Eye and Orbital Plastic Surgery
Our world-class surgeons are able to correct impaired vision and functions within the eye by addressing many underlying problems. The focus is to resolve disorders of the eyelids, orbits, and lacrimal system. Besides resolving impaired vision and functions to the eye and surrounding structures, our surgeons leave the eye looking cosmetically appealing and youthful.
Non-Surgical
Botox
Used for cosmetic procedures, reduces and/or eliminates the appearance of wrinkles in the face. This is achieved through minimally invasive injections. Created from an FDA approved substance, botulinum A, once injected into the face will block the nerves and muscles that are responsible for causing lines and wrinkles in the face.
Dysport
An injectable, used for temporarily lessoning and/or eliminating moderate-to-severe frown lines between the eyebrows, is placed directly underneath a furrow. It weakens the muscle to where contraction cannot be achieved.
Xeomin
This medication is used to treat involuntary closing of the eyelid. It is injected into the affected muscles to reduce the activity. A chemical in the body, called acetylcholine, is inhibited from signaling the nerves in that muscle to contract.
Chemical Peels
Aid in the smoothing of the skin through removal of damaged outer layers, also reducing scarring while removing blemishes. The three types of chemical peels are alphahydroxy acid (AHA), triachloroacetic acid (TCA) and phenol, ranging from mild to strong in toleration. Chemical peels reverse the effects of aging, damaged skin and other skin conditions. The overall appearance of the skin will be improved through the removal of dead skin cells while promoting growth of new ones.
Dermal Fillers
During the aging process, subcutaneous fat is lost. Muscles in the face are then working closer to the surface of the skin, causing lines and creases in the face to be visible. Dermal fillers help to diminish those lines and restore fullness back into the face.
Fraxel Laser
This FDA approved procedure uses fractional laser technology to help restore skin to its original texture, leaving the skin feeling smoother with a fresh feeling of youthfulness. This laser technology improves tone, as well as improvement to the pores, acne scars, unwanted brown spots, as well as a reduction in fine lines in the face.
Eye Lid
Blepharoplasty
Typically a cosmetic procedure, eyelid surgery can also improve vision by lifting a droopy eyelid from one’s field of vision. This procedure can rejuvenate tired looking eyes through removing excess fat, skin and muscle from the eyelids.
Blepharospasm
A condition, in which a patient blinks abnormally, is a form of focal dystonia. Although individuals with this condition may have normal vision, this disturbance interferes with visual perception. In the most severe cases, this disturbance may result in functional blindness. There is no cure for blepharospasm but there are treatments to combat the condition, such as oral medications, injections, surgeries, and brain stimulation.
Browpexy
This is a procedure in which the eyebrow is returned to an aesthetically pleasing location on the upper face by lifting the eyebrow through incisions in the upper-eyelid. An internal browpexy technique is achieved when brow fat is reattached to the forehead through an incision in the upper eyelid. A direct browpexy, another technique, is achieved when direct incisions are made above the brow with small amounts of brow ptosis. The pretrichial browpexy technique is performed through a longer incision, raising the brows and smoothing out the forehead, hidden along the hairline. Each procedure is done according to the needs of the patient.
Canthopexy And Canthoplasty
Canthopexy is a surgical procedure that lifts the corners of the eye, eliminating a tired appearance, and restores the look around the eye to a much more youthful expression. Moreover, canthoplasty, another surgical procedure, is used to create an upward slant in the corner of the eyelid. This procedure can also be used to correct a dystrophic appearance in that area of the eyelid.
Ectropion And Entropion
Ectropion is a condition in which the eyelid turns slightly outward. When this occurs the inner lid of the eyelid in either one section of the eye or across the entire lid, is exposed. Ectropion can be caused for any number of reasons (aging, paralysis of the face, scar tissue, or a birth defect). Whatever the case, corrections to this condition are done through surgery of eyelid repositioning. Entropion is a condition in which the eyelid turns slightly inward. Entropion, much like ectropion, can have many causes (aging, congenital defect, spasms, inflammation, or scarring). Irritation in the eye can cause damage to the cornea, if not corrected. Treatment for this condition is surgery with a local anesthesia.
