma or contact lens use or dry eyes or allergies, those are the kind of four big ones. So the procedure to correct ptosis is very, very different than a blepharoplasty. So blepharoplasty, you're removing skin or moving fat, and that can kind of alleviate some weight on the eyes, and that's. And that potentially can help. But those who have actual true lid ptosis, we have to work on the muscle that's responsible for opening the eye. So we would either reattach the muscle if it slipped or strengthen the muscle if it's been weakened. And that allows us to open the eyes. And that's what you had done. So we had a, we did a ptosis with a blepharoplasty. And that's, it's probably a little bit more technical and, and difficult than a, than a blepharoplasty, which is why most plastic surgeons don't perform ptosis repair. It's typically done by an ophthalmologist who has training in oculoplastic surgery. And that's typically the route that most people go to.

A (22:29)

Yeah. And I wore contact lenses for 30 years, and you and the ophthalmologist, who ruled out anything else going on, had asked if I wore contact lenses, and I had no idea. I was like, was there fine print that I missed when I, I don't.

C (22:48)

Know if they, if they disclose that when you're getting contact lens.

A (22:50)

Well, this is what I'm saying.

B (22:52)

Where are your glasses?

A (22:53)

Seriously?

B (22:54)

Do you wear glasses and just enjoy your life or.

A (22:56)

Laser eye. What? Laser eye correction. What's your view?

C (22:59)

Yeah, it works. I've had it. It works great. So, yeah, so in terms of, in terms of laser. Laser, there's been, like, huge improvements in, in the technology, and now they can correct a wide range of refractive error and astigmatism. So it works well for most people like ob, there's. You have to have an examination to rule out some medical conditions that. But the number of people that would benefit from a laser eye correction has increased significantly. And the benefit is you don't have to put something on your eye every day like a contact lens. So for me personally, I would, if someone would say choose between, like, contact lenses and glasses, I'd say glasses all the time. And if you didn't, if you wanted to be spectacle free, I would say go to do Lasik instead of contact lenses.

B (23:41)

Now, Carleen, off the halt, we mentioned that there was a part of the story that you hadn't shared yet, and that, that is that in 2024 you had. You saw Dr. Maleki blepharoplasty, and then you saw Dr. Maleki again in 2025.

A (23:55)

Yeah, exactly.

B (23:55)

Tell me everything.

A (23:56)

So. So we would have regular checkups. I can't remember how often it was like every few weeks, then it was every few months or that kind of thing. And what I had noticed is that my right eye, which was the primary drooper, was kind of drooping again.

C (24:10)

And that was the main. That was the main.

A (24:12)

That was the main one. So not to the degree that it had before, but it did start. It started Drooping again. And so you and I talked about it and you can take it from here.

C (24:23)

Yeah. So as I mentioned earlier, ptosis repair is an extremely delicate and tricky operation because we're not just removing skin. So we. So the first operation that Charlene had was a blepharoplasty with lid ptosis repair. So we removed a bit of skin and then tighten the muscle to raise the lid. So. And she had some improvement in terms of both the excess skin, but also in terms of the ptosis.

B (24:45)

And you're physically measuring this, right? You're physically measuring this, like a millimeter kind of device?

C (24:49)

