Types of Oculoplastic Surgery
There are many different oculoplastic surgeries designed to address medical conditions and/or cosmetic concerns. Some of the most common include:
Blepharoplasty (Eyelid Surgery)
Your eyes are often the first thing people notice about you and are an important aspect of your overall appearance. As we age, the tone and shape of our eyelids can loosen and sag. Heredity and sun exposure also contribute to this process. This excess puffy or lax skin can make you appear more tired or older than you are.
Eyelid surgery or blepharoplasty (pronounced “blef-a-ro-plasty”) can give the eyes a more youthful look by removing excess skin, bulging fat, and lax muscle from the upper or lower eyelids. If the sagging upper eyelid skin obstructs peripheral vision, blepharoplasty can eliminate the obstruction and expand the visual field.
According to the American Society of Plastic Surgeons, blepharoplasty (repair of droopy eyelids by removing excess skin, muscle, and fat) is one of the top five cosmetic plastic procedures performed. In 2012, over 200,000 blepharoplasties were performed in the United States.
Upper eyelid blepharoplasty is a surgical procedure that removes excess skin and fat in the upper eyelids. The excess skin may interfere with vision or result in eyelid fatigue. An incision is made in the natural crease of the eye and skin, muscle, and fat are removed.
Lower eyelid blepharoplasty is a surgical procedure that removes excess skin, muscle and fat from the lower eyelids. The lower eyelids may become droopy with the appearance of “bags” under the eyelids. A lower eyelid blepharoplasty is directed at removing the excess skin, muscle, and fat through a skin incision below the eyelid margin. The fat may be removed through an incision inside of the lower eyelid without the need for a skin incision.
Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or experience developmental delays from limitation of vision.
The symptoms are usually worse toward the end of the day and when tired. The usual cause of eyelid drooping is a loosening or stretching of the muscle and tendon that serve to elevate the eyelid. Surgical repair is directed to reattach or shorten the stretched muscle or tendon. The primary goal of ptosis surgery is to elevate the upper eyelid to restore a normal field of vision.
Ectropion (ek-trō-pē-än) is a condition in which the lower eyelid is “rolled out” away from the eye, or is sagging away from the eye. The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.
Entropion (en- trō- pē- än) is a condition in which the eyelid is rolled inward toward the eye. It can occur as a result of advancing age and weakening of certain eyelid muscles. A turned-in eyelid rubs against the eye, making it red, irritated, painful, and sensitive to light and wind. If it is not treated, the condition can lead to excessive tearing, mucous discharge and scratching or scarring of the cornea. A chronically turned-in eyelid can result in acute sensitivity to light and may lead to eye infections, corneal abrasions, or corneal ulcers.
Eyelid Growths and Skin Cancers
The eyelid skin is the thinnest and most sensitive skin on your body. As a result, this is often the first area on your face to show change from sun damage and aging. Unfortunately, sun damage and other environmental toxins not only cause the skin to age but also can cause serious damage. Skin cancer of the eyelids is relatively common and several types exist. The presence of a nodule or lesion on the eyelid that grows, bleeds, or ulcerates should be evaluated. This involves examination and, sometimes, a biopsy.
Any suspicious areas need to be evaluated and may require a biopsy to confirm the diagnosis of a skin cancer. Treatment of eyelid skin cancer involves the complete removal of the tumor followed by reconstruction of the eyelid. Complete removal of eyelid cancer is important to minimize the likelihood of a recurrence or spread of the cancer. The oculoplastic surgeon may remove the tumor and have the pathologist check the tissue margins and frozen sections, to be sure that the tumor is completely removed.
Another method involves a dermatologic surgeon excising the tumor, using Mohs’ technique, to ensure the total removal of the cancer. After the cancer has been completely removed, reconstructive surgery by an oculoplastic surgeon is usually necessary to preserve the function of the eyelid and obtain the best cosmetic appearance possible.
The eye must remain moist in order to retain its health and function. The lacrimal gland is a specialized gland that produces tears. With blinking, the eyelid spreads the tears over the surface of the eye and pumps excess tears into the tear drainage system. There is a delicate balance between enough fluid, too little, or too much. The eye may water excessively either due to dryness or obstruction of the outflow of tears from the eye.
The most common cause of tearing is a reflex, which occurs from the drying of the cornea or surface of the eye. If the lacrimal gland fails to produce enough tears, the surface of the eye begins to dry out. This results in symptoms of burning, tearing, and irritation. Lubrication will help control the drying and irritation and secondary reflex tearing.
There are also new medications that help the body to produce additional tears and keep the eye comfortable and protected. However, when increased lubrication does not relieve the discomfort, exposure of the tear drainage system with punctal plugs may be beneficial.
Another cause of tearing is an obstruction of the outflow of the tears from the eye. If the lacrimal gland is producing tears properly and the tear drainage system becomes nonfunctioning, the tears will back up, causing the tears to roll down the cheek. Sometimes the existing tear drainage system needs to be corrected and, at other times, the system needs to be bypassed entirely in order to create a new drainage path for the tears.
Managing thyroid and eye disorders, tumors, and trauma
Other Cosmetic Services
Including botox and dermal fillers for use around the eyes
Most oculoplastic surgeries can be performed on an outpatient basis, which means patients go home the same day and recovery is fairly quick.