Dr. Grant Moore

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Dr. Grant Moore

Oculofacial Plastic and Reconstructive Surgeon

18/09/2024

UPPER AND LOWER EYELID BLEPHAROPLASTY AND MID-FACIAL FAT GRAFTING
This case may look similar to other cases I’ve posted, but there’s more than meets the 👁, 😉. Many, many thanks to my beautiful patient for allowing me to post her photos and tell a bit of her story.
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So, what makes this case different? Ocular Cicatricial Pemphigoid (OCP). OCP is an auto-immune disease that can cause severe scarring of the inner surface of the eyelid, misdirection of eyelashes, and if untreated, blindness (google it if you’re curious). OCP is tricky because it’s often dormant until we are older or have an inciting event that activates the disease. Transconjunctival surgical incisions (i.e. my usual incision choice for lower eyelid blepharoplasty) can activate OCP.
Due to some concerning pre-operative exam findings, I performed a biopsy to confirm the diagnosis of OCP prior to surgery. Because of this, I used a subciliary skin incision (i.e., just below the lower eyelash line) for her lower eyelid blepharoplasty, and we were able to avoid activating her disease. In my experience, the best way to treat OCP is to avoid activating it.
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As for the rest of the case, mid-facial helped blend the transition between the lower eyelids and cheek. CO2 laser and a really conservative addressed redundant lower eyelid skin and wrinkles. Upper eyelid removed extra upper eyelid skin and increased tarsal platform show (i.e, the distance between the upper lashes and eyelid crease). My patient and I are both really happy with the results of her surgery. She was a joy to care for, and I appreciate her trust!
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Before-and-after photos were both taken with indirect lighting to maximize the appearance of shadows, wrinkles, and other contour irregularities.

25/06/2024

EYELID RETRACTION REPAIR
Lower eyelid retraction has many causes, including trauma, skin cancer, previous surgery, and severe sun damage. Lower lid retraction affects function (inability to close) and appearance of the eyelid.
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My patient developed right lower eyelid retraction (red arrow) following removal of skin cancer and reconstruction with another surgeon that healed in an unpredictable way. In this case, I repaired the problem by transferring skin from his upper eyelid to lower eyelid (pedicle flap with lateral tarsal strip and conjunctivoplasty). He feels much better now! I appreciate him trusting me with his care.

01/11/2022

The elusive Phoenix Lion, once thought to be extinct, was captured this Halloween. Although the safari team had anticipated a dangerous endeavor, the lion was easily lured with dog treats. Happy !

09/10/2022

Amazing time at the with my parents and . Nothing like expansive views and rocks over a billion years old to help refresh perspective.

16/09/2022

UPPER EYELID BLEPHAROPLASTY AND LATERAL BROW LIFT
This lovely patient underwent a functional upper eyelid to improve her peripheral vision, which was being blocked by excess upper eyelid skin. I also performed a subtle lateral brow lift to improve hooding at the outer portion of her eyelids. I appreciate my patient trusting me with her care; it was a privilege!😀

15/09/2022

UPPER AND LOWER EYELID BLEPHAROPLASTY
My lovely patient in her late 70’s underwent bilateral upper and lower eyelid to address redundant skin in her upper eyelids and fat prolapse (bagginess) in her lower eyelids.
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My patient and I are both over-the-moon with her results! She brightens up the exam room every time she comes to visit us, and now her eyes match her vibrant personality. I appreciate her trusting me with her care.
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Photo set 1: direct flash (good lighting)
Photo set 2: overhead lighting/bounce flash (bad lighting)
Photo set 3: inconsistent lighting

12/09/2022

MEN’S SURGERY MONDAY
This gentleman in his 70’s underwent bilateral upper and lower eyelid and direct festoon excision in his left lower eyelid. A conservative approach is a MUST for eyelid surgery in men, as it helps to prevent feminization of the eyelids.
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These photos were both taken with indirect lighting (i.e. a bounce flash and overhead room lights). Indirect lighting highlights shadows created by redundant skin and fat prolapse. In this patient, the reduction in shadows is most noticeable in the lower eyelids after surgery. My patient and I are both very happy with his results. It was a privilege caring for him!

31/08/2022

PTOSIS PTUESDAY
This lovely patient had asymmetric upper eyelid ptosis prior to surgery, with her left upper eyelid significantly lower than her right. She underwent bilateral upper eyelid external levator advancement surgery. Her eyelid height and symmetry are now much improved. Both my patient and I are very happy with the results of her surgery, and I appreciate her trusting me with her care!
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Symmetry in upper eyelid height and contour can be difficult to achieve, mainly due to neural control of eyelid height. In addition to anatomical changes in the levator muscle (i.e. the muscle that raises the eyelid), the brain plays a significant role in eyelid position. Believe it or not, lifting one eyelid can often lead to the other eyelid falling down (even if it didn’t undergo surgery). If you’re interested in learning more, google “Hering’s law eyelid.”

25/08/2022

UPPER AND LOWER EYELID BLEPHAROPLASTY WITH FESTOON REDUCTION
This photo series shows my patient, a wonderful lady in her 70’s, who underwent upper and lower eyelid blepharoplasty with festoon reduction and laser resurfacing of the skin around her eyes. If you’ve never heard of “festoons”, you’re not alone. Festoons are a second set of “bags” that accumulate underneath the eyelids, close to the top of the cheek. Some festoons are primarily composed of extra skin; others are filled with fluid.
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The second photo set (indirect, overhead lighting) best illustrates my patient’s festoons prior to surgery and their improvement following surgery. On her right side (left side of photo), the festoon (extra skin and fluid) was excised with a scalpel and cautery. Her scar is nearly imperceptible. On the left side, the festoon was reduced with laser resurfacing, as it was smaller and composed mainly of loose skin.
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At her most recent follow up appointment, my patient told me that she feels more alive and like herself again. It was a privilege caring for her!
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Photo set 1: direct flash (good lighting)
Photo set 2: overhead lighting/bounce flash (bad lighting)
Photo set 3: inconsistent before-and-after lighting

02/08/2022

MOHS RECONSTRUCTION MONDAY
Following Mohs excision of basal cell carcinoma, my patient was left with a large defect involving the margin of his right lower eyelid. Extra lower eyelid laxity can be a blessing sometimes, as in this case where laxity allowed for closure of the defect with a Tenzel-style flap instead of a Hughes flap (benefit: the patient’s eye didn’t have to remain closed for 3-4 weeks following surgery). I appreciate my patient trusting me with his care, and it was a privilege helping him with this problem. He’s 91 and still going strong!
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The upper photos show the defect from two angles; the upper right photo shows the defect on stretch. Upper photos taken on Dermatology Clinic iPhone, lower photos on our Sony Alpha series.
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18/07/2022

Great trip! Two continents, two beautiful weddings, many meals, and lots of quality time with friends. Back in clinic tomorrow.

12/07/2022

THE LID-BROW CONTINUUM
The upper eyelids and eyebrows compose a single aesthetic unit, and thus both areas should be evaluated when considering upper eyelid surgery. Does this mean that everyone who gets upper eyelid surgery also needs a brow lift? No, but a drooping brow can make even a perfectly done blepharoplasty appear sub-optimal.
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This photo shows a lateral view of my patient upper eyelid blepharoplasty and lateral brow lift surgery. Aside from her eye being more open, the lateral eyebrow is restored to a more youthful position, lateral skin hooding is no longer present, and the lid incision scar is difficult to visualize. She and I are both very happy with the results of her surgery. I appreciate her trusting me with her care; it was a privilege!

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