Yeah. So in the exam table, when we're examining you, we're looking at, you know, the position of the eyelid and we're looking at the muscles and we're. And so we make an estimation of how much to advance. So it's. So it's highly technical. So you get to the end result and on the table, she looked great. And in the healing process, and this is where. This is the part where most people don't really understand when you're doing an operation on anybody, any individual, there is a healing process. And in that healing process, there may be some variability in terms of how people heal and the outcome varies. So when you. When we. When I was seeing Carling in her follow up visits, I was looking at how the swelling was going down and things were improving. When she got to the point where the swelling had gone away completely, we got to quote, unquote, her kind of final result. That's when we did kind of some measurements again. We said, okay, Carlene, this is your measurement today. And we compare that to our measurement prior to our surgery. We have photos and we saw that there was an improvement in the ptosis, but not a complete resolution, meaning that the eyelids came up a little bit, but there was still a little bit of asymmetry between the eyes. And then we had to have this conversation, was like, carlene, how do you feel about this? And so we went back and forth and she was like, well, I'm not sure. I think I'm okay with it. And I said, well, it's really your call. And I said, listen, well, let's continue to follow you. I followed you for another, I think another year probably, right? And then at one of your follow ups, you said, you know what, I think this has kind of bothered me enough that we should look at it again. We looked at it again. I did some measurements again. I said, there's enough of a difference here that I felt Confident to do a secondary ptosis repair, meaning going back in and buying that muscle again and tightening it a little one more bit. But it wasn't an easy decision. And we were kind of. You were a little bit hesitant, and. And I, you know, and in full disclosure, I wanted to do what was in your best interest. So I didn't want to push you in one direction or another, but I felt that I can explain, you know, what I can do for you, but you have to ultimately make the decision.

A (26:43)

He let me come to my own decision and. Which I appreciated. And I can just say I'm so glad that I had it redone. Like, I'm so happy with the result now. And so I. I don't know what that the takeaway is for people. Every situation is different, but for me, I just. I don't think I ultimately would have been completely happy had I left it. And I don't see this as, like, a failure in any way. I don't see this as doing any, like, anything having gone wrong. I appreciate that. Again, you go back to that example of the celebrity we talked about earlier. It's like, I don't want to, you.

B (27:22)

Know, go too far.

A (27:23)

I don't want to go. I would rather that we did it this way than take the risk of going too far. And it's funny because you and I collaborated on a post with our. The before and after, and everyone can take a look at breaking Beauty's feed to see that. And I was looking at the comments, and most people were like, wow, this is amazing. This is amazing. And one person was like, I think you could have gone further.

B (27:43)

Yeah.

A (27:44)

And it's like, this is. I mean, again, everybody's different, but for me, I don't want it further. I don't want to change the shape of my eyes. Like, I always had puppy dog eyes. That's what I was told. And I want to maintain my character that looks like my mom and my brothers. And, like, I don't want a big round eye that I never had.

C (28:06)

Yeah, absolutely.

A (28:06)

You know what I mean?

C (28:07)

It's so funny they made that comment, because I get that comment all the time. So you can imagine in my field, it's a very public thing, so we're posting before. So every once in a while we'll say, oh, you could have done a little bit more here. There's always a critic in the audience. But the reality is that I'm not that person's surgeon. I'm the patient's surgeon.

A (28:27)

Exactly.

C (28:27)

So the patient and I Have a discussion, we decide on how far we want to go. And of course I'm going to give my professional and honest opinion. I'll say, listen, I think we can go this much because we don't want to change. But ultimately. And so I'm really happy that you came to that decision yourself. And then we, and we did that together. But. And right now I think that we were just talking about this before. I can't even tell which, like, which eyelid was the eyelid that had ptosis.

A (28:54)

I know.

B (28:55)

So that's really good.

A (28:56)

Good.

B (28:56)

I think it's important because I think revisions are a big part of cosmetic surgery.

A (29:02)

Yeah.

B (29:02)

It happens frequently. And it doesn't mean it's bad or good. It's just like an constant dialogue with your provider. Right. About what?

C (29:11)

And here's some advice to kind of listeners. If you're going to undergo any type of cosmetic or plastic surgery, one of the questions that you should ask your surgeon is that, should things not go as planned? Are you able to do your own revision surgery? And that's a really important point. Right. So people will do blepharoplasty or rhinoplasty or facelifts, but if you're not comfortable doing revision work on your own patients or other people's pain, like, that's a, that's a really important distinction. So. Yeah, so you need to be able to be comfortable with that anatomy enough that you don't just do the easy cases, but you do the difficult cases too. Yeah, I think that's, that's critical in.

