Functional Eyelid Surgery
Repair of Droopy Eyelid (Ptosis Repair Surgery)
In evaluating the upper eyelids, in addition to evaluating for the presence of excess eyelid skin (dermatochalasis) and the position of the eyebrow, it is important also to assess the position of the eyelid itself. Many patients develop a lowering of the upper eyelid position with time as a result of the weakening of the associated eyelid elevation muscle and attachments. This condition is known as eyelid ptosis.
Eyelid ptosis can often impair a patient's peripheral vision or, in very severe cases, even their central vision.
Eyelid ptosis often co-exists with dermatochalasis and brow ptosis, and often all three components need to be evaluated and addressed in order to obtain the best results. It is important to understand that the primary goal of eyelid ptosis repair and any additional functional upper eyelid surgery is to improve the visual function of the eye and less so to improve the aesthetic appearance of the face.
Functional Upper Eyelid Lift & Brow Lift (Upper Eyelid Blepharoplasty & Brow Lift)
In some patients, the degree of dermatochalasis or brow ptosis adversely affects the patient's visual function. These conditions, when severe, may impair a patient's peripheral vision or even their central vision. The removal of the excess upper eyelid skin and elevation of the eyebrows in these patients can significantly improve their peripheral vision. The most successful and long-lasting brow lifts for these patients often involve placing an incision directly above the eyebrow and lifting the eyebrow tissue. The incision is placed adjacent to the eyebrow hairs, and although it softens with time, it does leave a minimal scar at the incision site. Patients should be accepting of this before surgery. It is important to understand that the primary goal of functional upper eyelid blepharoplasty and brow lift surgery is to improve the visual function of the eye and less so to improve the aesthetic appearance of the face.
Repair of Eyelid Malpositioning
There are many medical conditions of the eyelids that can cause eye irritation, infection, or tearing including in-turning of the eyelids (entropion), out-turning of the eyelids (ectropion), and misdirection of the eyelashes. There are a variety of surgeries that may be used to correct the eyelid position, depending on the cause.
The unique training of ophthalmic plastic surgeons makes them the ideal physicians to evaluate and treat various eyelid lesions and eyelid skin cancer. They can easily remove most eyelid lesions in the office under local anesthesia, such as lidocaine. Some of these lesions require suturing of the wound, but most will heal very nicely without any closure.
Eyelid skin cancers require the coordinated efforts of both a Mohs dermatologic surgeon and an ophthalmic plastic surgeon. The Mohs surgeon is best able to remove all of the skin cancer while still preserving as much healthy tissue as possible. After the skin cancer is removed, the resulting defect requires an ophthalmic plastic surgeon in order to reconstruct the eyelid to allow full functionality and cosmesis.