Eyelid Surgery and Appearance Medicine

Oculoplastic Surgery

Your eyes need the surrounding eyelids and face to work well to function properly. And your eyes express who you are! There are a lot of good reasons to keep them looking and feeling good.

Surgeons, Adam Watson and Peter Ring at Eye Institute have specialised training in surgical and minimally invasive techniques to fix functional problems of the eyelids and upper face as well as the special knowledge and experience required to freshen and rejuvenate the area around the eyes.

Ptosis
Ptosis usually refers to a drooping of the upper eyelid – so that the eyelid tends to sit lower on the eye. Advanced eyelid ptosis may cause difficulties with vision but more commonly gives a sleepy or severe appearance (when the eyebrows need to be lifted to lift the eyelids) and tiredness and aching around the eyes, especially later in the day.

The cause of ptosis is usually an age-related sagging of the tissue that holds the eyelid up, but it may be congenital or be caused by nerve problems.

Ptosis repair is carried out under local anaesthetic with or without sedation, usually with no discernible scar, and can make a dramatic difference to appearance and function.

Blepharoplasty
Sagging or excessive skin and fat of the upper eyelids may give the eyes a tired or hooded appearance, and may even obstruct vision. And in the lower eyelids, it causes “bags” under the eyes. Blepharoplasty is the name given to the surgery that addresses these problems and it may be carried out on the upper eyelids, lower eyelids, or both.

Blepharoplasty leads to a freshened and more youthful appearance by carefully refashioning the skin and fatty tissue of the eyelids. It is performed under local anaesthesia, usually with sedation, as a day surgical procedure.

Upper eyelid blepharoplasty involves careful removal of excess eyelid skin, sometimes with underlying fatty tissue. The skin wound is largely hidden in the normal skin fold of the upper eyelid.

Upper eyelid blepharoplasty may be combined with a procedure to lift the brows for a more powerful effect. Brow lifting is carried out either via an internal approach (often through the upper blepharoplasty incision) or an external approach (removing skin and underlying tissue), depending on your individual needs.

Lower eyelid blepharoplasty may be carried out with a skin incision just below the eyelashes if there is excess skin. The incision usually heals well with an almost imperceptible scar. Otherwise, surgery may be carried out through the back of the eyelid (trans-conjunctival approach) leaving no visible incision.

Swelling and bruising usually take a few weeks to fade completely, helped by initial use of icepacks and other techniques your surgeon will discuss with you. Sutures are usually tiny and dissolving but may be removed by your surgeon.

Botulinum Toxin
Commonly known as Botox®, this minimally invasive treatment is excellent for diminishing facial lines and wrinkles that are brought on by muscle activity.

Common areas for treatment are frown lines between the brows, forehead lines and crows’ feet. Treatment takes only a few minutes and doesn’t require anaesthesia and the effect lasts for about 4 months.

This is a great way to achieve a relaxed, rested look. Botox® is also effective for the treatment of involuntary eyelid twitches and blinking that may interfere with vision.

Facial Fillers
A filler is an injectable, natural gel that fills out fixed furrows and creases that are present even when the facial muscles are relaxed. Hence a filler will tend to have a complementary effect with Botox®. Fillers work to smooth contours and plump up areas where tissue volume has been lost. Typical fillers include collagen and hyaluronic acid (Restylane®). The effect is reversible and lasts between 6 and 18 months. Treatment is usually carried out after application of ananaesthetic cream.

Both Botox and fillers may be useful adjuncts to eyelid and brow surgery to give the best possible outcome.

Ectropion, Entropion and Misdirected Eyelashes
Occasionally as we age, the eyelids become unstable, turning either inward (entropion) or outward (ectropion). Entropion is very uncomfortable due to eyelashes rubbing on the eyes. Ectropion gives eyes a constantly red-rimmed appearance and is associated with watering and discomfort.

Both are readily corrected with surgery, carried out under local anaesthetic as a day procedure.

In addition, it is not unusual for a few eyelashes to grow the wrong way, irritating the eye and requiring removal to obtain relief. If the eyelashes grow back repeatedly, still causing trouble, permanent surgical removal can be carried out with a short surgical procedure. Techniques include radiofrequency electrosurgery, cryotherapy and excision.

Skin Tumours
The eyelids are one of the commonest sites on the face for the development of both benign sunrelated “lumps and bumps” and skin cancers. Early recognition and treatment of these problems is desirable. Surgery to remove these often requires specialised techniques to restore both good function and appearance to the eyelids. Eye Institute’s oculoplastic surgeons have great experience in this type of surgery.

Watering Eyes
There are many different possible causes for watering eyes. The first question to answer is whether your eyes are producing too many tears, or whether they can’t drain a normal volume of tears adequately.

The first problem, tear over-secretion, is usually caused by irritation or inflammation of the surface of the eye. Oddly, a dry eye problem can sometimes cause watering of the eyes – the dry surface of the eye becomes irritated causing reflex excess tear production. Eyelid inflammation (blepharitis) and an unstable tear film can also cause this. Medical treatment using drops, hot eyelid compresses and, sometimes, oral medication usually help this.

The second problem, poor tear drainage, may also have a number of causes. Examples are a blocked tear drainage duct, narrow or displaced tear drainage openings (puncta), or lax eyelids causing the normal tear drainage “pump” (usually activated by blinking) to fail. The treatment for these types of problems is usually surgical.

One of the commoner surgeries is a dacryocystorhinostomy (DCR). This operation involves making a small skin incision on the side of the nose and creating a bypass for the blocked tear drainage pathway. It is usually carried out under local anaesthetic with sedation provided by an anaesthetist as a day procedure. Other surgery may be aimed at widening the tear duct openings or tightening the eyelids.

Prevention
Many of the problems discussed here could be avoided, minimised or delayed with simple daily attention to sun protection. Not only skin tumours arise from many years of sun exposure. Facial wrinkles, blotchy skin pigmentation and eyelid ectropion are also largely caused by long term sun exposure. Regular, daily use of a UV-blocking moisturiser and sunglasses are sensible measures to preserve the health and good looks of your eyelids and face.

In addition, other sensible measures include:

• not smoking
• a balanced diet including good quantities of fresh vegetables
• drinking generous quantities of water daily
• adequate sleep

Eye Institute’s doctors Adam Watson, Peter Ring and team look forward to discussing your eyelid and upper face problems with you. We’ll help you find the best solution. To make an appointment, or to find out more information, fill out our enquiry form, or contact Eye Institute's friendly team on free phone 0800 393 527.



Affiliated provider benefit to Cataract Patients
- no need for prior approval
- no money up front for surgery
- Southern Cross pays us directly