Plastic surgery is performed to “mold or reform” a part of the body and may be divided into two main types – reconstructive and cosmetic. Reconstructive surgery restores impaired function, is medically necessary and generally is covered by patients’ health insurance. Cosmetic or aesthetic surgery is done to change one’s appearance to a more pleasing alternative. Plastic surgery in the area of the eyelids and facial regions is often both reconstructive and cosmetic, resulting in improved visual function and improved appearance.
Oculoplastic surgery is the area of ophthalmology that deals with diseases and abnormalities of the eyelids and face, the lacrimal (tear) system and the orbit (bony cavity surrounding the eye). Our oculoplastic surgeon, Dr. David Lyon, performs aesthetic, plastic and reconstructive surgery as it relates to the eyes and surrounding facial structures on patients of all ages. He is a member and Fellow of the American Society of Ophthalmic Plastic of Reconstructive Surgery, www.asoprs.org.
Your eyes are the first thing people notice about your face. Unfortunately, natural aging changes commonly appear first around your eyes, making you look tired or sad. Men and women from their 30′s to their 80′s undergo cosmetic surgery to alleviate eyelid puffiness, heaviness, bulges and drooping caused by excessive skin, muscle and fatty tissue. These aging changes are often accelerated by heredity, allergic swelling, sun exposure and smoking. Reasonable expectations are to correct sagging and bulging eyelid and eyebrow tissues and to reduce wrinkling which may make you look older than you feel. The result is a freshened, rested, more youthful appearance!
Blepharoplasty (eyelid surgery) is one of the most commonly performed cosmetic procedures. This surgery consists of the artful removal of excess and redundant skin and underlying bulging tissue, and includes elevation and anchoring of the deeper muscle layers.
In many people, excess upper eyelid tissues hang downward, hooding the eyelashes and even causing significant visual obstruction. The weight of the excess upper eyelid tissues may cause browache and fatigue or may cause eyelashes to turn inward and irritate the eye. Utilizing a fine skin incision hidden in the natural upper lid crease allows the surgery to be completed with little scarring.
Lower lid blepharoplasty reduces puffiness, bags and bulges under the eyes and can be extended to include cheek lifting. In many cases, the surgery can be done using an incision on the inside of the lower lid, thus eliminating a visible skin scar. Alternatively, if excess skin also needs removal, the incision is made just below the eyelashes.
A brow or forehead lift is often done in combination with eyelid blepharoplasty. Sagging brows may crowd the eyelid space and fail to support the upper lids. Brow lifting restores the normal brow position and contour and reduces forehead creases. Browlifting can be accomplished through a variety of approaches, with small-incision, endoscopic and transblepharoplasty approaches now being a popular and less invasive alternative.
Office procedures to improve your appearance, with little or no recovery time are becoming more and more popular. Botox® and Restylane injections are two of these common procedures.
BOTOX® (Allergan, Irvine, CA)( www.botox.com, www.botoxcosmetic.com) is a purified protein which acts as a neurotoxin. When injected in small doses into muscles, it causes a temporary (3-6 month) weakening of the muscles and it has been FDA approved for therapeutic use in blepharospasm and certain other disorders since 1989. BOTOX® Cosmetic is the only treatment approved by the FDA for the temporary relief of moderate to severe frown lines between the eyebrows. After this short office procedure, results can be seen within a couple of days and can last for up to 4 months.
Restylane® (Q-Medical, Uppsala, Sweden) (www.RestylaneUSA.com) is a non-animal derived form of injectable hyaluronic acid used for facial soft tissue augmentation. It provides 6-12 months effect and is FDA approved for filling in the furrows between the eyebrows. It is a natural carbohydrate and doesn’t require skin testing for allergies like bovine collagen. Often patients receive Botox® injections to relax the muscles between the brows and any residual creases may then be filled in with Restylane®. Other locations where it is used include the nasolabial folds, lower eyelid-cheek interface and lips.
Several other temporary, semi-permanent and permanent injectable fillers for smoothing facial furrows and age-related tissue loss are also available.
Oculoplastic surgeons perform may other types of eyelid, lacrimal and orbital surgery to correct abnormalities and deformities caused by aging, disease or trauma. Common examples include ptosis (drooping eyelid) repair and thyroid eye disease surgery.
Upper eyelid drooping, or ptosis, may be present from birth or may develop at any age to involve one or both eyes. Ptosis is considered significant when it interferes with normal vision or visual development and is most commonly corrected by surgery to tighten or repair the main muscle that opens the eye.
Thyroid Eye Disease
Thyroid eye disease is the most common cause of prominence or bulging of one or both eyes. It is associated with autoimmune thyroid disorders, most commonly Graves’ disease, and may cause a wide array of visual problems including loss of vision, double vision, orbital pain, ocular redness and irritation and dry eye symptoms.
What about the eyes? How are they affected? It appears that the antibodies that stimulate the thyroid gland into overactivity cross-react with the muscles and fat behind the eyes in about half of the people with Graves’ disease. This may happen before, at the same time, or long after the thyroid condition is detected and is known as Graves’ ophthalmopathy, or thyroid eye edisease. This attack on the muscles and fat behind the eyes causes inflammation with swelling and muscle enlargement. Since the eye is surrounded by the bony orbit, swelling and muscle enlargement push the eye forward causing the characterstic “bulging eye” appearance. Swelling and congestion of the muscles often leads to muscle imbalance problems causing double vision. The space between the eyelids widens, known as eyelid retraction, which accentuates the “stare” and may cause incomplete blinking and eyelid closure with resulting eye dryness, redness and irritation. Rarely, the enlarged muscles press on the optic nerve causing loss of vision, which uncorrected, may cause permanent blindness.
In most patients, the eye disease is active and changing for 12-18 months until the orbital inflammation burns out. Treatment during this time is supportive and includes lubricating eye drops and ointments, cool compresses, head elevation during sleep, anti-inflammatory medications, sunglasses, smoking cessation and eye patching or prism glasses for double vision. Surgical rehabilitation of the permanent changes produced by the thyroid eye disease is generally reserved until the disease is inactive and stable. However, emergent surgery is sometimes needed when optic nerve compression causes visual loss.
Once the thyroid disease and the eyes are stable, corrective surgery falls into three main categories: orbital decompression to restore normal eye position and relieve pressure, eye muscle surgery for double vision, and eyelid surgery to normalize lid position. Patients may need none, one, two or all three of these types of procedures depending upon the severity of their disease. Orbital decompression entails removal of bone and fat from the orbit to allow the muscles to spread out into the surrounding air-filled sinuses with resulting relief of pressure on the optic nerve and return of the eye to a more normal position within the orbit. Eye muscle surgery serves to realign the eyes to eliminate or minimize troublesom double vision. Eyelid surgery is performed to reposition the lids closer together, allowing for complete lid closure and relief of ocular exposure. Excess fat and skin in the eyelids can also be removed to help restore normal appearance.
Oculofacial surgery can affect the function and lubrication of the eye and possible complications of this surgery can include loss of vision. An ophthalmic plastic surgeon is uniquely qualified to perform these procedures as an ophthalmologist with added training in aesthetic and reconstructive oculoplastic surgery.
Please contact us at (913) 261-2020 to schedule a consultation with our oculofacial plastic surgeon Dr. David Lyon
The American Society of Ophthalmic Plastic and Reconstructive Surgery