A (29:50)

Terms of people who don't do that.

C (29:53)

Yeah, there are people who do plastic surgery and they do only primary surgery. They do, they don't do any revisional work really.

A (30:00)

So if there's a problem, the one and done surgeons.

C (30:02)

So if they're, if they're, if there's a problem complication, they'll be, oh, this is out of my expertise. And they'll actually say that this is not in my expertise area. I'm going to refer you on to. So I, I probably like 30 of my, of my, of my practice is revisional work with other surgeons who've done surgery. So if you do, if you've done your surgery well, then if you're unable to correct the problems or potential problems that come as a result of it, then it's a little bit of a problem because you're you.

A (30:30)

Okay. I've not, I've never heard that before. That's a great piece of advice because we've often asked in the past. Like what to ask to try to vet who. Who you're gonna ultimately go with.

C (30:40)

Do you do revisional work?

A (30:41)

Yes.

C (30:41)

You do your own visual work, and also you do other people's revisional work. So if. If someone's not doing any revisions at all, that's a bit of a red flag. That means that. Okay, you either haven't done enough surgeries.

A (30:52)

Yeah.

C (30:53)

To. To encounter problems. Which is a problem. Right. Yeah. If you've only done surgeries, like, for, like, one or two years, and you haven't done enough operations, you don't know how to fix problems.

A (31:02)

Yeah.

B (31:02)

Right.

A (31:03)

Well, essentially, you're not accountable for your work is what that means.

C (31:06)

You don't have enough experience.

B (31:07)

You don't have the expertise. Yeah.

A (31:09)

Right. Right.

C (31:10)

Okay. So it's not that they don't. It's not that they don't want to do it.

A (31:12)

It's just.

C (31:12)

They don't have the expertise to do it.

A (31:13)

Right. Okay.

B (31:14)

Right.

A (31:14)

Yeah, fair enough. Fair enough.

B (31:16)

And I mentioned before that you often do post your surgeries online on social media, so everyone can go look at this.

C (31:22)

Yeah.

B (31:23)

But what's interesting is it's local anesthesia, which you mentioned for the most part.

C (31:27)

Yeah, yeah.

B (31:28)

So how do people deal with that? Like, I. Because it's like, you know, when you get a tooth pulled or something, you're very aware of what's going on. Okay, so. So is there a Valium?

C (31:39)

Yeah. So let me. So let me explain. So it's not. It's not just done under local anesthesia. So none of the surgeries I do are just done under local anesthesia. They're all done with local anesthesia with some degree of sedation. So every single patient gets at least an Ativan, which is. Which is an oral sedative which calms your nerves, and 99% of them get also IV sedation. Which means that they give. That we give them.

B (32:02)

Oh, yeah.

C (32:02)

That's the good stuff. And that's the stuff that acts kind of quickly.

A (32:06)

Yeah.

C (32:06)

And. And it calms you down. And we have control over how much, you know, medication we give you. And so that makes people more comfortable. Yeah, but you are. But you are correct. Majority of my surgeries, we do this awake. So the patient's aware, but they're kind of in a more relaxed state.

A (32:20)

So I can speak from experience. You're in a very. It's like. Like, it's like, you know that because your. Your eyes need to be open, and you can explain that part to do for part of the surgery. But like, you, you know it's going on, but you don't care.

C (32:35)

Yes, exactly.

A (32:36)

So it's kind of like the local anesthetic anesthesia thing where you're getting the dental, but you're also get kind of getting this other, this other medication where it's like you just don't care. We're just like kind of chatting like someone's doing my.

