Blepharoplasty (Eyelid Surgery)

Eyelid surgery is a popular cosmetic procedure, as it removes unwanted fat and skin from the upper and lower eyelids. This gives the eyes a more open look, and the whole face a more youthful appearance. When some people have LASIK and their vision is corrected so glasses are no longer necessary, they wonder how their eyes can be made more youthful-looking. Blepharoplasty is a cosmetic procedure we offer which will do that.

Blepharoplasty has a reconstructive value too. When the upper eyelids droop, they can sometimes block part of the visual field. You can read more about that below, under Ptosis Repair.

Graves’ Disease

This is the term applied to an inflammatory disorder often associated with thyroid disease.  The common problems caused by this disease are proptosis (bulging eyes), eyelid retraction (staring appearance), diplopia (double vision), exposure keratitis (dry eyes due to the eyelids not closing properly), and optic nerve compression.  The last two conditions are the most serious.

The cause of Graves’ disease remains a mystery, but most doctors believe the disorder is an immunologic malfunction.  Graves’ disease can even occur years after a patient is treated for their thyroid condition.  The diagnosis of Graves’ disease depends on the patient’s symptoms and clinical signs and the use of laboratory studies, X-Rays, and CT scans.

Graves' Eye Disease Treatment

The first objective in treating a patient with Graves’ disease is to get the thyroid levels normal and stable.  This is handled by an internist or endocrinologist (hormone specialist).  Stabilizing the thyroid levels usually involves long months of care and treatment.  Once the thyroid is stable the eye problems related to the Graves’ disease can be better monitored.

Ectropion and Entropion

Ectropion is a condition where the eyelid turns outward, exposing the inner surface. It usually happens on the lower lid. It can be congenital, related to aging, caused by scar tissue if a person has sustained a burn injury, or caused by Bell’s Palsy (a paralysis of the facial nerve).

As we age, many of our muscles and supporting structures weaken, and this can occur around the eyes.  One adverse effect of weakened muscles is an entropion, or inwardly turned eyelid.  When the eyelid is turned inward, it causes irritation of the eye.  The correction of an entropion involves an outpatient procedure that causes little discomfort, and results in almost immediate resolution of the problem. It can be performed in the office or an outpatient surgery facility.

Ptosis Repair

Ptosis means drooping, or sagging. The eyelids can droop for a variety of reasons, sometimes obscuring vision when the upper eyelid droops. A blepharoplasty is done to correct this by removing excess skin and fat from the eyelids. When the elevating muscle itself is weak, it may need to be tightened to raise the eyelid.

Scar Revision

Scars take about a year to fully shrink and fade, and by that time some people have a very thin, almost invisible scar, while others still have a red, prominent scar. Some even have a larger scar than they started out with – known as keloid scarring. Some develop hypertrophic scars, which are similar to keloid scars, except they stay within the boundaries of the original wound.

Large, prominent scars can be reduced with scar revision surgery. Excess scar tissue is removed and the wound is re-sutured. If necessary, a new incision can be made across the old one in a zig-zag fashion, creating a new scar line which can heal more unobtrusively.

Mohs Reconstruction

Mohs surgery is used for removal of a malignant tumor. It is done by removing tiny pieces of the tumor and examining them under a microscope. If they are cancerous, more tiny pieces are removed until the microscope shows healthy tissue remaining. This is a precise way of preserving as much healthy tissue as possible while still removing all cancerous tissue.

This leaves the patient with an open wound. Rather than leaving this to scar over, the patient is referred to a cosmetic surgeon who performs a Mohs Reconstruction. Using healthy tissue from elsewhere on the face or body, skin grafts are positioned to replace the lost tissue. Our surgeons do this reconstructive work with a great deal of artistry and precision, so that your eyelids and upper facial area will heal naturally.

Orbital trauma surgery

Trauma to the upper face can fracture the bony socket which cradles the eye – the eye’s orbit. CT scans and three-dimensional scans enable a surgeon to determine the exact damage to this area. Cranio-facial surgery techniques have also improved, so that our surgeons can offer delicate and effective repair procedures.

The bone around the eyes is thin, making it necessary to use external materials to strengthen it. Bone can be taken from elsewhere on the body such as the hips or ribs. Cartilage is sometimes used. Other materials such as artificial bone and titanium plates are often used also.

Opening of tear ducts (nasolacrimal probe)

The eyes drain their excess tears out through tiny openings on  the eyelid called puncta (singular is punctum). Passages called nasolacrimal ducts run from here into the nose. In some babies and young children, these ducts are blocked. If they do not open after non-invasive measures are applied, such as gentle massage and wet washcloths over the eyes, surgery can be done called nasolacrimal duct probing.

A very thin metal probe is inserted into the punctum on each side and passed down to the opening in the nose. Water can be squirted through to clear the passage. If this is not successful, the alternative is to insert a thin plastic probe, and leave it there for several weeks or months. That keeps the passage open until it can stay open on its own.

Dacryocystorhinostomy (DCR)

If the two possible nasolacrimal probe procedures are not successful, the third alternative is a DCR. This surgery is usually required in adults and builds a new drainage system. With the patient under general anesthesia, an incision over the nasal bridge is made and through it a new passage way in constructed.

Then a new opening is made through the bone for the plastic tube to exit into the nose. The plastic tube remains in place while the area heals, keeping the new drainage canal open. A few months later, it is removed. We almost always have great success with this surgery.

Our oculoplastic surgeons are:

Mark L. Malton, MD

James P. Pressly, MD

To learn more about oculoplastics, and how we might be able to help you or your family with vision problems,  please call or email our Charlotte, N.C. office. Someone on our friendly staff will be glad to schedule a personal consultation for you.