Oculoplastics: Cosmetic & Reconstructive Surgery Conditions & Procedures

Eyelid Surgery

Eyelid surgery is a common method of treatment for entropion (inward turning of the eyelid), ectropion (outward turning of the eyelid), ptosis (drooping of the eyelid), and some eyelid tumors.

Eyelid surgery is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare but can include bleeding, infection, and eyelid asymmetry due to uneven wound healing. Differences in healing between the eyes may cause some unevenness after surgery.

After eyelid surgery, bruising or a black eye is common but resolves quickly. It may be difficult to close your eyelids completely due to swelling, making the eyes feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring, and infection. To most people, the improvement in vision, comfort, and appearance after eyelid surgery is very gratifying.

Blepharoplasty

Blepharoplasty

As we mature, the delicate skin around the eyes can appear puffy, saggy, or droopy. Eyelid skin stretches, muscles weaken, and the normal deposits of protective fat around the eye settle and become more prominent. The surgical procedure to remove excess eyelid tissues (skin, muscle, or fat) is called blepharoplasty.

Blepharoplasty can be performed on the upper eyelid, lower eyelid, or both. The surgery is performed for either cosmetic or functional reasons. Sometimes excess upper eyelid tissue obstructs the upper visual field or can weigh down the eyelid and cause the eyes to feel tired. Most often, people choose blepharoplasty to improve their appearance by making the area around their eyes firmer. When blepharoplasty is performed to improve vision rather than for cosmetic reasons only, the costs may be covered by your health insurance plan.

Blepharoplasty for the lower eyelid removes the large bags under the eyes. It is unusual for third-party payers to cover lower-lid blepharoplasty.

The surgery is usually performed on an outpatient basis and can take one to three hours. Upper-eyelid incisions are made in the natural crease of the lid, and lower-lid incisions are made just below the lash line. A procedure for lower-lid blepharoplasty, known as transconjunctival lower-lid blepharoplasty, removes or redistributes excess fat through an incision inside the lower lid. The incisions are closed with fine sutures.

Swelling, bruising, and blurry vision are common after blepharoplasty. Stitches are removed three to five days after surgery, except in the case of transconjunctival blepharoplasty, where the self-dissolving sutures require no removal.

Possible complications associated with blepharoplasty include bleeding and swelling, delayed healing, infection, drooping of the upper or lower eyelid, asymmetry, double vision, and dry eye, to name a few. It is important to note that the puffiness of the fat pockets may not return, but normal wrinkling and aging of the eye area will continue.

Browlift

Sun, wind, and gravity affect the skin and muscles of the face over time. One of the most noticeable aspects of aging is a progressive drooping of the eyebrows. This can cause wrinkling of the forehead, from raising one's eyebrows, as well as vertical wrinkles or furrows between the eyebrows. Sometimes the eyebrows or excess eyelid tissue can obstruct vision.

A browlift (also called a forehead lift) elevates the brow, smoothes forehead skin, and can remove vertical lines between the eyebrows. Incisions are made in inconspicuous places, either behind the hairline, in one of the forehead wrinkles, or immediately above the eyebrows. If an endoscope (a small tube with a fiber-optic light) is used, the incisions can be very small. After the muscles are tightened and excess skin is removed, the incision is closed with sutures. The operation is usually performed on an outpatient basis under either monitored anesthesia care (MAC) or general anesthesia.

Swelling and bruising, common after a brow- or forehead lift, begins to subside in seven to 14 days. Numbness and itching are common during the healing process. Sutures, staples, or clips are removed within seven to 14 days after the surgery. Incisions in the hairline may damage hair follicles and result in some hair loss.

Ptosis

Ptosis

Ptosis is drooping of the upper eyelid. The eyelid may droop only slightly or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision.

Congenital ptosis, or ptosis that is present at birth, requires treatment in order for normal visual development to occur. Uncorrected congenital ptosis can cause amblyopia or "lazy eye," which is an impaired visual development. If left untreated, amblyopia can lead to permanently poor vision.

Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle, the muscle that lifts the eyelid. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Whether they have had surgery or not, children with ptosis should be examined annually by an ophthalmologist (Eye M.D.) for amblyopia, refractive disorders, and associated conditions.

Ptosis in adults is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases, such as diabetes, that involve the levator muscle or its nerve supply.

If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.

Thyroid-Related Ophthalmopathy

hyroid-Related Ophthalmopathy

The thyroid gland, located in the front of the neck, produces hormones that regulate your body's metabolism (the process by which the body transforms food into energy).

