Ophthalmic Plastic & Reconstructive Surgery in Queens & Long Island

Am I A Candidate For Eye Lift Surgery?

seewell — Tue, 31 Aug 2010 20:41:37 +0000

The right candidate will understand that eyelid surgery is performed exclusively to remove under-eye bags, correct puffy upper eyelids, and restore vision that is obscured by excess skin and fat in the eyelids. The best candidates for eyelid surgery have realistic expectations concerning the outcome of the procedure. These ideal candidates will also understand that blepharoplasty can correct puffy upper eyelids and smooth the appearance of under-eye bags or puffiness. Eyelid surgery can address the features that cause you to appear older and more tired than you truly are, but the procedure will not remove crow’s feet, smooth wrinkles around the eyes, or erase dark circles beneath the eyes.

Orbital Trauma

seewell — Sun, 09 May 2010 00:54:33 +0000

Eyelid laceration, tear drain injuries, bleeding within and bruising around the eye, and fractures of the bones of the eye socket are problems resulting from trauma, which should be evaluated and treated by an oculoplastic surgeon. Trauma to the orbit and eye area usually causes bruising and may be associated with fractures of the orbital bone blowing out into the surrounding sinus. Fractures causing double vision or large fractures into the sinus should typically be repaired in a timely fashion. Sometimes this is not possible but late repairs, despite being more difficult, can still be done.

Sometimes trauma is severe enough to irreparably injure the eye. Along with diseased eyes that are blind, painful and disfiguring, the removal of an eye is indicated when the eye can not be salvaged. Reconstruction of the eye socket to prepare it for a prosthetic eye typically leads to a very pleasing result in addition to the benefits of removing the blinded eye or diseased, painful eye. Finally, eye socket that have already had the eye removed may also experience problems and need regular examinations and further reconstruction.

Graves’ Disease

seewell — Sun, 09 May 2010 00:53:26 +0000

Thyroid orbitopathy (also known as Graves’ Disease) is an autoimmune inflammatory disorder that affects the tissues of the orbit. It can cause swelling or retraction of the eyelids, extraocular muscles and other soft tissues surrounding the eyes. Patients with this disorder usually have an associated thyroid abnormality which may manifest either before, during or after the orbital signs and symptoms. However, a small percentage of patients may only have eyelid and orbital manifestations of the disorder without developing a thyroid abnormality. Thyroid orbitopathy can develop and affect patients with varying degrees of severity. The disease can begin suddenly and progress rapidly over days to weeks or it can occur gradually. The majority of patients have mild inflammation, the most common signs and symptoms of which are retraction of the upper and/or lower eyelids and bulging of the eyes. In cases of moderate inflammation, patients may also have varying degrees of double vision and eyelid swelling as well as visible redness of the lids and eyes. A small percentage of patients with thyroid eye disease develop severe inflammation, which can result in compression of the optic nerve and permanent vision loss. In most cases, the inflammatory process is self-limited and runs a course lasting 6 months to a few years before subsiding. After the inflammatory phase of the disease subsides, scarring of eyelid and orbital tissues may result in the persistence of eyelid retraction, proptosis and double vision. It is important to be evaluated by an ophthalmologist to assess the ophthalmic manifestations of the disease as well as by an endocrinologist to manage concurrent thyroid abnormalities. Patients with mild orbitopathy are usually evaluated on an interval basis to monitor progression of the disease and managed with measures to reduce ocular symptoms. Patients with moderate to severe orbitopathy may require medical or surgical intervention to reduce inflammation or improve vision. Once the inflammatory phase of the disease has subsided, patients with eyelid abnormalities, double-vision or proptosis may be eligible for surgical correction to improve their function and appearance. Cigarette smoking has been associated with development of worsening thyroid orbitopathy, therefore cessation of smoking is universally recommended in these patients.

Tear System

seewell — Sun, 09 May 2010 00:52:12 +0000

Tears nourish and lubricate the surface of the eye as well as wash away debris. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision. Patients who experience tearing either have a problem with tear production or tear drainage. An obstruction of the tear ducts may occur due to aging, trauma, inflammatory conditions, medications or tumors. If the tear pathway become blocked, tears cannot drain properly and may overflow from the eyelids onto the face, appearing as if you were crying. Discharge from the corner of the eye, swelling, pain and infection may also result. In mild cases, a treatment of warm compresses and antibiotics may be recommended. In more severe cases, surgical intervention to bypass the tear duct obstruction (dacryocystorhinostomy or DCR surgery) may be recommended. A DCR is performed by creating a new tear passageway from the lacrimal sac to the nose, bypassing the obstruction. A small silicone tube called a stent may temporarily be placed in the new passageway to keep it open during the healing process. In a small percentage of cases, the obstruction is between the puncta and the lacrimal sac. In these cases, in addition to the DCR procedure, the surgeon will insert a tiny artificial tear drain called a Jones Tube. A Jones Tube is made of Pyrex glass and allows tears to drain directly from the eye to the lacrimal sac.

