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 to also assess the position of the eyelid itself. Many patients with time will develop a lowering of the upper eyelid position as a result of 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 and/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 softens with time, does leave a fine scar at the incision site so patients should be acceptable of this prior to 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 ophthalmic plastic surgeon, because of their unique training, is the ideal physician to evaluate and treat various eyelid lesions and eyelid skin cancer. Most eyelid lesions are easily removed in the office under local anesthesia such as Lidocaine. Some of these lesions will 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 as well as 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.