What is oculofacial plastic surgery?
Oculofacial plastics is a specialized form of surgery that focuses on aesthetic and reconstructive aspects of the face, eyelids, the brow, orbital bones, tear duct system, and nose. There are only 500 worldwide physicians that specialize in this field. The main organizing body for oculofacial plastic surgery is the American Society of Ophthalmic Plastic and Reconstructive Surgery, which credentials only a handful of fellowship training programs. About 20 surgeons are trained each year in this field. These surgeons are meticulously trained in aesthetic and reconstructive facial surgery during their 2 year fellowships.
What types of conditions do oculofacial plastic surgeons treat?
Oculofacial plastic surgeons perform eyelid procedures such as repair of droopy eyelids, repair of orbital and facial bone fractures, repair of blocked tear ducts, removal of tumors around the eye and on the face, and rejuvenation procedures such as eyelid lifts, brow lifts, facelifts, liposuction, eyelash transplants, nasal reshaping, and laser resurfacing. They also perform minimally invasive procedures such as Botox® and fillers (Restylane, Juvederm, Perlane, Radiesse, Sculptra, Elevess, Evolence).
Extra Upper Eyelid Skin and/or Fat
The thin skin of the upper eyelids can stretch, causing this area to look wrinkled with hanging skin (dermatochalasis). An upper blepharoplasty or “eyelid lift” is required to improve the appearance of loose upper eyelid skin. READ MORE ABOUT UPPER BLEPHAROPLASTY HERE
Lower Eyelid Bags
Lower eyelids may show the appearance of dark circles, loose skin, bulging fat, and shadows with age. These are often the result of aging changes in this area. Treatment includes several options including lower blepharoplasty (eyelid lift), fat shifting or transfer, injectable fillers, and laser resurfacing. READ MORE ABOUT LOWER BLEPHAROPLASTY HERE
Droopy Eyelids (blepharoptosis)
This condition is characterized by an upper eyelid that rests in a low position, often interfering with vision. This is corrected with a blephoroptosis or “ptosis” repair which often involves lifting or repairing a separation in the eyelid muscle and its tendon (levator resection, levator advancement, levator reinsertion, conjunctivomullerectomy, frontalis sling). READ MORE ABOUT BLEPHAROPTOSIS HERE
Droopy Brows (Brow Ptosis)
With age, the brows may assume a lower than desired position. This can contribute to a tired appearance and excess skin in the upper eyelid region. It may even interfere with vision. Correction of a mildly low brow can be accomplished with injections of botulinum toxin which creates lift. Reinflation of a deflated brow with injectable fillers or fat will lift a sunken brow. More significant brow droop is improved with a browplasty or brow lift. There are several approaches to surgical brow lifts including an open brow lift (bicoronal lift) and a small-incision (endoscopic type) brow lift. Implants or bioadhesive may be used to maintain the improved brow position. READ MORE ABOUT BROW LIFTS HERE
Malpositioned Lower Eyelids (Ectropion and Entropion)
Some people will experience lower eyelids that are turning outward or inward. This may occur due to aging, stretched tissues, or scarring from previous injuries or surgeries. Correction of these problems involve skin and tendon repositioning (canthoplasty, canthopexy, retractor reinsertion, lid shortening, lid rotation), and in rare cases, the placement of a skin, cartilage, or mucosal graft.
Watery eyes or tearing can have multiple causes which include dry eyes, irritation, and blockage of the tear duct. To improve this condition, the underlying cause must be addressed. This can be as simple as the application of artificial tear drops, or can be complicated as in tear duct blockage repair. Surgery of the tear duct may involve a tear duct bypass procedure (dacryocystorhinostomy) or the placement of a glass bypass tube (Jones Tube) from the inner corner of the eyelids to the inside of the nose (conjunctivodacryocystorhinostomy).
The eyelids may be damaged or partially removed as a result of trauma or skin tumor removal. Reconstruction is performed by using nearby skin and tissues from the patient’s own body (tarsal flap, Hewes procedure, Tenzel flap, etc). Eyelid “borrowing procedures” may be used (i.e. Hughes procedure or Cutler-Beard procedure), using portions of the patient’s own normal eyelids. Two-stage procedures are sometimes utilized, completing the reconstruction in more than one step. The result is often very natural and aesthetically pleasing.
Facial and Orbital Bone Fractures
Traumatic injuries can cause breaks in the bones of the face, the nose, and around the eyes. These are identified with x-rays or CT scans. In many cases, mini-plates, implants, and/or titanium microscrews may be used to re-align shifted bones and restore a normal appearance.
Benign and malignant tumors may occur within the bony orbit surrounding the eye or on the eyelids and skin around the eyes. Treatment may entail biopsy of the lesion and tumor removal or other tumor therapies. Reconstruction may be necessary to restore the original function of the structures involved.
Thyroid Eye Disease
Thyroid disease can affect the eyes and the surrounding structures. Common thyroid eye problems include bulging eyes (exophthalmos), lifted upper eyelids (eyelid retraction), double vision (diplopia), and severe dryness. A variety of treatment options exist ranging from artificial tear drops to oral medications and surgery of the eyelids and orbit. The aggressiveness of the treatment reflects the severity of the disease.
The eyelids may spasm or twitch uncontrollably in patients for unknown cause. This is termed “essential blepharospasm”. Treatment requires denervation of the orbicularis oculi muscle that acts to close the eyes. Chemodenervation is the most common therapy, which used botulinum toxin to relax the muscles in spasm.
Frown Lines and Wrinkles
Lines and wrinkles that form as a result of frowning, sun damage, and aging can be treated with minimally-invasive procedures. Botox® and fillers are exceptionally effective at wrinkle reduction when performed by an oculofacial expert. Newer techniques include GFX™ or Relaxed Expressions™, a radiofrequency device that silences nerves that cause muscles to frown in precise areas. Laser resurfacing, intense pulsed light, photodynamic therapy, and radiofrequency skin tightening all work to rejuvenate the face with great accuracy. Each of these treatments works in different ways to target fine and deep lines, brown spots, red spots, large pores, and skin textural changes. A consultation with an oculofacial plastic surgeon will help in selecting the appropriate treatment modality.
Laser liposuction reduces areas of fat that do not disappear with diet and exercise. The laser has been proven to minimize the downtime after the procedure by coagulating blood vessels and reducing bruising. After melting fat with the laser, a small tube is used to gently suction the fat cells. The neck and jowls respond well to laser liposuction, among other areas.
Loose neck and jowls
With age, the neck and facial muscles become lax, and the fat compartments of the face deflate, leading to a weary appearance. A long-term solution is a lower face and neck lift (rhytidectomy and platysmaplasty) which elevates the muscles of the face (SMAS) and redrapes the skin in a more desired position.