TODAY'S AJENDA #89

I’ve always promised you honesty, even when it’s uncomfortable or may be risky for me personally or professionally. For years on Good Morning America, I covered taboo topics from menopause to alcohol consumption, to living with anxiety, and more. 

But cosmetic surgery? That’s usually at the top of women’s “don’t discuss” list. 

Despite the industry being valued at nearly US$60 billion and women accounting for 88% of all cosmetic procedures, most stay silent out of fear of judgment. 

But I don’t do secrecy around things that are common, safe, and might help you make an informed decision. About seven weeks ago, I had plastic surgery on my face for the first time.  

I actually cringe when people try to pass off enhanced results as “natural.” It’s dishonest and perpetuates the exact stigma that keeps us all silent. The only way to change it is through honest conversation. Also, when I find or do something that is helpful in some way, it’s always my default position as a doctor to share that info, rather than gate-keep it.

So, I wanted to have an honest conversation with you about the who, when, where, what, why, and how of my recent plastic surgery:

Let me start by saying I’m extremely lucky. My brother, Dr. Evan Garfein, is a world-class plastic surgeon and Chief of Plastic Surgery at Montefiore Medical Center in NYC.

But there’s a firm (and smart) doctor code about not operating on your immediate family. However, Evan has an extensive network. He knows the best surgeons in NYC, Dallas, Philadelphia, LA, and Madrid, and is a personal friend of the now Kris Jenner-famous Dr. Steven Levine. 

I had access to an unofficial Rolodex of the world’s top plastic surgeons. I also knew all the “insider info” on:  

• Their patients’ complications 

• Whether they drop their patients’ names (which is a STRICT violation of patient privacy and generally reflects both insecurity and poor standards)

• How they really treat their non-famous patients 

It just comes with the territory of having lots of doctors and a top plastic surgeon in your family. I could have called any of these surgeons, and I was willing to travel anywhere to see the best.  

The person I chose? It was actually Evan’s long-time partner, Dr. Oren Tepper, whom I’ve known for 15 years. If his name sounds familiar, you may remember him from the widely covered surgical separation of conjoined twins on CNN. That was his team.

What makes both Evan and Oren unusual is their dual training. Most cosmetic surgeons focus on healthy patients seeking elective procedures (such as facelifts, breast augmentations, rhinoplasties). But Evan and Oren are also trained in reconstructive surgery. 

This branch of plastic surgery restores parts of the body affected by trauma, cancer, or congenital conditions. It’s a completely different level of surgical complexity. Being fluent in both is rare, and it’s one of the reasons I trusted Oren so deeply.

And when you choose a surgeon, you’re choosing their entire ecosystem: the anesthesiologist, the nursing team, the office staff, the post-op support. At their Tribeca practice, Greenwich Street Aesthetics, that ecosystem is exceptional. From Genevieve to Briana to Sarah and everyone I encountered, it felt meticulous, calm, and patient-centered.

I had two procedures: upper blepharoplasty and autologous fat grafting. 

In non-doctor terms: Oren removed excess skin from my upper eyelids and transferred fat to fill hollows in my lower eyes, temples, and hands. Here’s the summary: I’m thrilled!!  

My husband and adult children think I look 10+ years younger. That said, I started from a good place before the surgery. I’m lucky to have good genes with respect to aging (my 86-year-old mother looks amazing). I’ve also had little sun damage, prioritized sleep, and never smoked. 

Because of that baseline, I look like an “enhanced” version of myself. (I don’t particularly use the term “rested” to describe results: I didn’t feel I looked “tired” before, because I wasn’t! My goal was to just address a few areas that bothered me.) 

People who don’t know I had surgery haven’t noticed anything, which, in my opinion, is the gold standard. When I look in the mirror, sometimes even I forget what Oren did. That’s exactly the outcome I hoped for.

The procedure took place at their beautiful surgical center at 497 Greenwich Street in Tribeca, which has three operating rooms, a board-certified anesthesiologist, and a highly experienced nursing staff. Patients fly in from all over for surgery there. I was lucky to go home to my own bed afterward.

My surgery was on October 7. Two weeks before, Oren had me pause my hormone therapy due to the small increased risk of blood clots with estrogen-containing medications. Not all surgeons do this, but given my daughter’s prior postoperative pulmonary embolism (thankfully resolved), we weren’t taking chances.

“How was it to stop hormones?” It was…a spicy detour. I had a few hot flashes (and my sleep wasn’t the best), but it was nothing unmanageable. Definitely a reminder of how helpful hormone therapy can be. 

The surgery itself was smooth. I opted for general anesthesia (I’m a bit of a wimp about being awake during procedures) and felt zero pain afterward. Truly zero. 

“How long was your recovery?” It took 2–3 weeks because of the fat transfer. Had I done only my upper eyelids, I would’ve been back in the world in about five days. The bruising under my eyes lasted three weeks but was covered easily with makeup.

Interestingly, the soreness wasn’t on my face. It was from the fat harvesting on my hips and inner thighs. Even that was mild. I think I took Tylenol twice.