A (32:58)

Today's episode is brought to you in part by Laundry Sauce. So, fun fact about me, I don't love cleaning, but I do like doing my laundry. I have no problem with it. I think it's because I'm such a clothes horse. So I like to look after my clothes. And if you're like me, you need to know about laundry sauce because it's really an elevated kind of game changer for washing your clothes. It's like perfume that you would wear but for your clothing. Now, a lot of you might also be thinking, but, Carlene, I know you're sensitive. You're sensitive to scents as well. Well, that's why I'm so excited, because Laundry Sauce has just released their first ever hypoallergenic fragrance. It's called Himalayan Cashmere. I'm so excited to try this one. It's a soft blend of airy floral sweet pear and warm amber. It's going to wrap you up in this creamy sandalwood Himalayan musk that's like a cashmere sweater. How perfect is that? They have all sense, though. Australian sandalwood, French saffron, whatever vibe you're vibing with, they have it. And here's the best part. Laundry Sauce is having their biggest sale of the year right now. You can get up to 40% off site wide for a limited time. So you can stock up or you can gift somebody else. Introduce them to the wonderful world of laundry sauce. And laundry sauce isn't just about smelling incredible. It's engineered for performance, too. So you can bet that your favorite pieces are going to look and feel brand new when you're done. For a limited time only, our listeners get 20 off your entire order when you use code beauty@laundrysauce.com that's 20 off atlaundrysauce.com with promo code Beauty. After you check out, they're going to ask where you heard about them. So don't forget to drop our name. Trust us, your laundry's never smelled this good.

B (34:48)

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A (36:57)

The most googled question around Blepharoplasty is how long does it last? Yeah, I didn't know that was the most googled question.

C (37:03)

I was like I get that question all the time.

A (37:05)

I didn't even ask that. So am I going to be back seeing you in 15 years?

C (37:09)

So yeah. So blephar, I mean nothing is permanent in the sense that you know your face is aging, your skin is becoming more relaxed and things so but typically when a well executed blepharoplasty typically lasts for years to decades. How many years? How many decades? It's hard to know because it depends on the patient's aging profile. So but it's not uncommon that when we do blepharoplasty that because and I've seen my I've Seen some patients who I've did blepharoplasty done 15 years ago, and they still look good.

A (37:37)

Yeah.

C (37:38)

I'm like, okay, you still look good. So good. Because they're seeing me for other things. They're coming to me for xyz and I'm like, oh, let's take a look at your eyes. Your eyes looks to look great. So, yeah, it's not that you will absolutely need to do another blepharoplasty. That's not true that you may not need to do another blood. But if it does happen, it happens very gradually over years to decades. Typically, I'll tell patients I probably won't have to do this, anything like that, in that nature, probably for 10, 15 years, but it could be longer. Right. Typically what happens is that people's. The rest of their face starts to sag, their eyes start. The brows start to droop, their face starts to droop. But once you've removed eye bags, once you've done fat grafting, once you've removed excess skin, typically those things don't come back in a short period of time. It's going to be like, like many, many, many years to decades.

B (38:20)

So post recovery, you mentioned within a week, usually people are wearing makeup, doing their everyday life. I think that was the case for Carlene.

A (38:26)

Yeah.

B (38:27)

No, also, I want to ask about scarring, because people may be interested in. In that, and I'm sure you've perfected it at this point. So how do you go about, like, hiding scars? Sometimes on social media, people will be, like, called out, so you can see this scar, that scar. So what's the most modern way of, like, preventing that?

C (38:44)

Yeah, so most of it has to do with planning. So when you're planning surgery, most surgeons who are doing this, like, cosmetic surgery, and they do a lot of it, try to plan to make their incisions in areas that are either completely hidden or not very visible. So, for example, for an upper lip blepharoplasty, we hide the incision in your eyelid crease.

B (39:05)

Okay.

C (39:06)

So when you open your eyes, you really don't see it.

B (39:08)

And how big is it?

