Oculoplastics

Cosmetic Surgery

Conjunctival tumors may first appear as a pink or brown bump on the eye. Depending on the specific type it is, conjunctival tumors have a relatively low incidence of metastasis, but it is vitally important that it be caught early so as to prevent it from invading the orbit and progressing into malignant melanoma. Surgery to remove the tumor is the treatment of choice for most conjunctival tumors although the patient may need additional treatment with cryotherapy (a freezing technique) and surgery on the sclera and epithelium. Patients with certain conjunctival tumors may require chemotherapy as well. Procedures: -Baggy Eyelids -Blepharoplasty -Droopy eyebrows -Bulging Eyes -Chemical Peel -Dry Eyes -Blockage of the tear duct -Laser Resurfacing -Wrinkles

Baggy Eyelids (Dermatochalasis) and Droopy Eyelids

Excessive skin on the upper or lower eyelid. Baggy eyelids are sometimes referred to as “puffy” or “heavy” eyelids. While some people are born with heavy or “dreamy” eyelids (congenital ptosis), others may develop bags as a result of the aging process or injury. Blepharoplasty is the name of the surgery that is performed to remove baggy eyelids to improve appearance. Individuals who have “droopy” eyelids have a condition called “ptosis” (pronounced “toe-sis”). This occurs when the tiny muscle and tendon that lifts the eyelid becomes weak or slack, causing the upper eyelid to hang too low over the eye. This often impairs vision. In order to see better, people with ptosis sometimes lean their head back, raise their eyebrows or physically lift the lid with their finger. Ptosis can be congenital, meaning that a person was born with the condition. Children with droopy eyelids tend to have additional eye problems, such as amblyopia or “lazy eye,” strabismus (eyes that may cross or be unaligned), astigmatism, refractive errors or blurred vision. Ptosis can also be acquired, as a result of aging. Acquired ptosis can occur as a result of cataract or other eye surgery, when the tendon may become weakened.

Blepharoplasty

Blepharoplasty is the name of the surgery that is performed to repair droopy eyelids. Upper eyelid blepharoplasty is the surgery performed to reduce excess skin and fat in the upper eyelids. During surgery, the surgeon makes small cuts (incisions) in the natural contours and creases of the upper eyelids. Excess skin and fat is removed and reshaped. The incisions are then closed with tiny sutures (stitches). Because the incisions are made within the eyes’ natural contours, they are barely visible and the scars fade over time. Lower eyelid blepharoplasty reduces excess fat or skin in the lower eyelids. The surgeon makes incisions in the inside or outside of the lower eyelids and gently removes excess fat. The incisions are then closed with tiny sutures. Incisions made on the inside of the eyelids are not visible. Incisions made on the outside of the lower eyelids are barely visible and the scars fade over time.

Droopy eyebrows

Excessive skin below the eyebrow (between the brow and the eyelid). Also referred to as “heavy” or “droopy” eyebrows. Brow lift surgery is performed to remove excess skin in order to improve one’s appearance and visual function.

• • Coronal Brow Lift Procedure. This procedure raises the eyebrows and reduces creases and wrinkles on the forehead as well as excess skin at the bridge of the nose. The surgeon makes an incision across the top of the head, a few inches above the hairline. The brow and forehead are lifted upward and excess skin is removed. The incision is closed with sutures.

• • Direct Eyebrow Lift Procedure. This procedure elevates drooping eyebrows by removing excess skin above the eyebrows. The surgeon makes incisions directly above the eyebrow and removes excess skin. The incisions are closed with fine sutures. They fade over time and can be covered by makeup. In men, thick eyebrows hide the scars very well.

Bulging Eyes (Exophthalmos)

When an abnormal amount of the eye “white” is exposed, it may be because the eyeball is pushed forward. When this happens, the cause is often a swelling or growth that occurs behind the eye. The eye may feel dry and the patient may have difficulty seeing and may have double vision or blurriness. The eyelid may not close properly. The most common cause of bulging eyes is Graves’ disease, a type of hyperthyroidism (which is an overactive thyroid gland). Other causes may be eye tumors or an eye infection. If one or both of your eyes bulge, it is important to see an ophthalmologist immediately.

Chemical Peel

The chemical peel can be performed separately or in conjunction with upper blepharoplasty, lower blepharoplasty, the coronal brow lift or the direct eyebrow lift to reduce wrinkles and remove blemishes. With this procedure, the physician applies a chemical to the skin that tightens the skin by removing the top layer of the skin.

Dry Eyes

When the lacrimal system does not produce enough tears to properly wet the eye, the surface of the eye dries out. If this happens, your eye will feel gritty and it may burn or sting. Over-the-counter or prescription eye drops may temporarily resolve the situation, but it is important to see your ophthalmologist if you continue to have dry eyes. You may have a problem that requires more than a superficial solution. Chronic dry eyes can lead to an eye or tear duct infection. If medication fails to correct dry eyes, a procedure may be performed that involves the insertion of silicone or collagen plugs to keep the tear drainage ducts open allowing tears to remain in the eye. This procedure is called “dacryocystorhinostomy”.

Blockage of the tear duct

Eyes that continually water may have damage in the lacrimal system, the part of the eye that is responsible for producing tears. Normally, our eyes tear when we cry or when we are exposed to certain smells (like onions) or irritations (like allergies). However, the ducts that make up the lacrimal system can sometimes become blocked. This may be caused by an injury or an infection. Tearing may also be due to loose lower lids (lacrimal pump dysfunction) or even dry eye syndrome. Also, children can be born with a blockage of the tear duct. With no place to go, tears become stagnant within the duct, leading to infection. You may notice crusting or pus to collect around the eyelids. Sometimes these obstructions resolve on their own. At other times, children may need to see an ophthalmic surgeon to correct the problem. If your eyes tear excessively, be sure to see an ophthalmologist as soon as possible.