It wasn’t because I was unhappy with how I looked, or because I was chasing youth. Honestly, I’d been feeling incredible over the past 18 months since starting my own ‘wellness experiment,’ and I wanted to look as energetic and strong on the outside as I felt on the inside. 

Over time, though, my upper eyelids had developed that soft fold of extra skin, and like almost every woman in her 50s, I’d lost volume in my midface and temples. 

I don’t use filler, so fat transfer offered a natural, permanent solution without the risk of looking fake. Plus, my mother had had her eyelids done at 52. I always knew this might be in the cards for me, too.

For this part, I asked Dr. Oren Tepper to give you his expert insights.

Q: How is upper blepharoplasty done?

The surgeon makes an incision in the natural crease of your upper eyelid (so the scar is hidden when your eyes are open) and removes the excess (i.e., hanging) skin that’s started to hood over your lashes.  

In some cases, they may also remove a small amount of fat if the upper lid looks heavy or bulging, though that’s less common to avoid a hollowed appearance.

Q: General anesthesia or local with sedation?

An upper blepharoplasty can be done under local anesthesia or sedation. It’s a great option for patients seeking an “in-office” procedure under local anesthesia in about 60 minutes. If you’re combining it with other procedures (such as fat grafting), general anesthesia may be preferred. Dr. Jen opted for general anesthesia.

Q: What are the risks?

It’s a relatively low-risk procedure with little to no risk to the eye itself. Potential complications like bleeding or infection are uncommon. 

The main thing surgeons avoid is over-resecting upper eyelid skin (aka removing too much skin). 

Q. What is autologous fat transfer? 

The surgeon “harvests” fat from one area (hips, thighs, abdomen) and injects it elsewhere to restore volume, using a liposuction-like technique. For Dr. Jen, who actually had very little fat to ‘harvest’, we took fat from the flanks/sides and inner thighs.  

It’s a wonderful tool to replace age- or weight-related facial volume loss. The procedure is low risk, can be done under local anesthesia or light sedation, and unlike fillers, which the body fully resorbs, fat integrates into the tissue and lasts nearly permanently. 

There are also different filtration methods: larger fat particles (“microfat”) are used for volume, while smaller particles (“nanofat”) can help with skin quality. 

Q: Costs?

Upper blepharoplasty procedures range from $5K to $20K. 

Fat grafting tends to be in the same price range, but can vary depending on how many areas are being treated. 

Q: Why did you choose an anesthesiologist and not a nurse anesthetist?

Because we’re a boutique cosmetic surgical facility, we prefer to partner with a single group of board-certified anesthesiologists. We believe this helps us maintain consistency and deliver a safe and luxurious experience every time.  

Q: How do you use pre-op 3D imaging?

We’ve helped pioneer 3D imaging and printing in plastic surgery. While much of this innovation began in our reconstructive surgery, we now apply this same high-tech precision to cosmetic procedures. 

3D photographs give us a detailed surface map of the face, helping us measure volume loss and restoration over time. For patients, it lets them visualize how they’ll look after surgery, which is incredibly helpful in assuring we share the same expectations. 

I’m a firm believer that everyone should capture a 3D facial scan during their young adulthood. This can help establish a baseline for comparison as they age. (It’s also far more effective than bringing old 2D photographs, like a wedding photo, to a future consultation. But we still find it helpful to see older photos of what our patients looked like 5-10 years earlier.)  

Q: What is recovery like?

Recovery from an upper blepharoplasty and/or fat grafting is basically one week. After fat grafting, patients can return to normal activities in 3-5 days. For an upper blepharoplasty, sutures are typically removed at post op day 4-5. Fat-harvest sites can be sore and bruised for a few days to a couple of weeks, depending on the individual. 

We also recommend against strenuous exercise after a blepharoplasty for 1-2 weeks to avoid higher blood pressure along the delicate suture lines of the eyelids.  

Why Share Any Of This At All? 

Because cosmetic surgery shouldn’t be taboo. It’s 2025. When people try to pass things off as “natural,” it’s not only dishonest, but it leaves everyone else chasing a perfect standard that doesn’t exist. 

I don’t want to contribute to that standard. You deserve real information, clear expectations, and a doctor who tells the truth, even when that truth is, “Yes, I had plastic surgery, and yes, I’m really happy I did.” And you definitely deserve the 411 on “who the doctor goes to.”  

If this sparks questions for you, let me know on my Instagram!  

New newsletter section alert! 🚨 Starting this week, every issue of Ajenda will feature one of my recipes. Expect protein and fiber-rich meals that come together fast and are ideal for people who hate to cook (like me). 

First up is this artichoke and white bean skillet. I must confess that until literally last month, I had NOT liked artichokes. But on my recent trip to London, a Selfridge's Foodhall employee recommended I try an artichoke salad. I loved it. 

That is the inspiration for this easy and healthy meal. It’s made with EVOO instead of butter and is packed with protein. Enjoy!  

Subscribe to my paid newsletter, Off Duty, where I step away from the doctor’s desk and the television sets and share the info from my real that nobody else has access to.

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ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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^{This material is provided solely for informational purposes and is not providing or undertaking to provide any medical, nutritional, behavioral or other advice or recommendation in or by virtue of this material.  This newsletter is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.}