Ophthalmic plastic and reconstructive surgery (oculoplastic surgery) is a unique specialty combining training in ophthalmology and plastic surgery. This specialty has developed because of the amount of knowledge, expertise and special techniques needed to treat patients with conditions involving the eyelids and eyebrows, the lacrimal (tear drainage) system, the orbit (the bony socket around the eye), and the area of the face adjacent to the eye.
The primary difference between general and ophthalmic plastic and reconstructive surgery is on the emphasis of the health of the eye and preservation of vision. Oculoplastic surgeons have a special awareness of the importance of function as well as appearance This subspecialty came in to existence because of the delicacy involved in operating on the area surrounding the eye, and has resulted in significant surgical advances. Additionally, this highly specialized field provides expertise in revising and repairing unsatisfactory results from previous cosmetic or reconstructive surgeries surrounding the eye.
This field is divided into two areas: cosmetic and reconstructive surgery.
Cosmetic oculoplastic surgery is concerned with improving the appearance of the eyelids, eyebrows, forehead and face. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat, usually along with excess skin and muscle, from the upper and lower eyelids. Tendons that have shifted out of place with age or trauma may be moved and repositioned so that they will function more naturally. Eyelid operations make the person look younger, and it also allows women to take better advantage of makeup. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision.
Reconstructive oculoplastic surgery involves the correction of defects caused by aging, trauma, tumors and congenital abnormalities. Most of these conditions can detract from appearance and cause discomfort. Certain conditions – such as eyelid tumors, eyelid position problems, thyroid disease and congenital ptosis (droopy eyelids), can cause significant permanent damage if left untreated.
Cosmetic eyelid surgery (technically called blepharoplasty) is a procedure to remove fat – usually along with excess skin and muscle – from the upper and lower eyelids. Eyelid surgery can correct dropping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision. However, it won’t remove crow’s feet or other wrinkles (see Collagen or Botox) or lift sagging eyebrows (see endoscopic brow lifts). While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.
In many cases, Dr. Weiss utilizes a procedure for improving the appearance of the lower eyelid that avoids a skin incision altogether, which he has been popularizing since 1986 when it was first introduced among oculoplastic surgeons. In a transconjunctival blepharoplasty (TCB), a tiny incision is made inside the lower eyelid and fat is removed from behind the eyelid without a skin incision. The incision is closed behind the eyelid with a single dissolving suture.
Ptosis (droopy eyelids) is a condition in which the position of the upper eyelid margin is abnormally low; it usually results from the aging process, trauma, or is present from birth. This is a completely different problem than extra skin in the upper eyelids, although both of these conditions may be present in the same patient. Ptosis is corrected by shortening the tendon which raises the eyelid. Brow elevation and ptosis procedures are sometimes covered by insurance if excessive skin or the eyelid is obscuring vision, weighing down the lashes, or causing a feeling of discomfort or brow ache because of difficulty keeping the eyelids open.
Because relaxation of the eyebrows may compound the sagging of the upper eyelids by crowding the eye and producing an abnormal appearance of fatigue and premature aging, an operation to elevate the brows is recommended for some patients.
The most recent advance in brow elevation is called the endoscopic brow lift or upper face lift. Tiny incisions (about one-half inch) are made just behind the hairline and the procedure is performed by inserting an endoscope through these incisions, similar to endoscopic knee surgery. In addition to elevating the eyebrows, the endoscopic approach is effective in reducing the crow’s feet or laugh lines, the frown lines between the eyebrows, and forehead furrows – resulting in a more rested, youthful appearance.
Outpatient surgery is less costly and time consuming, and far more convenient – you can return home the same day of surgery. The pleasant ambiance and non-institutional setting of our surgical facility is also more comfortable for the patient. Your only concern should be what type of music that you want to listen to over our state of the art surgery suite sound system – or ask Dr. Weiss to play you one of his own piano recordings of Chopin waltzes or jazz standards.
Eyelid surgery is commonly performed under local anesthesia – which numbs the area around your eyes – along with oral sedatives. In some cases you may elect to have more sedation, including general anesthesia, but it’s usually not necessary. You’ll be awake but relaxed and insensitive to pain during the surgery, although some people may feel occasional tugging or mild discomfort. Music of your choice will be playing in the background to relax you even further. More complicated or extensive procedures do require general anesthesia or IV sedation.
To avoid the potential for increased bleeding, patients who will be undergoing cosmetic eyelid surgery are instructed to avoid taking aspirin or any over-the-counter products containing aspirin for two weeks before surgery. Cigarette smoking, vitamin E, and certain spices in Szechwan food are also known to increase the potential for bleeding and are to be avoided before surgery. In addition, a combination of pre-operative vitamins, Bioflavonoids, antioxidants, holistic medications (see nutritional medicine section), and meticulous surgical technique markedly reduces post-operative bruising.
You should be able to read or watch television after two or three days. However, you won’t be able to wear contact lenses for about two weeks. Most people feel ready to go out in public (and back to work) in a week to ten days without makeup. Healing times vary from patient to patient, but generally you will be able to ride down the elevator after having the stitches removed after six days and no one will know that you had surgery!
They are removed between 5 and 10 days.
Because of Dr. Weiss’ special surgical techniques and pre- and post-operative care, about half of his patients have almost no bruising or discoloration at all (there is always mild to moderate swelling). Bruising, when it does occur, usually resolves completely in 7-10 days and can be covered with makeup well before that. Swelling or slight puffiness is also 85%-90% improved within 7-10 days after surgery, although occasionally a small amount of tissue swelling may persist for weeks or months.
You can try to put them in a week later. If it doesn’t feel right remove them and wait a few days longer.
Except for occassional watery eyes, your vision is unaffected. No bandages are needed, although you will may be asked to wear some protective shields over the eyes at bedtime for the first week.
If you would like to learn more about cosmetic eyelid surgery, or find out if you would benefit from this procedure, please call our office at 949-720-1400 to schedule a private complimentary consultation with the doctor.