Oculoplastic surgery (also known as ophthalmic plastic surgery) is a specialized dynamic field of medicine that combines the microsurgery of ophthalmology with the cosmetic principles of plastic surgery. This branch of ophthalmology focuses on plastic and reconstructive surgery of the eyelids, tear ducts, and orbit, along with cosmetic surgery of the eyelids and brows. Oculoplastic surgeons also perform aesthetic rejuvenation procedures on the face with Botox/Xeomin, and facial fillers like Juvederm, Radiesse, and Belotero.
Eyelid Lift
Blepharoplasty and ptosis repair to correct droopy eyelids are among the foremost commonly performed procedures by an oculoplastic surgeon.
Blepharoplasty is a procedure to get rid of excess sagging skin and muscle from the eyelids to revive a younger look and improve peripheral vision. As you age, your eyelids stretch, and therefore the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, droopy upper lids and bags under your eyes.
Why it’s done
You might consider blepharoplasty if droopy or sagging eyelids keep your eyes from opening completely or pull down your lower eyelids. Removing excess tissue from your upper eyelids can improve your vision. Upper and lower lid blepharoplasty can make your eyes appear younger and more alert.
Blepharoplasty could also be an option if you have:
- Baggy or droopy upper eyelids
- Excess skin of the upper eyelids that interferes along with your peripheral vision
- Excess skin on the lower eyelids
- Bags under your eyes
The Procedure
If you’ve got surgery on your upper and lower eyelids, the surgeon generally works on your upper lids first. He or she cuts along the fold of the eyelid, removes some excess skin, muscle and possibly fat, and closes the cut.
On the lower lid, the surgeon makes a cut slightly below the lashes in your eye’s natural crease or inside the lower lid. He or she removes or redistributes excess fat, muscle and sagging skin, and closes the cut.
If your upper eyelid droops near to your pupil, your surgeon may do blepharoplasty with a procedure called ptosis (TOE-sis) that gives additional support to the eyebrow muscle.
Ptosis repair is an eyelid lifting procedure to revive the edge of the eyelid (from where the eyelashes emerge) to its normal state above the pupil. Recovery from blepharoplasty and ptosis repair is quick and at most times not painful. The procedure is usually performed in an ambulatory surgery center on an outpatient basis.
Double eyelid surgery
Double eyelid surgery is a specific sort of eyelid surgery during which creases within the upper eyelids are formed, creating double eyelids. You would possibly choose this procedure, called blepharoplasty, if you would like to correct a condition, like droopy eyelids or eye bags or if you would like to alter the appearance of your eyelids.
Some people have visible eyelid creases, referred to as double eyelids. Some were born without eyelid creases. That’s called a single lid or a monolid. There’s nothing medically wrong with either.
Some reasons you would possibly want double eyelid surgery include:
- Your eyelids are interfering with your vision.
- You have one single and one double eyelid, and you’d like them to match.
- Permanent creases can help make your eyes appear larger.
- It are going to be easier to use certain types of makeup.
Incisional procedure
Eyelid surgery should be performed by a professional cosmetic surgeon experienced in this sort of procedure.
The proposed double eyelid line is carefully measured and marked with a pen.
Sedation or general anaesthesia is administered, along side local anaesthetic . Several small incisions are going to be made along the double eyelid line and therefore the marked skin will be removed. The orbicularis oculi muscle and fat tissue will be removed between the incisions and skin are going to be closed with glue or stitches which will need to be removed four or five days after surgery.
The incisional technique could also be a decent option if you’ve got thick skin, need extra skin and fat removed, or are trying to find a permanent result. This procedure isn’t reversible.
Some potential risks are:
- allergic reaction to anesthesia
- infection
- temporary or permanent changes to vision
- visible scarring
Non-incisional procedure
A double eyelid can even be created without an incision. This procedure is named the buried suture technique. It’s also performed under general anaesthesia or with IV sedation and native anesthetic.
As with the incisional technique, the eyelid are going to be carefully measured and marked. Then, a series of small punctures are made within the skin along the line.
Sutures are placed through the punctures and tightened until they form the required crease. The sutures will remain beneath the skin, out of sight. You won’t need to return to have them removed.
You’ll have less scarring with the non-incisional procedure, and it can be reversed. The non-incisional technique may be a decent option if you don’t need extra skin and fat removed.
Some potential risks are:
- asymmetry or loosening of the double fold
- irritation from the sutures
- infection
- visible puncture marks when your eyes are closed
- inclusion cyst from a buried stitch
Brow Lift
A browlift is a procedure to lift the eyebrows back to their normal anatomic site. In men, the traditional brows rest at or simply above the frontal bone above the eyes. In women, the traditional brows are usually higher and rest above the bone. Surgery is performed to lift the brows if they’re sagging below these areas. Sometimes combined with blepharoplasty and/or ptosis repair, brow lifting can even be done at an ambulatory surgery center in an outpatient setting.
Why it’s done?
Aging typically causes the brows to maneuver down. As skin and soft tissues lose elasticity, the gap between the eyebrows and eyelashes also shortens.
The lower position of the eyebrows can cause you to look tired, angry or sad. A brow lift can raise the eyebrows and restore a refreshed, more pleasing appearance.
You might consider a brow lift if you’ve got a low or sagging brow that’s contributing to sagging upper eyelids.
Types of Brow Lift Surgery
Cosmetic surgeons use different techniques for brow lift surgery; which is best for any given patient depends on a patient’s goals, unique anatomy, and therefore the extent of corrections needed to realize the required results.
