What is it?

Oculoplastics is the ophthalmic sub-specialty which deals with surgery around the eye socket, eyelids, skin around the eyes, and tear ducts. Some types of oculoplastic surgery are considered both medically necessary and can be covered by your Medical Services Plan. Some of these procedures are routinely done in-office, whereas some are done in a hospital. Your oculoplastic surgeon will discuss these options with you and determine which is best suited for your case.

Procedures we offer

Ptosis surgery

Ptosis is a drooping or sagging of the upper eyelid, which may affect one or both eyes. It is most common in older people, although it can occur as a congenital or birth defect, or as a result of an eye injury or disease. At its most severe, ptosis can obstruct vision, as the upper eyelid sags so much that it begins to cover the pupil. Many people with severe ptosis find themselves tilting their heads back to speak. Ptosis can also cause tiredness and aching around the eyes, as the eyebrows are constantly lifted in order to see properly. To examine the eyelid your doctor will look at the center of the pupil and how it relates to the upper eyelid called the marginal reflex distance. When it’s below a certain level Ptosis surgery may be performed. Ptosis surgery is performed by an ophthalmologist who specializes in eyelid surgery. During surgery an incision is made in the eyelid and the levator muscle. The levator muscle is then reattached with small stitches at the desired height. The skin is then closed with fine stitches that are usually removed after 7-12 days.

Blepharoplasty

Blepharoplasty includes surgery to repair droopy eyelids that may involve removing excess skin, muscle and fat. As you age, your eye lids stretch, and as a result, excess fat may gather above and below your eyelids, causing sagging skin of the upper lids and bags under your eyes. Besides making you look older, severely sagging skin around your eyes can reduce your side vision (peripheral vision), especially the upper and outer parts of your field of vision. Blepharoplasty can reduce or eliminate these vision problems and make your eyes appear younger and more alert.

MSP coverage may depend on whether the surgery repairs a condition that impairs vision. If you have the surgery only to improve your appearance, the cost will not be covered by MSP. Our staff will book a special visual field test for you that is done in our office to determine whether or not you will be eligible for MSP coverage.

How is the recovery from surgery?

Patients usually have a short recovery time after blepharoplasty. Although bruising and swelling is usually worse on the day after surgery, this typically resolves within 7-10 days. During the first 48 hours, the use of cool compresses can greatly reduce discomfort, bruising, and swelling around eyes and face. The stitches remain in the skin for about 7-10 days. Most people return to normal activity after 7-10 days following blepharoplasty, and by 2 weeks most of the bruising and swelling will be resolved. There is often a worsening of dry eye symptoms after surgery, and lubrication drops may be required. Some residual eyelid asymmetry and droopiness is common.

What to expect during your procedure?

Blepharoplasty is usually done in our office. Your surgeon will inject numbing medication into your eyelid, so the rest of the procedure will be pain-free. If you have surgery on your upper and lower eyelid, the surgeon generally works on your upper lids first. Your surgeon will make an incision along the fold of the eyelid, remove some excess skin, muscle and fat, and finally close the incision. On the lower lid, the surgeon makes an incision just below the lashes or inside the lower lid. Your surgeon removes or redistributes excess fat, muscle and sagging skin, and closes the incision. Blepharoplasty usually takes less than one hour, depending on the amount and location of tissue being removed.

After surgery you may temporarily experience:

Blurred vision from the lubrication ointment applied to your eyes
Watering eyes
Light sensitivity
Double vision
Some pain
Redness where the cuts were made
Puffy, numb eyelids
Swelling and bruising similar to having “black eyes”

Entropion & Ectropion surgery

**Entropion** is a condition in which your eyelid turns inward so that your eyelashes and skin rub against the eye's surface. This causes irritation and discomfort.
When you have entropion, your eyelid may be turned in all the time or only when you blink hard or squeeze your eyelids shut. Entropion is more common in older adults, and it generally affects only the lower eyelid. **Ectropion** is a "turning out" of the eyelid. Typically occurring on the lower eyelid, the skin of the inner lid is exposed, either in one section of eye or across the entire lid. This prevents tears from draining from the eye correctly, resulting in irritation. Common causes of ectropion include age-related weakening of the connective tissue around the eye, sun damage, tumors, burns and the removal of too much skin during blepharoplasty. An operation is usually needed to fix an entropion or ectropion. The surgery lasts between 45 to 60 minutes and is performed with “freezing injections” (local anesthesia) with or without sedation as a day procedure. This operation will involve tightening of the lower lid, which will correct the lid laxity.

Botox injections

Botulinum toxin has found numerous uses in medicine. Botox blocks signals from the nerves to the muscles. The injected muscle can no longer contract, which causes the muscles to relax. This agent has become the treatment of choice for a number of movement disorders, and has been advocated for many other conditions such as:
- Aesthetic reduction of facial wrinkles
- Blepharospasm
- Oromandibular Dystonia
- Meige Syndrome
- Hemifacial Spasm
- Apraxia of Eyelid Opening
- Treatment of Tics, Tremors, and Myokymia
- Facial Nerve Synkinesis
- Strabismus
- Headache Syndromes
- Hyperhidrosis and Lacrimal Hypersecretion Syndromes
- Eyelid Retraction
- Spastic Entropion