Oculoplastics and Reconstructive/Orbital/Lacrimal Diseases

This service deals with disease and surgery of the eyelid, the structures around the eyelid which are known as the orbit, and the tear drainage system, the lacrimal system. The position of the eyelid is vital to the health of the eye. Lid malposition can occur as people age or from other disease processes. The eyelid can become droopy, known as ptosis, the eyelid skin can become redundant, sometimes the eyelid can turn in or out. There are many names for lid malpositions, such as ectropion, entroption, ptosis, for example.

Eyelid Rejuvenation/Blepharoplasty

The American Society of Plastic and Reconstructive Surgeons estimates that 57% of all cosmetic surgery performed by their membership involves the face. Of this group, nearly 40% have surgery on the eyelids as part of their facial surgical procedure.

Many agree that the eyes are perhaps the most expressive portion of the face. As a result of facial muscle movement and contraction, tissue stretching, and, of course, time, creases (wrinkles) form, bags (fat pockets) expand and the skin becomes lax and sags. These transformations lead to the common abnormalities involving the eyelids over time: puffiness due to enlarging fat pockets, crow's feet, those wrinkles in the outer corners of the eyelids from years of eyelid squeezing, creases and wrinkles on the eyelid skin from folding and stretching of the skin and, excess skin especially on the upper lid which may actually cover over the lashes in severe cases. Surgery can correct all of these to some degree but improves some better than others.

The initial evaluation with a physician that performs eyelid aesthetic and reconstructive surgery is centered around three questions: 1) What feature of the eyelids is perceived as being abnormal? 2) Are any other areas of the face contributing to the eyelid abnormality or under consideration for cosmetic rejuvenation? and 3) Are any underlying eye or health abnormalities present that could compromise the anticipated procedures or its results? It is worthwhile examining these questions in some detail.

Prior to an initial consultation with a physician, careful scrutiny of the face and eyelids in a mirror and in recent photographs will lead many patients toward a more concrete idea of what it is exactly that they do not like about their eyes. Being able to pinpoint a problem area enables the surgeon to address your needs and helps to avoid misunderstanding about desired post-operative appearances. This also conveys to the surgeon that you have given some thought as to what appears abnormal and that you're not just "shopping" for a new look; something that if left to the discretion of the surgeon and his tastes may not end up to be at all what you had expected.

Careful examination of the periocular area often reveals contributing abnormalities missed when focusing just on the eyelids. Excess upper lid skin may be partially attributable to a brow and forehead that have sagged with time. Excess horizontal forehead wrinkles, brow hairs less than one-half inch from the eyelashes and excess upper lid skin that primarily covers only the outer half of the upper eyelid are clues to the presence of brow ptosis or droop. Deep or prominent crow's feet are often difficult to correct with eyelid surgery alone and may require a temple lift or face lift in combination with eyelid surgery to achieve maximal correction. Dissatisfaction with other facial features such as the nose, chin or jowls is important to note as these procedures may be performed in concert with eyelid surgery. Besides excess skin, fat and wrinkles, the lids themselves may be lax and droopy resulting in the need for corrective surgery. An unacceptable outcome would occur after removing excess skin from an upper eyelid that wasn't recognized as being set too low prior to surgery.

Protecting the eye and keeping it moist and lubricated is the function of the eyelid. By tightening the skin and underlying muscles, surgery could compromise the ability to close the eye completely and allow the eye to dry. Careful preoperative assessment of tear function and corneal sensation and eye movements are essential in ensuring that the eye is able to maintain a normal moist condition after surgery. Frequent eyelid infections increase the risk of postoperative cellulitis and must be controlled prior to any surgery. While easy bruising, blood thinners, daily aspirin intake, high blood pressure and diabetes slow the healing process or prolong the convalescence after the procedure, surgery can usually be performed with minimal risk in almost all cases.

Cosmetic eyelid procedures are typically performed under local anesthesia on an outpatient basis. The eyes are not bandaged shut and vision is quite normal enabling reading and other activities to be enjoyed during the convalescence. Perhaps the most surprising feature is the swelling and bruising after surgery. As thin as the eyelid skin is, it's no wonder why it bruises easily. Most of this is gone within 5-7 days but can persist for up to 14 days in individuals that bruise easily. This has practically no effect on the surgical outcome but is usually obvious even to the most casual observer. It is not uncommon to take a week away from your normal activities to "hide out" until the eyelid appearance returns to normal.

The decision to have aesthetic eyelid surgery can be extremely rewarding. Careful preoperative attention to eyelid abnormalities, associated brow problems, any potential eye or physical maladies and dialogue with the surgeon about the planned surgery and its outcome yields the most satisfying and lasting results.

Before

After

Elaine came to Dr. Fries at Eye Surgeons Associates, because her lower lid began to turn out. "While I was there Dr. Fries noticed that I was lifting my eyebrows to see. I didn't even realize I was doing that. He told me that he could also fix that by removing some of the excess skin there. The surgery went great, everyone was wonderful. Dr. Fries has a wonderful bedside manner. After the surgery, I had some minor discomfort on my lower lids. There were stitches, but I still went to work the next day with a little extra cover-up. Now, I can see without lifting my brow and I look 15 years younger! I recommend this surgery and Dr. Fries to everyone." Click here to download (PDF)

Please visit The American Society of Ophthalmic Plastic and Reconstructive Surgery for additional information

Barb from Donahue, IA stated

"My daughter had a customer who had bletharoplasty and said that I should have it done. I talked to my optometrist and made an appointment with Dr. Fries. Dr. Fries did a fabulous job and insurance covered it. I had surgery on Thursday and went to work on Monday with stitches and some bruising. In 5-6 days it was fading and the stitches were out in one week. There was no pain. I didn’t know what I was missing – a whole panoramic view. I would recommend this to anyone. It was no big deal and the benefits are great."

Other diseases an Oculoplastic Surgeon would treat

Skin cancer has become a serious health threat. Skin cancer can occur in the eyelids and around the eye. Any discoloration, bump, or new growth on the eyelid should be examined by a eye physician. Especially worrisome signs include bleeding, rapid growth, or destruction of the normal eyelid appearance.
There are many diseases that affect the structures around the eyelid, in addition to the eyelid. The vast field of orbital disease and surgery encompasses problems like Graves orbitopathy, cancer, infection, and congenital and vascular malformations.

Cancer and other diseases and malformations of the orbit can often involve surrounding structures, like the sinuses and brain.

Sometimes disease or trauma causes loss of an eye.

A common complaint of many patients is tearing. This can occur for many reasons, including a blocked tear drainage system. This affects children and adults.

There are many disorders of facial movement, including benign essential blepharospoasm and hemi-facial spasm. These can sometimes be treated with BOTOX. BOTOX, is purified botulinum toxin which when injected locally, prevents a muscle from comtrating. Ophthalmologist have been using BOTOX for many years in the treatment of these disorders. BOTOX can also be used for cosmetic purposes.