Laser Resurfacing

Laser resurfacing is a procedure designed to diminish deep wrinkles, sun spots and acne scarring. It is used to improve one’s appearance. It is particularly good at removing fine lines around the mouth. The laser uses a high-density beam of light to remove thin layers of skin and/or multiple layers of skin to achieve a smooth, youthful effect. Laser resurfacing has also been found to improve the skin’s elasticity and firmness.

Wrinkles

As skin ages, it becomes drier and less elastic. Though wrinkling is considered a natural part of aging, certain health conditions, such as dry skin, or habits (smoking, excessive alcohol use or sun exposure) contribute to premature wrinkling of the skin.

Enucleation

Enucleation refers to the surgical removal of an eye. This procedure is generally recommended only when there is no other choice. Enucleation is usually performed for several different reasons: to remove a malignant tumor that has developed within the eye; to alleviate intolerable pain in a blind eye affected by a condition such as uncontrollable glaucoma; or to reduce the risk of “sympathetic” inflammation of the remaining eye when one eye has been severely injured and blinded. Removal of an eye is considered a drastic and traumatic measure to most people. Although many patients who require this surgery have no vision in the affected eye, those who do have vision recognize that enucleation will result in instantaneous, permanent, total blindness of that eye. Furthermore, all patients who undergo this procedure will require an artificial eye (ocular prosthesis) as a cosmetic substitute for the real eye.

Eyelid and Orbit Injuries

The eyelids and the bones of the orbit may be damaged by many types of trauma car accidents, fights, sports injuries, etc. Proper repair of the initial injuries as well as possible needed plastic revisions may be extremely important in restoring the proper protective function and cosmetic appearance of the eyelids and orbital bones. If the eye is damaged to the extent that it must be removed, an artificial eye (prosthesis) is usually made to fit the empty socket. At times, it may be necessary to perform additional surgical procedure on the socket to make the artificial eye appear more attractive.

Ectropion

When the lower eyelid turns outward, this condition is called ectropion. When the lid turns inward, this is called “entropion”. When someone experiences ectropion, the eyelid skin may rub against the eye, leading to excessive tearing, mucous discharge as well as crusting of the eyelid and a general uncomfortable feeling that something is in the eye. This condition can also affect vision. Ectropion occurs when the skin of the eyelid become weakened as a result of aging. However, it can result from chemical or thermal burns, conditions such as cicatricial pemphigoid, or allergies. Though rare, some children are born with ectropion. To prevent damage to the eye, surgery is recommended to repair entropion. This is achieved when your surgeon tightens the eyelid and its adjacent muscles. This is usually performed on an outpatient basis under local anesthesia. After surgery, you will have to wear a patch over the treated eye for a short period. You will also need to use a topical medication for about a week.

Graves’ Disease

In Graves’ disease, the thyroid gland goes into overdrive and produces more hormones than the body requires. As a result, people with Graves’ disease become very “hyper,” and exhibit a variety of symptoms: weight loss despite increased appetite, irritability, heat intolerance, irregular heartbeats, and in women, changes in menstrual cycles. In addition to these symptoms, some people with Graves’ disease develop skin problems that cause the lower legs to become red, shiny and swollen. Until the patient receives treatment for Graves’ disease (see below), creams and lotions can temporarily relieve some of these symptoms. Another condition that may develop with Graves’ disease is bulging of the eyes. This is caused when fluid builds up behind the eyeball, causing it to protrude out of the orbit. In addition to the cosmetic changes this causes to the eye, thyroid eye disease includes additional symptoms such as dry eye, redness and swelling, excess tearing, sensitivity to light, blurring and double vision. Currently, there are three treatments for Graves’ disease. Together with your physician, you can discuss which one is best for you. -Anti-thyroid medications which block the affects of the excess thyroid hormones -One-time treatment with radioactive iodine, which essentially destroys the thyroid gland. Afterward, the patient will need to take thyroid hormone replacement drugs -Surgery to remove most of the thyroid gland. As with radioactive iodine treatment, the patient will need to take supplemental thyroid medication after surgery

Involuntary Eyelid Blinking

Blepharospasm (pronounced “bla-for-o-spaz-m”) is the name for a condition in which the eye blinks excessively and involuntarily. It usually occurs in persons in their 50’s or 60’s, and to women more commonly than men. While its cause is not yet known, it is believed that blepharospasm is caused when there is a miscommunication among the signals between the brain and the eye muscle. The patient may also experience spasms of the face and neck muscles as well. Some people may have an episode of blepharospasm while for others, it becomes a chronic condition. Blepharospasm is also known as dystonia (impaired or disordered muscle tone) or dyskinesia (a defect in voluntary movement). It is important to have blepharospasm evaluated by a trained eye health professional because it may be a symptom and not a condition unto itself. Sometimes, blepharospasm may be the result of dry eye, eye infection, corneal disease, acute glaucoma or several other types of ocular conditions. Stress, fatigue, bright lights, and situations where one may need to stare ahead (watching television or driving) may exacerbate blepharospasm. However, a variety of relaxation techniques may decrease symptoms temporarily. Treatment for blepharospasm include medications, local injection of botulinum toxin (also known as “botox” injections which are used for cosmetic purposes) and surgery. As with treatment for any kind of condition, it is important to discuss with your physician the treatment that works best for you.