C (39:09)

Oh, the. Well, it's the length of your crease. So it's like, you know, like 3, 3 centimeters in length. But in terms of width, it's very small. It's like a millimeter at most, and it's in your crease. So when you are healing, once you're healed and that can. And the final healing, usually I tell patients, you know, you gotta wait at least Six months to get your final healing. So some of the stuff is done internally. So when I do ptosis repair, sometimes it's done internally. So there's no scars or lower blepharoplasty. I do most of my lower blepharoplasty internally, so there's no external scars. Brow lifts I do typically from the hairline, so it's kind of hidden in your hairline. So I think the planning is important. And then the aftercare, you want to follow your surgeon's instructions to the T, which means no kind of bending over, no exercise for the first two weeks. You don't want to rub your eyes because potentially things can open up or splay, and so you want to avoid those activities. And we have lots and lots of good treatments for scars. We have lasers and scar creams that can help improve the scars. So I'm not, not. I'm usually not super, super concerned with people not healing well, quote, unquote, because I think that we can, we can manage them.

A (40:17)

Yeah. And you have kind of like a. In office suite, I guess, that does all non surgical stuff.

C (40:25)

Yes.

A (40:26)

And so is that designed to be in conjunction? Like, did you create that to be in conjunction to the surgeries or is as. As an alternative.

C (40:36)

Oh, that's a great question.

A (40:37)

Does it help the scarring or is.

C (40:39)

It so, yeah, it came out of a desire to improve outcomes more. So when I, so I, it all started off with the CO2 laser. So when I started my practice, we were, I was doing blepharoplasties, I was doing a lot of them. And, and blepharoplasty is great for removing skin, removing fat, opening eyes. But in terms of like, wrinkles and fine lines, surgery can help a little bit. But really, that's not really the realm of surgery. Like, if you, if someone comes to me says, I just want to improve my wrinkles, that's not a surgical problem. So then what I did was the very first laser that I bought was a CO2 laser. And this was like way back when. So almost all of my lower blepharoplasties I do with CO2 in a patient who's a candidate for CO2. And what it does is it helps helps tighten the skin around the eye. So the fine lines and wrinkles tell.

B (41:31)

Me that's a dramatic difference for people I've seen that have done huge difference.

C (41:35)

Yeah, so it started off like that. It started off as an, as an effort to just improve outcomes. I wanted my patients to have the best outcomes possible. So I, I Said, okay, let's go and figure out how we can do that. And the first thing I did was I bought a CO2. And then from that, it kind of snowballed. I was like, okay, well, what else can we do to improve outcomes? And then so. And then we got other lasers, Erbium, a diode, so we can treat veins around the eyes. We can do other kind of treatments. Then we got into radio frequency microneedling. We got into. We did start doing Botox and prp. So it was all in an effort to kind of serve my surgical patients. But the side benefit is that there are some patients who come to see me who are just not candidates for surgery yet. Right. And they're like, okay, I want to improve xyz. And I said, well, listen, we can start with this laser. We can start with Botox, we can start with this. And then whenever they do become ready, then we have the capability of serving them in both ways.

B (42:32)

What I want to do is the PRP and microneedling under the eyes.

C (42:35)

I like PRP and I use a lot of PRP as well in conjunction with. But I would say, like, PRP and CO2 is probably more powerful than PRP and Microsoft.

B (42:44)

I don't know if I want to get my skin blasted off, you know, because CO2, what we're not saying is very ablative.

C (42:50)

It's an ablative laser.

B (42:51)

So you're basically, the downtime is probably more than what Carlene had. You're wearing Vaseline all over your face.

C (42:55)

Yeah. So the downtime is probably about two weeks. So if you're able to kind of. Kind of move your social calendar for two weeks and like, you know, not because you'll be red, you'll be red and you'll be crusty, then it's a good. It's a good. It's a good treatment. And you can tailor it to the individual. So more. More intense. If you've got more wrinkles, less intensity or less wrinkles. So I have some. Because I've posted on social media, I have some patients who are a little bit younger who don't have as many fine lines, and then their CO2 recovery is like five, six days. They look. They look amazing. I'm like, how is that possible? Well, it's because it's tailored, Right. So it's not. CO2 is just the device. I can tailor the CO2 based on what I'm. So if someone only has a mild degree of fine lines and wrinkles, it can be a very short recovery. Whereas if Somebody who's got significant wrinkles and fine lines, it could be a longer recovery. So, so there's a range with these types of things. But if downtime is an issue with you and you can't take any downtime, then probably CO2 is not the option for you. But we have other options that can help with that.