Eyelid Crease Fixation and Formation
Creases in the eyelid change due to the aging process, injuries, and inflammation. This change occurs because the skin around the eyelids are much thinner than other parts of the face and body. Fixation and formation of eyelid creases is done for both cosmetic and functional purposes.
Eyelid Lesions
Lesions on and around the eyelids may be malignant or benign. If the case is a benign lesion, individuals usually prefer to eliminate the growth as a whole, called an excision or excisional biopsy.
Floppy Eyelid Syndrome Treatment
FES is an ocular condition that occurs when the upper eyelids are loose and may become turned inside out. Lubrication to treat this condition usually turns out unsuccessful because there may be additional problems that can only be resolved through surgery. In surgery, a segment of the eyelid is removed, tightening the eyelid and turning it to a correct position.
Ptosis
Usually the result of aging, ptosis or the drooping of the eyelid is mostly seen in the older adult population. Some may develop this condition after an injury or eye surgery with some extreme cases found in children born with drooping eyelids.
Tarsorrhaphy
This procedure is achieved when the eyelids are partially sewn together to create a narrowing of the palpebral opening. If the eyelids become weak and can no longer blink effectively, the cornea and the rest of the eye may develop problems. This procedure helps protect the eye until a more permanent action can be taken.
Trichiasis
This condition occurs when the eyelashes turn inward and irritate the cornea. Treatment includes removing and correctly positioning the lashes. If recurrence is the case, epilation with electrosurgery may be more suitable. During epilation with electrosurgery a radiofrequency device is employed to permanently remove the follicles of the affected eyelashes. An electrode wire is inserted into the eyelash follicle and an electrical current destroys those follicles, ending hair growth.
Orbital
Enucleation
This procedure is the removal of the eye due to severe pain, injury and trauma, blindness, and disease. In most cases the enucleated eye is replaced with an orbital implant and an artificial eye. An evisceration is a similar procedure that only removes the contents of the eye but leaves the shell of the eye. The doctor will best understand which procedure should be attempted, based on a number of indications.
Orbital Decompression
This surgery creates space within the orbit, allowing the eye to return to its natural position. Patients who have eye proptosis will undergo this surgery. The focus for the surgery is removing the bone from one or more walls of the orbit as well as removing orbital fat. Removing bone and fat from the orbit will help maintain symmetry in the tissues of the orbit, reduce proptosis, and release any compression on the eye.
Orbital Fracture
This fracture is a break or crack in one or more of the bones of the eye socket. An orbital fracture can cause double vision depending on whether eye muscles are injured or trapped in the fracture. Once the swelling recedes from this injury, the eye may appear more recessed compared to a normal eye. This treatment is necessary for both cosmetic and functional purposes. If surgery is a must, the incisions are small, and placed inside the eyelid or in creases in the skin.
Orbital Implant
Implants are attached to the muscles and structures in the eye socket during surgery. This allows for an ability to retain movement in the artificial eye. Ocularists are specialized in creating prosthetic eyes out of non-toxic, and non-allergenic materials that look and feel natural. A patient who undergoes this surgery will obtain custom-fitted prosthesis to match their other eye.
Orbital Mass
These are lesions behind and around the eye, which impact nerves, muscles, and blood vessels in the eye. Double vision, vision loss, and severe pain are common symptoms of orbital masses. Imaging tests are key for diagnosing whether these tumors are benign or malignant. If the tumor causes visual problems, surgical excision may be necessary. A biopsy may be conducted to provide a more definitive diagnosis.
Orbital Reconstruction
This is a procedure that repairs deformities and complications of the orbit, which include orbital dystrophy, exorbitism, and fractures. Orbital reconstruction will help correct deformities through a number of various techniques.