In a small number of people, the thyroid gland produces either excessive hormone, inadequate hormone, or it inadequately regulates thyroid hormones. An overproduction of thyroid hormone is often associated with a condition known as Graves' disease; an underproduction is associated with a condition known as Hashimoto's disease. Atypical regulation of the thyroid hormone can cause problems associated with the structure surrounding the eye and the area within the orbit, and it also can cause subsequent vision problems.

Some eye problems associated with the disease are:

  • Eye protrusion: This occurs when the muscles around the eyes swell, which pushes the eye forward. People with this condition look as if they are staring.
  • Eyelid retraction: The combination of eyelid swelling and eye protrusion sometimes causes the eyelids to retract and reveal the sclera (the white part) of the eye.
  • Dry eye: Because of protrusion and eyelid retraction, the eyes are more exposed to the environment. This causes blurred vision, light sensitivity, dry eye, excessive tearing, irritation, and inflammation.
  • Double vision: Muscle swelling may cause double vision.
  • Eye bags: Eyelid swelling can cause tissue around the eyes to bulge forward.

These problems are treated by non-surgical and surgical methods. Non-surgical methods include taking steroid medications by mouth to control swelling and inflammation, wearing sunglasses to relieve light sensitivity, and applying lubricating ointment to relieve dry eye. Surgical methods include repositioning the eye muscles, removing scarred tissue, and relieving compression on the optic nerve to preserve sight.

Botox® Injections

Botox

Before Botox® injection

Botox

After Botox® injection

Botox is the trade name for botulinum toxin. In its pure form, botulinum toxin is a poisonous neurotoxic protein that is found in certain spoiled foods and causes muscle weakness. It acts as a nerve impulse blocker, preventing muscles from contracting. In an extremely dilute form, botulinum toxin has many medical applications.

Botulinum toxin is used to treat ocular conditions such as blepharospasm, an excessive contraction of the eyelid muscles that forces the eyelids closed, and hemifacial spasm, an excessive contraction of the facial muscles on one side of the face. When the toxin is injected directly into the muscles of the face or the eye, it causes the overactive muscles to relax. It usually takes a few days for the therapeutic effects to be noticeable, and the injections may need to be repeated every four to six months.

Botulinum toxin also is used to treat certain kinds of double vision. The toxin is injected directly into the eye muscle opposite the paralyzed muscle.

Botulinum toxin can be used for cosmetic purposes to soften wrinkles around the eye. Also it can weaken the brow muscles in order to diminish the deep furrows or frown lines that may appear in the middle of the forehead.

Side effects of the injections are temporary. They can include a droopy upper eyelid, double vision, and being unable to close the eyelids.

BOTOX® Cosmetic is a very popular in-office procedure to smooth out facial wrinkles, forehead creases, frown lines between the eyes, and crow's feet.

BOTOX® Cosmetic works by inactivating hyperactive muscles facial muscles around the eyes and lower forehead that may give a person an angry, tired, or displeased appearance - even when they are not experiencing that emotion. As the muscles are made inactive, longstanding skin creases will soften and may eventually disappear. The result is a softer, more relaxed, and pleasant appearance.

Cosmetic Fillers

Cosmetic fillers are materials used by physicians to restore volume and fullness to the skin of the face in order to correct mild, moderate, or severe facial wrinkles and folds. Areas treated include the forehead and around the eyes as well as lines from the nose to the corners of the mouth (nasolabial folds), in addition to other depressions such as acne scars.

Common cosmetic fillers include hyaluronate, a biodegradable and fully biocompatible substance that can provide volume and fullness to the skin. Collagen, derived from animals like cattle, is also used but may produce allergic reactions in some people. An allergy test is needed before treatment with collagen injection. Fat injection, using a patient's own adipose tissue taken from the abdomen, thighs, or buttocks, can also be used. Other injectable fillers include resorbable suture material (polyglactic acid) and biocompatible calcium hydroxyl appetite microspheres that are suspended in an injectable gel.

Injectable fillers plump up the skin to smooth away facial lines and wrinkles. In contrast, botulinum toxin (Botox) is a drug that relaxes the muscles underlying the wrinkles. One product does not necessarily replace the other product, and often they are used together in different areas of the face to provide the most natural line and wrinkle reduction.

Patients must realize that the corrections from cosmetic fillers usually are not permanent. Some fillers last longer than others, but patients should expect to need repeated treatments every nine to 12 months or, with the longer-acting agents, every few years to maintain the desired results.

Complications from injectable fillers are infrequent and usually minor. Risks include allergic reactions (from collagen), bruising, swelling, puffiness, infection, and lumpiness.

Ask your ophthalmologist (Eye M.D.) about treatment options and decide together which cosmetic filler might be appropriate for you.