B (43:57)

I think we also need to talk about dark circles. Number one question we get. And bags.

C (44:02)

Yes.

B (44:03)

Talk to me what you would recommend.

C (44:04)

Okay, so dark circles is a very kind of generic term and it's a little bit confusing because we. People don't know exactly what they're talking about in terms of why they have dark. So the way that I, I think about dark circles, I think about it kind of in three different ways. So yours, your, you can have dark circles because of hollowing. So if you look at your under eye area, if you have an indentation, so like everyone has a tear trough, but if that tear trough continues on all the way around your eye and goes to the other side, so it's like a half circle indentation, then that's one very common cause of dark circles and we have good treatments for that. I'll talk about that. Second cause of dark circles would be eye bags. So if you have an eye bag, the eye bag is casting a shadow below it and that's creating some darkness. So that's the second cause. The third cause would be the actual skin itself. If the skin itself is pigmented is darker and that could be either genetically or because of sun damage, then that skin will be darker and you'll, you'll, it'll look like you have quote, unquote dark circles. So we actually have treatments for each one of those problems. So if you have eye bags, the, the, the, the solution is surgery. Hands down. There's no real. You can.

A (45:21)

Because we're talking about. It's popping out.

C (45:23)

Yeah.

B (45:23)

So it's sagging.

C (45:24)

Yeah. You can see the puffiness coming out under the eye. So, so there I have lots of patients who have, who've had, you know, eye bags. And then they'll try to look for like a quick fix and they'll do fillers to the hollowers. Yeah. Mask the eye bag. And yes, it does work temporarily. It does. And I've had, you know, and I've had experience with that too. So I've done fillers on patients who had eye bags. This is years ago, many years ago. And it does work. However, it's very short term and potentially can cause other problems. The other problems that occurs is that you get kind of swelling effects. Because if you got to think about it, if you have an eye bag and you have to add filler to the top of that eye bag to mask it, that's a lot of filler. Yeah, that's a lot of hyaluronic acid gel. That's a lot of swelling. Because the hyaluronic acid fillers, in general, the way they work is that they draw water in. They're hydrophilic, so they bring water in. So if you're adding a product underneath the eye bag, that's going to draw water in eventually, over time, you're just going to get pooling of that water and then it'll just sit on your cheekbone. And so that's a problem that I see very commonly. It's called malar edema. So. So for me, eye bags, as soon as you have eye bags, that's a surgical problem. Don't even mess with, like, anything else. It's surgery.

A (46:36)

There's only. There's no cooling tips gel eye creams that are gonna have winning.

C (46:41)

There are other things that are out there too, like these creams. Like, it's basically hemorrhoid creams you put under your eye to shrink, and it's like. But then it bounces back, like, with a vengeance. So you put it on for like, for like, you know, 30 minutes, an hour looks good for like an hour or two. And then take off the hemorrhoid cream and then it like, bounces back. So eye bags, it's surger. If it's hollowing, then. And it's. If you have hollowing by itself, you don't have eye bags, then yeah, maybe fillers is an option, but I think a better option is fat transfer. Fat grafting. Fat grafting basically means we borrow fat from another part of your body and we put that fat into the hollows, and that corrects the hollowing. The reason I like fat transfer fat grafting better than fillers is because your fat as a substrate, as a, as a tissue, doesn't draw water in. You don't. It's not hydrophilic. So when I add fat there and it corrects the hollowing, once you've healed from that fat transfer procedure, a, it's a permanent solution because you've developed blood, blood supply to those fat cells. And B, you don't have to worry about that in like two years or three years, you're going to get fluctuation and swelling because fillers. Think of it. Think about fillers as acting like A sponge, it draws water in whereas fat does not act like a sponge. So that's probably my number one treatment for under eye hollows.