Thyroid Strabismus Surgery
Common symptoms of thyroid eye disease are swollen eyelids, as well as bulging and red eyes. If glasses and prisms are not an effective measure of treatment, thyroid muscle strabismus surgery may be recommended. This surgery repositions fibrotic eye muscles to better align the eyes, thus correcting double vision that may be associated with thyroid eye disease.
Lacrimal
Balloon Dacryoplasty
This is a surgical procedure, known as balloon dacryocystoplasty that opens a tear duct once it is blocked. The incision for the surgery is made in the nose or the face. During the procedure, a very thin wire is inserted through a hole in the corner of the eye. In doing so, tears will drain. A deflated balloon, attached to the wire being inserted, is inflated with a liquid. The pressure from doing so will open and expand the blocked duct. Once the balloon deflates, it will be removed along with the wire. To prevent infection, antibiotics will be taken several days after the surgery to prevent any type of infection.
Canalicular Repair
When there are breaks in the normal tear duct drainage system it is called canalicular lacerations. This type of injury is usually the result of blunt or sharp trauma. Surgery will be most effective within the first 48 hours of the blunt injury. The severity of the patient’s injury will dictate which techniques will be performed.
DCR
Dacryocystorhynostomy or dacryocystorhinostomy (DCR) is a procedure that is performed if tear blockage cannot be effectively treated. DCR is a surgical procedure to construct a new tear drain after blockage occurs. During the surgical procedure the doctor makes an incision in the side of the nose to create an opening between the tear drainage system and the nose. With the endoscopic approach to the procedure, a lighted tube with a microscopic camera is guided through the nasal opening to access the tear duct area. Once a new tear drain opening is created between the eye and the nose, a stent is placed in the new tear drain and kept in place for several months to ensure the duct will continue to remain open. In cases where the tear drain blockage cannot be cleared, a small drain is inserted to offer a more permanent solution to a clear tear duct.
Lacrimal Gland Biopsy
This procedure is performed if a lacrimal gland growth or enlargement is present. Lacrimal gland tumors may include eyelid swelling that lasts for several months. A biopsy is typically conducted based on the size of the tumor in the area. If it cannot be determined if the tumor is benign or malignant, an incision biopsy will be performed to remove a sample of the growth. Once the tumor can be categorized as malignant the entire gland will be removed.
Lacrimal Gland Plication
The lacrimal gland produces tears as well as helping to keep the surface of the eye lubricated. If the lacrimal gland protrudes, sarcoidosis may be the culprit, an inflammatory disease. Dry eye syndrome is a strong indication that there may be an issue with the lacrimal gland. Plication is a surgery, which takes the lacrimal gland and repositions it so the tears can be produced with limitations on swelling and protrusion.
Lacrimal Plugs
Also known as punctal plugs, punctum plugs, or occluders, lacrimal plugs are the choice method for treating dry eyes. When eye drops or ointments fail, lacrimal plugs can relieve dry eye symptoms. They are placed on the opening of the tear duct, reducing the drainage of tears, and increasing moisture in the eyes. Temporary plugs may be useful for days to several months, whereas a permanent plug may be implanted if there was a successful response to the temporary plugs. The implanting of the plugs only takes a few seconds by a skilled doctor.
Tear Duct Obstruction
While many cases of tear duct obstructions clear after the first year of life for children, the pathology for adults is a lot different. In adults when an obstruction exists, tears cannot properly drain from the eyes, causing an overflow to the surface of the eye on the eyelashes and eyelids. The eyelids may become swollen with a yellow or greenish discharge. Tear duct massages as well as antibiotic eye drops may relieve the discharge, but if the obstruction does not clear, a minimally invasive procedure may help. A probe passed through the tear duct and into the nose may open any obstructions. In some cases however, surgery may be needed to clear the tear duct obstruction.