Basal Cell Carcinoma

<%= image_tag F02.jpg %> Basal cell carcinomas are the most frequent type of malignant tumor to affect the eyelid, making up 85% to 95% of all malignant eyelid tumors. They are most commonly found on the inner portion of the lower eyelid, particularly in elderly, fair-skinned people. Prolonged exposure to sunlight seems to be a risk factor for developing this form of tumor.

There are many different kinds of basal cell carcinomas, but the nodular variety is one of the most common. It appears as a raised, firm, pearly nodule with tiny, dilated blood vessels. If the nodule is in the eyelash area, some lashes may be missing. The nodule may have some superficial ulceration and crusting and may resemble a chalazion or stye. While these tumors are malignant, they rarely spread elsewhere in the body. For most of these tumors, surgery is the most effective treatment. In severe cases, when the tumor has been neglected for a long time, it can spread into the eye socket, which may ultimately require removal of the eye and adjacent tissue.

Depending on the nature of your eyelid tumor, your ophthalmologist (Eye M.D.) may suggest one of many possible procedures to remove the tumor, including normal surgical excision, microsurgery, or cryosurgery. You should discuss the various options and their advantages and disadvantages with your ophthalmologist.

Eyelid surgery to remove the tumor and repair the eyelid is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare, but asymmetry of the eyelids is one possible complication.

After eyelid surgery, bruising or a black eye is common, but it resolves quickly. It may be difficult for you to close your eyelid completely, making the eye feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring, and infection.

Sebaceous Cell Carcinoma

Sebaceous Cell Carcinoma

A tumor is an abnormal growth of any tissue or structure; it can be either benign or malignant. A tumor can affect any part of the eye, such as the eye socket, eyeball, eye muscles, optic nerve, fat, and tissues.

Sebaceous cell carcinoma is a type of tumor that originates in the eyelid glands of elderly individuals. It is relatively rare but still accounts for 1% to 5% of malignant eyelid tumors. These highly malignant tumors may recur, invade the eye socket, or spread to the lymph nodes. The tumor may look like a chalazion or stye, making it difficult to diagnose.

Immediate surgical intervention is usually necessary for this type of tumor. In some cases, radiation therapy may be an alternative or may be used in conjunction with surgery.

Squamous Cell Carcinoma

Squamous Cell Carcinoma

A tumor is an abnormal growth of any tissue or structure; it can be either benign or malignant. A tumor can affect any part of the eye, such as the eye socket, eyeball, eye muscles, optic nerve, fat, and tissues.

Squamous cell carcinoma is a malignant eyelid tumor, occurring in approximately 5% of malignant eyelid tumors. The most common location is the lower eyelid, particularly in elderly, fair-skinned people. This tumor appears as a raised nodule, and it can lead to loss of eyelashes in the involved area.

When detected and treated early, the outcome for this type of tumor is excellent. However, if the tumor is neglected, it can spread to the lymph nodes in the neck. Surgery is the most effective treatment.

Ectropion

Ectropion

Ectropion is an outward turning of the lower eyelid, most commonly caused by aging, although eyelid burns or skin disease may also be responsible.

Normally, the eyelids help lubricate and cleanse the eye during blinking. An eyelid that is drooping and has lost contact with the eye can cause dry eyes, excessive tearing, redness, and sensitivity to light and wind.

Surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid can then protect and lubricate the eye properly, so that irritation and other symptoms subside.

Eyelid surgery to repair ectropion is usually performed on an outpatient basis and under monitored anesthesia care (MAC). Following surgery, your ophthalmologist (Eye M.D.) usually prescribes an antibiotic ointment and will instruct you to avoid heavy lifting and straining, aspirin, and eyelid manipulations for seven days.

Entropion

Entropion

Entropion is an inward turning of the eyelid and lashes toward the eye, usually caused by relaxation of the eye muscles and tissue due to aging.

Entropion usually affects the lower lid. The skin and eyelashes rub against the eye and cause discomfort and tearing. The irritated eye can produce mucus and become red and sensitive to light and wind. If an entropion is not treated, rubbing of the skin and eyelashes can lead to infection or scarring of the eye, which can cause vision loss.

Surgery can be performed to tighten the eyelid and return it to its normal position. The eyelid then protects the eye properly, and irritation and other symptoms subside.

Eyelid surgery to repair entropion is usually performed on an outpatient basis under monitored anesthesia care (MAC). Following surgery, your ophthalmologist (Eye M.D.) usually prescribes an antibiotic ointment and will instruct you to avoid heavy lifting and straining, aspirin, and eyelid manipulation for seven days.

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