Endoscopic Brow Lift
Increasingly, cosmetic surgeons are using the endoscopic method for brow lift surgery, which is far less invasive than previous techniques, yet can often achieve an equally desirable result. For an endoscopic brow lift, your cosmetic surgeon will make a series of very short incisions (about ¾” in length) just behind the hairline. Then, employing a special tiny camera and thin instruments, he or she is going to reposition the muscles and lift underlying tissues of the forehead, removing excess fat and tissue as required to make a naturally younger brow.
Temporal or Limited Incision Brow Lift
A temporal brow lift involves slightly longer incisions than an endoscopic brow lift and is most typically performed in conjunction with eyelid surgery. Incisions about 1-inch long are made just above each temple, behind the hairline. Through these incisions, your plastic surgeon will lift and reposition the tissues of the outer brow area. Then, through the incisions made for an upper eyelid procedure, the gap between the eyebrows is lifted to smooth frown lines.
Classic or Coronal Brow Lift
Once the quality technique, the coronal brow lift has generally fallen out of fashion, as well-qualified cosmetic surgeons are typically ready to make needed improvements with less invasive techniques. In certain cases, however, a coronal brow lift could also be necessary to attain a patient’s desired results. this method involves one long incision made behind the hairline, running from ear to ear. Excess skin, fat and tissue are removed and therefore the remaining skin and brow muscles are repositioned into a younger appearance.
Forehead Lift
A forehead lift is the surgical removal of excess fat and skin, as well as a tightening of the muscles in the forehead area. It can correct sagging brows or deep furrows between the eyes. It is often done in conjunction with a facelift, in order to create a smoother facial appearance overall.
Types of techniques
There are two types of surgical techniques available for a forehead lift, including the classic forehead lift and the endoscopic forehead lift:
In the classic forehead lift, the surgeon will make an incision that is similar to a headphone-like pattern. This incision is called a coronal incision and starts at about ear level and continues across the top of the forehead to the other ear. The surgeon then carefully lifts the skin of the forehead removing any excess tissue and fat and, if necessary, realigns the muscles. During the procedure, the eyebrows may also be repositioned at a higher level, and any excess skin is trimmed.
The difference between the endoscopic forehead lift and the classic forehead lift is the size of the incision. With the endoscopic forehead lift, the surgeon makes three to five short scalp incisions that are each less than an inch long. An endoscope is then inserted through one of the incisions allowing the surgeon to see the muscles and tissues underneath. In a different incision, the surgeon inserts another instrument that lifts the forehead skin. Excess tissue and fat are then removed and, if necessary, muscles are realigned. Like the classic forehead lift, the eyebrows may also be repositioned at a higher level. The recovery period and scarring are minimal, in comparison to the classic forehead lift.
Cosmetic Ptosis
PTOSIS or a droopy eyelid, refers to a drooping of the upper eyelid of one (unilateral ptosis) or both eyes (bilateral ptosis). The droop may be barely noticeable, or the eyelid can descend over the entire pupil. It can affect both children (congenital ptosis) and adults (acquired ptosis). Reasons why an eyelid may droop include genetics or damage to the eye, and the condition is more likely with age.
It is often seen that people with a droopy eye raise their eyebrows unconsciously (resulting in horizontal forehead lines). If the skin is relatively tight, some eyelid elevation can happen with eyebrow raising. Ptosis repair is not performed by most cosmetic and plastic surgeons as ptosis surgery is a highly specialized and delicate procedure. Ptosis correction surgery is only performed by oculofacial/oculoplastic surgeons who have training in both facial cosmetic surgery and ophthalmology.
Ptosis Symptoms
The most obvious sign of ptosis is the drooping upper eyelid. Depending on how severely the eyelid droops, people with ptosis are often concerned about the cosmetic appearance. Vision may also be affected depending on how low the eyelid is relative to the pupil. Sometimes people with ptosis tilt their heads back to try to see or raise their eyebrows constantly try to lift the eyelids.
- Increased heaviness of the eyelid
- Impaired vision
- Tilting of the head to see better
- Constant raising of the eyebrow in order to lift the eyelid
- Headache due to forehead muscle strain and eyestrain
The degree of drooping varies greatly. For some people, it may be subtle and not always noticeable. For other people, it can make it hard for them to see. In the most severe cases, the eyelid may cover the pupil entirely.
Congenital Ptosis is a type that is present when someone is born. It is a rare condition that will be persistent without treatment. While the condition is benign, it can result in cosmetic, psychological, and function problems for children. This type of ptosis can affect one or both eyes.
The other type of ptosis is Acquired Ptosis. There are several subtypes that fall under this category. All of these types of ptosis occur as a result of an underlying medical issue.
Types of acquired ptosis include:
Myogenic ptosis: This type occurs as a result of certain diseases, such as myasthenia gravis, congenital myopathies, and myotonic dystrophy. The levator muscle dysfunctions, which stops the eyelid from going up into the correct position.
Aponeurotic ptosis: This type of ptosis is usually seen in elderly people. The aponeurosis of the levator muscle and the muscle itself lose tone. They then suffer the effects of gravity as a result of aging, causing an eyelid to droop.
Mechanical ptosis: With this type, the muscles cannot raise the eyelid because it is too heavy. This may be due to orbital fat prolapse, blepharochalasis, or eyelid tumors.
Neurogenic ptosis: This type occurs as a result of sympathetic or oculomotor nerve damage. Central nervous system damage may also cause this type of ptosis.
Traumatic ptosis: The levator may become disinserted as a result of certain types of trauma, causing this type of ptosis.