A (47:54)

It's all natural, guys.

C (47:56)

It's all natural and it's your and it's yours, right? So it's like, it's the best type filler, so it comes from your own body. And so I would say for hollows use fat transfer over filler. And then for, for hyperpigmentation of your skin, I would say that you there we have some excellent lasers for hyperpigmentation. So laser treatment to lift off that sun damage and, and some brightening creams, combination of brightening creams. And so, so if you do.

A (48:21)

What's the laser? What's the laser? Because there's so many.

C (48:23)

We have different lasers. So the laser that I would. So CO2 is definitely one laser. If you have wrinkles, if you don't have wrinkles and it's just pigmentation, then I would say the ND AG or diode laser and then erbium laser if you're kind of slightly, slightly darker skin tones and you want to lift up. So we have different lasers for different skin tones and also different problems. But I would say that those are the main ones.

A (48:46)

Have you really shopped the brightening eye creams out there or do you just have one that you went with? Like, have you really gone the gamut?

C (48:53)

Yeah, we have and we've tried them and we've used them on our, on our patients. We use them on our self service. So I think the brightening creams that are out there, they kind of fall in two different categories. So you can have the hydroquinone brightening cream. So hydroquinone is a compound that actually suppresses the melanocytes, the pigment produced in cells in your skin. And it's very effective at brightening the skin. However, depending on the percentage of hydroquinone in that cream, 2%, 1%, 4%, 6%, you can get further brightening of the skin, but also it can cause inflammation. So. So it's not a great treatment for long term. So if I'm trying to treat short term, can I get some pigmentation down? I will use one of those creams if I'm looking for long term.

A (49:36)

Sorry, is that by prescription only?

C (49:38)

Yeah, you need a prescription, you need prescription for over a certain percentage. So for 2% or under, you can get at a doctor's office. If it's over 2%, like 3, 4, then you need to get a prescription and it has to be compounded so that's kind of one category of bright ingredients. And that actually, actually works. Like, it really works. Works.

A (49:54)

Yeah.

C (49:54)

But it's not a good long term treatment. Right. You can't be on that for like years. It doesn't work that way. You'll cause problems.

A (50:00)

Okay.

C (50:01)

And then there's some non hydrocodone brightening creams, creams that have compounds like niacinamide and other. That, yeah, transamic, that, that can help and those you can, you can use that as more for like maintenance. And so and those are available over the counter and they're available at most kind of cosmetic institutions. And they, they do work, but it's like, like I would think of it more like maintenance in terms of. Because in order to decrease the pigmentation you need something a bit stronger than that.

A (50:30)

Okay. So maybe you start with hydroquinone and then go to.

C (50:33)

That's what we typically do. Or we can do them at the same time.

A (50:36)

Right.

C (50:37)

You can use them, you know, at the same time, but you'll just stop, you'll just stop the hydroquinone after like three months and then just carry on with the non HQ creams to maintain the skin. And if you do that in conjunction with a laser, amazing results. You can get very, very nice results.

A (50:51)

That. What's the, what's the brand you like for the maintenance? Niacinamide and the.

C (50:56)

Well, we, we, yeah, we carry kind of two of them. So Vivier is one of them that has a, has a great brightening cream and Alastin has another one as a, a good brightening cream. Yeah.

A (51:07)

Okay, great.

C (51:08)

And Viva is a Canadian brand. So if you want to support Canadians.

B (51:11)

It is a good line. It's a low key sleeper hit line.

A (51:14)

Great.

B (51:15)

SPFs as well. Yeah. Okay, so we've covered a lot of ground here.

A (51:18)

I know.

B (51:19)

I'm gonna say, is there anything that maybe is top of mind for you that's coming up more in your practice that maybe we didn't touch on today? That is blowing up in the group chat of plastic surgeons.