Eyelid Reconstruction

seewell — Sun, 09 May 2010 00:49:22 +0000

Defects in the eyelid may arise form a variety of situations, but most commonly after trauma or tumor excision. Some simple superficial defects may require a few sutures, local wound care, and heal within a week to 10 days. After traumatic injuries or removal of larger growths or skin cancers, larger defects may extend through the entire lid. Many of these can be sutured together directly, but many others may require more complex reconstructions. The complex cases, may require the transfer of adjacent tissues, or from other parts of the eyelid face or body. Sometimes these more complex reconstructions require more than one operation to complete (“staged reconstruction”).

Eyebrow Lift

seewell — Sun, 09 May 2010 00:45:22 +0000

Eyebrow lifting addresses eyebrow position, and often the loose or wrinkled forehead skin and underlying tissue. The brow lift can be performed through an incision hidden within the hairline. This procedure lifts everything from the hairline down to the eyebrows and can address eyebrow shape and asymmetry. The scar from the incision, once healed, is virtually undetectable. Alternatively, a section of skin and underlying tissue above and following the length of the eyebrows can be removed to raise the brows. This procedure is ideal for those who do not want to involve the hairline. This technique beautifully lifts a sagging brow while tightening and smoothing the forehead by pulling the skin and tissue of the forehead down rather than up. It therefore lowers the hairline which is ideal for a receding hairline and/ or a high forehead. This procedure also addresses eyebrow shape and asymmetry. Care is taken to position the scar just along the eyebrows so that it is hidden.

Eyelid Cancers

seewell — Thu, 02 Oct 2008 01:36:41 +0000

As the eyelid skin is the thinnest and most sensitive skin on your body, 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 can cause serious damage. Skin cancer of the eyelids is relatively common and several types exist, including basal cell carcinoma, squamous cell carcinoma, melanoma, and sebaceous cell carcinoma. The presence of a nodule or lesion on the eyelid that grows, bleed or ulcerates should be evaluated. This involves examination and a biopsy.

Skin cancer needs to be removed surgically by a skilled individual who can not only remove the tumor but reconstruct the eyelid or area where the tumor was removed. Sometimes surgeon will do this themselves at a surgical facility with an on site pathologist who can immediately examine the specimen to ensure the whole tumor was removed. Other times, the help of a dermatologic surgeon specializing in Mohs surgical excision will be utilized. This procedure is completed into two steps, the first in the dermatologist’s office with immediate examination of the tumor to ensure its complete removal followed by the reconstructive surgery by your surgeon. Oculoplastic surgeons are the optimal person to repair these defects as the eyelid is quite delicate.

Entropion

seewell — Thu, 02 Oct 2008 01:33:01 +0000

Entropion 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. Entropion may also occur as a result of trauma, scarring, or previous surgeries. 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. If entropion exists, it is important to have a doctor repair the condition before permanent damage to the eye occurs.

There are a number of surgical techniques for successfully treating entropion. The most common surgical treatment involves tightening of the eyelid and its attachments to restore the lid to its normal position. Most patients experience immediate resolution of the problem following surgery. A non-incisional entropion repair, uses sutures, may be performed as an in-office procedure under local anesthesia. This procedure requires several strategically placed sutures which evert the eyelid. This procedure is an excellent treatment for patients who are not suitable for surgery, or until more definitive surgery can be performed.

Ectropion

seewell — Thu, 02 Oct 2008 01:30:16 +0000

Ectropion means that 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. Ectropion is usually due to stretching of eyelid tissue associated with aging, although it may also occur as a result of facial nerve paralysis, trauma, scarring, previous surgeries or skin cancer. The inner, reddish conjunctival surface can be exposed and visible. Normally, the upper and lower eyelids close tightly, protecting the eye from damage and preventing tear evaporation. If the edge of one eyelid turns outward, the two eyelids cannot meet properly and tears are not spread evenly over the eye. Patients with ectropion may complain of tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.

Ectropion may need surgical repair, depending on the severity. Most patients experience immediate resolution of the problem once surgery is completed with little, if any, post-operative discomfort. After your eyelid heals, your eye will feel comfortable and be protected from corneal scarring, infection, and loss of vision.

Ptosis

seewell — Thu, 02 Oct 2008 00:59:37 +0000

Ptosis is the medical term for drooping of the upper eyelid. When the upper eyelid margin is lowered to cover the pupil, it may cause a reduction in the field of vision. This may be due to a muscle or nerve weakness. Patients with ptosis can have difficulty keeping their eyelids open. and will often raise their eyebrows to compensate for their 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 developmental delay from limitation of their vision.Ptosis can be corrected surgically and usually involves tightening the levator muscle to elevate the eyelid. Often in congenital ptosis, the levator muscle is extremely weak. A “sling” operation can be performed, to enable the forehead muscles to elevate the eyelid(s). For some cases with small amounts of ptosis, surgery on the muscle on the inside of the lid may be performed.