Cosmetic and Reconstructive Plastic Surgery
The specialty of oculoplastic surgery includes cosmetic and reconstructive surgery of the eyelids and peripheral eyeball tissues. Most commonly known is the operation called blepharoplasty. This is the procedure for removing excessive eyelid skin and reducing puffy lids. Sometimes it is called an eyelid "tuck." While many blepharoplasties are done purely for cosmetic reasons, there are some visual conditions for which this may be helpful. For example, as we age, there is often a redundancy of the upper eyelid skin which results in a large fold of sagging skin that hangs down and obstructs the upper portion of the vision. Removal of this skin (and occasionally the fat pad behind it) by a blepharoplasty is done for a medical eye problem and may be covered by insurance.
Other types of reconstructive eyelid plastic surgery would include ptosis repair (surgery to elevate a drooping eyelid), tear duct reconstructive procedures for tear duct obstruction that is associated with constant watering of the eye(s), and removal of eyelid tumors, both benign and malignant. Positional problems such as entropion, a condition in which the edge of the eyelid rolls inward causing the lashes to rub against the eyeball, or the opposite, ectropion, in which the edge of the eyelid falls away from its contact with the eyeball resulting in tearing and redness, are two other examples of conditions that are corrected by oculoplastic surgery.
Why see an ophthalmologist for these conditions? Many people, when seeking plastic surgical procedures, will first think of a plastic surgeon, not an ophthalmologist, especially if the surgery is purely for cosmetic reasons. Most general plastic surgeons, however, are not trained in managing the ocular complications that can occur from these operations. Removal of too much skin, for example, during a blepharoplasty can result in the inability to fully close the eye during normal blinking. This can result in a serious dry eye problem. Ophthalmologists are trained in managing dry eye problems, and are also familiar with the intricate anatomy surrounding the eyes. Thus, an ophthalmologist, trained in oculoplastic surgery, is fully qualified to manage all these situations.
BOTOX is a medication that works by blocking nerve impulses to injected muscles. In 1989, Botox was first approved by the U.S. Food and Drug Administration for the treatment of patients with crossed eyes, eyelid spasms and partial facial muscle spasms. Ophthalmologists were the first to use Botox, and still use it frequently, for these conditions. In 2002, the FDA approved the use of Botox for treatment of severe wrinkles between the eyebrows (glabellar area). It has been used with great success treating forehead and "crows feet" wrinkles as well. Our practice has extensive experience with the usage of Botox for both medical and cosmetic purposes.
BOTOX is very safe and effective. Treatments take usually just a few minutes and involve injections with a very fine needle into specific muscles. Most patients experience little or no discomfort. The maximal effect of Botox takes about 3 - 7 days and will last three to four months, sometimes longer. Pregnant women or those who are breast feeding should not use Botox.