C (51:29)

Oh, I think right now the thing that's really blowing up is fat transfer. Fat transfer is the thing that's. Everyone's talking. Every meeting that I go to, I'm going in. Is it. In April I got invited to speak at a facial plastics meeting in Germany in Cologne. So I'm going there and my whole talk is about modern techniques in blepharoplasty, how to use fat, when to use fat, and all the different techniques of using fat. Because fat transfer People don't know has been around for a very long time. It's probably been around for like 20, 25 years. But initially, plastic surgeons who are doing fat transfer weren't getting great results because of the technique. They were using macro fat, big fat molecules. So people were having kind of lumpy, bumpy kind of appearance. So. So it didn't really take off until like, maybe, I would say four years ago. Three, four years ago, when more modern techniques started becoming more and more. And now. So now what we're doing is. We're doing. What I'm doing in my practice is micro fat. So micro fat grafting is basically fat particles less than a millimeter. And then we can further refine that fat to like, smaller particles, smaller particles to get something called nano fat. So microfat. Nanofat, basically, where by using the smaller fat particles, we can get very, very delicate and get into the minutiae of correcting people's hollowing. And it's been working amazing for under eye hollow. So I can do very, very kind of elegant, subtle corrections with those things. And in terms of the nano fat, we're getting the growth factors to improve the skin quality. So that's really what a lot of people are talking about at conferences. And that's certainly what I'm talking about when I get invited to meetings to speak on this topic.

A (53:05)

Yeah.

B (53:06)

And when you're saying fat transfer, that's still a surgery, or you're like, you're harvesting, like, how do you do it?

C (53:12)

That's a good question. It's kind of like. So it's. It's typically done by surgeons. Yeah, there are a couple of dermatologists here and there that are starting to do fat transfer. It's done. It's done by surgeons primarily because it's done typically in conjunction with surgery. So either facelifts or blepharoplasty.

B (53:29)

Right.

C (53:30)

But it can be done on its own. So I have patients that I've seen that I've treated who've who just have hollowing. They'll have no eye bags, no loose skin, not a lot of wrinkles, just have hollowing and will do fat transfer on its own. So technically speaking, it's not really a surgery per se. I'm not cutting anything out. So we're basically doing a mini, mini liposuction. So we'll borrow fat from a part of your body that has excess fat, and everybody carries a bit of extra fat either on their abdomen or their flanks or their thighs. So we'll. So we'll harvest that fat, like a mini liposuction, and then clean that fat, prepare that fat, and then process that fat to get those smaller fat particles and then inject that fat, just like we used to do with fillers. So I use a cannula, inject the fat, and I can be very, very granular, very precise with the fat injections. And. And it works well. So. So it's kind of a gray zone. It's not really a surgical procedure per se, but it's mainly done by surgeons.

B (54:24)

Well, we've taken up a lot of your time today.

A (54:26)

We've learned a lot.

B (54:28)

I feel like I've gotten consult and learn so much about Carlene's journey. So we really appreciate you. You're very welcome.

C (54:33)

Thank you so much for having me.

B (54:35)

And if everybody wants to follow you, if they are not as squeamish as me, you're giving lots of great advice on your social media where they can, where can they find you?

C (54:44)

So my, my handle on social media is just my name, so. Dr. Babak B A B A K Maleki M A L E K I. And yeah, you can follow me on, on that handle. And yes, I, I'm trying to, I try to be as transparent as possible online in terms of education. So show the good, the bad, the ugly and. And so people can understand it and potential.

A (55:03)

New office coming, potentially.

C (55:05)

New office. Yes, exactly. We'll keep you posted.

A (55:07)

All right.

B (55:08)

Thank you so much.

A (55:08)

Thank you so much.

C (55:09)

Thanks a lot.

A (55:12)

Thanks for listening. You can find details on every product mentioned in today's episode, along with our exclusive promo codes on our blog@breakingbeautypodcast.com While.

B (55:21)

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A (55:27)

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