Hi this is Dr. Young Seattle Plastic Surgeon. What were treating today
are called malar crests and malar mounds
They are the bags under the eyes maybe not directly under the eyes
but really more inferior to that. We're going 
 to show you a pictures of that
and explain how we're doing it. The approach 
 that we're doing is a direct excision.
of the malar mounds and crests. There's other ways to treat that. 
of the malar mounds and crests. There's other ways to treat that. 
You can do a mid-facelift, fat injections, and other type of facelifting techniques.
to get at the malar crest and malar mounds. 
 What I'm going to show you now is
a drawing here. What we're doing is a geometric line
excision of the malar crests. Now when you see these things come over
and they mound up over here, as you can 
 see that this is part of his nose.
We're going to take this skin and muscle and close it
Essentially, this is what you end up with. When 
 he sits up, you no longer see those.
Essentially, this is what you end up with. When 
 he sits up, you no longer see those.
coming over and creating these mounds of tissue underneath the eye.
Now, back over here you can see some of his eyelashes
and eyelid eyes are more up here, but these are malar crests
essentially malar mounds. essentially what that is, its the orbicularis oculi
or the eye muscles that surrounds the eye that closes and blinks the eye.
and that kind of comes over as you can 
 see when he sits up, its more like
...this. It comes over the smiling muscles. And essentially 
 there are a lot of different ways
to treat it. You can do a midface lift and excise some muscle here.
But those can cause problems. Sometimes to best treat these malar crests...
.. is to directly excise the malar crests and mounds
with the qualification that there is a direct incision line there.
...which most people don't necessarily like. In order to hide that better
We created a geometric line pattern that breaks up 
 that straight line (or avoids a straight line)
Now typically people will see anything that is about point seven centimeters in length
and anthing longer than that. So if its longer than that 
 you would benefit from breaking up that straight line
And the shape that I'm specifically talking about is a straight line.
Anything longer than point seven centimeters, about that long
Will be seen by a person as a 
 noticeable shape. And picked out really easily.
That's why we're going to break up that straight line.
into multiple patterns so its not as easily seen. So 
 we're going to show you in a little bit.
Thank you!
So what we've done here is excised that 
 pattern that we had drawn out earlier.
And we included a cuff a muscle and what your seeing here is muscle
And here your seeing some fatty tissue. And what 
 we're going to do is bring this together.
This is going to come over here and we're going to bring this together
Its going to close really nicely into that patter.
And its pretty straight forward. We've excised and included a cuff of a muscle.
We're just going to close right now. Thank you.
