Oculoplastic eye surgery is the cosmetic, corrective and reconstructive surgery of the eyelids, the tear ducts and the orbit (the bony socket surrounding the eye) rather than the eyeball itself.
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Why choose an oculoplastic eye surgeon rather than a plastic surgeon for eyelid surgery?
Oculoplastic eye surgeons are M.D.s who are board certified in ophthalmology and who receive their fellowship in plastic surgery of all the tissues surrounding the eye, rather than generalized plastic surgery. Due to their background in ophthalmology, they are highly knowledgeable of the physiology and function of the eyes. By limiting their specialty to these areas they are acutely aware of the importance of balancing excellent cosmetic and reconstructive results while improving or maintaining the function of the eyes.
What are common oculoplastic eye surgery procedures that may be considered medical necessities?
Ptosis
Ptosis is the drooping of the upper eyelid. This process can occur due to aging, contact lens wear, injury, sometimes after cataract surgery or other eye surgeries and even more rarely from tumors or other neurological problems. This condition may interfere with your vision and therefore would be considered a medical necessity. There are tests to be done to determine whether the condition is considered reconstructive or cosmetic. The surgical treatment involves correcting the levator muscle to allow it to lift the lid properly.
Entropion
Entropion occurs when the upper or lower eyelid turns inward, causing the skin and eyelashes to rub against the eye. The cornea (the clear surface of the eye) is extremely sensitive to the misdirected lashes and may result in redness, irritation, excess tearing, crusting of the eyelid, mucous discharge, foreign body and decreased vision. Treatment involves surgery to restore the eyelid to its normal position, and thereby, turning the eyelashes out and away from the eye.
Ectropion
Ectropion occurs when the lower eyelid sags and turns out, resulting in exposure of the eye. Tearing, redness, crusting of the eyelid, mucous discharge, irritation, scarring of the cornea, and decreased vision may result. Ectropion may be the result of aging, injury, eyelid growths, or facial paralysis. Temporary relief may be achieved with ointment until surgery can be performed. Surgical repair involves repositioning the eyelid against the eye by tightening the supporting lid.
Eyelid Growths
Growths on the eyelids and face may be benign (cysts, nevi, chalazions) or malignant (skin cancers). Upon examination, treatment with topical applications and/or warm, moist compresses may be advised or excision may be recommended. These normally can be done simply in the clinic at same day as the exam. If the growth is suspicious, it would be sent to the lab.
Tear Duct Problems
Blockage of the tear ducts may occur at birth, or as a result of injury, disease or infection. The symptoms may include pain, chronic tearing, crusting, and watering or discharge. The tear sac may become acutely infected due to blockage of the tear duct system. Warm compresses, antibiotics and/or irrigation may be the first course of treatment or surgery may be necessary. The type of surgical repair depends on the age of the patient and location of the obstruction. One highly successful procedure involves the construction of a new "bypass" route connecting the upper tear ducts to the nose for drainage of tears.
Reconstructive Surgery
Reconstructive surgery is done to restore or enhance physical image and function following injuries, burns, or birth defects. The eyelid is reconstructed to open and close properly and to protect the eye. Fractures of the orbital bones are internally repaired to restore the alignment of the facial bones and position of the eye within the orbit.
What are the oculoplastic eye surgery procedures that may be either medical necessity or cosmetic?
Blepharoplasty
Upper or lower lid blepharoplasty is the surgery to correct excessive skin on the upper or lower eyelids and bags or extra fat above and beneath the eyes. These conditions may be due to aging, heredity and sun damage and create a tired, sad, or even angry expression. Sometimes sagging eyelids can interfere with vision. When that is the case, the procedure may be considered a medical necessity. However, many patients are interested in eyelid and eyebrow surgery solely to improve their appearance. This elective procedure to remove excess skin folds and fat pockets can enhance the patient's sense of well-being, restore a youthful appearance and relieve eye fatigue caused by droopy skin.
Brow Ptosis
On occasion, a patient may experience a brow drop in which the eyebrow itself sags below the brow rim. This may or may not interfere with the vision. In this case, a brow lift is recommended to elevate the sagging brow back to its' proper place. This may occur in conjunction with ptosis repair and blepharoplasty. If the vision is obstructed by the drop in the brow, it may be considered a medical necessity, but either way, correction results in a more refreshed look.
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Where are the oculoplastic eye surgery procedures performed?
All eye surgery procedures other than eyelid chalazions and some tumor removals are performed in our fully accredited eye surgery center on location at our clinic on any outpatient basis. Patients are given a sedation that results in a "twilight state" in which the patient is comfortable and is able to recover quickly from the anesthesia.
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