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Oculoplastic Surgeons: Explained

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What are Oculoplastic Surgeons?

Most people know what a “Plastic Surgeon” is, and assume that all plastic surgeons are trained to perform the same surgeries. While both general “Plastic Surgeons” and “Oculoplastic Surgeons” are trained to perform surgery on the skin, muscles, and bones of the human body, Oculoplastic Surgeons focus their expertise on the face, and more specifically, the upper face. After completing medical school, Oculoplastic Surgeons are trained, and become Board Certified as Ophthalmologists. They then undergo 2 additional years of training that focuses on surgery involving the forehead, eyebrows, eyelids, midface, orbit (eye socket), and lacrimal (tear drain) system. By restricting their study to the face, Oculoplastic Surgeons become experts in both reconstructive and cosmetic surgery of the human face surrounding the eyes.

Conditions Oculoplastic Surgeons treat:

Many, but here we will discuss the most common upper eyelid/eyebrow conditions treated:

While you may feel that droopy eyebrows and upper eyelids are “just part of getting old,” the visual field loss caused by these conditions causes decreased quality of life, restricts visual field, and is potentially dangerous. Therefore, lifting and removing excess tissue around the eyes is often paid for by your insurance company. During a visit with an oculoplastic surgeon, it can be determined which factors contribute to restriction of your visual field, and you will discuss the surgical options to correct these problems. These are the types of issues oculoplastic surgeons most commonly correct.

What is eyelid and/or eyebrow surgery like?

Eyelid and eyebrow surgeries are most often performed on an outpatient basis (no hospital stay required) by oculoplastic surgeons using a sedating/relaxing medication through an I.V. along with local anesthetic to numb the tissues. Most eyelid and eyebrow surgeries and their recovery periods are relatively painless, but do result in temporary bruising and swelling that lasts 1-2 weeks.

Below are brief descriptions of the most common eyelid and eyebrow surgeries performed by oculoplastic surgeons at our outpatient surgical centers.

Upper Eyelid Blepharoplasty:
Oculoplastic surgeons correct the excess skin, muscle and fat in the upper eyelids. A single incision is made within the natural crease of the upper eyelid, and the excess skin, muscle, and fatty tissue is removed. The incision is sutured using a fine suture material that dissolves on its own over a 2 week period (no need for suture removal). Because the eyelid skin is the thinnest skin in the body, and the fact that the incision is hidden within a natural fold of the eyelid, virtually no scar results from this surgery.

Eyelid Ptosis Repair:
Eyelid ptosis is due to a weak or stretched muscle that moves the upper eyelid, allowing it to fall into the pupillary axis, thereby obstructing the upper portion of your vision. Depending on the type of muscle weakness, ptosis repair is performed by oculoplastic surgeons via one of two approaches:

  1. Anterior (front) approach: Anterior ptosis repair involves an incision within the natural eyelid crease, followed by tightening and/or reattaching the loose muscle. The skin incision is closed with fine stitches that dissolve within 2 weeks.
  2. Posterior (back) approach: Posterior ptosis repair involves everting the upper eyelid, and tightening/shortening the weak upper eyelid muscle. The sutures are placed on the back of the eyelid, so there is no skin incision required for this approach.

Eyebrow Lift:
Droopy eyebrows often coexist with excess upper eyelid skin, and can be lifted by oculoplastic surgeons by one of several techniques, most of which are covered by medical insurance. Many times, this surgery is performed along with upper eyelid blepharoplasty. A mild degree of eyebrow ptosis can be corrected through the same incision used to perform blepharoplasty surgery. Dissection is carried out beneath the eyebrows and sutures are used to secure the brows to the orbital bone beneath the brows. More severe eyebrow ptosis can be corrected by making an incision in the upper brow hairs and removing a small amount of tissue above the brows. In patients wishing to avoid a visible scar, an endoscopic forehead lift is performed through a few incisions hidden behind the hairline. This option is considered cosmetic surgery, and is not covered by medical insurance.

Most people beyond 55 years of age have some laxity and drooping of the upper eyelids and eyebrows. If you have tired, heavy, hooded upper lids and/or brows, I would be happy to see you in consultation to discuss your concerns with you, and determine whether the problem is covered by your insurance. We can then discuss surgical options to improve your vision and/or appearance in whatever manner we deem appropriate.

Cosmetic Options:
In addition to the surgical procedures offered, I have extensive training in non-surgical cosmetic procedures including botulinum toxin (Botox) for wrinkles, Facial fillers, and facial resurfacing with chemical peels. Used alone or in conjunction with surgical correction of eyelid malpositions, these non-surgical options offer cosmetically pleasing options to combat the effects of aging. If you would like to discuss surgical and/or non-surgical options to improve your appearance, please call Dr. Berbos’ staff to schedule a consultation.

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