Oculoplastics Procedures

Botox Injections

Botox is the trade name for botulinum toxin. In its pure form, botulinum toxin is a poisonous neurotoxic protein that is found in certain spoiled foods and causes muscle weakness. It acts as a nerve impulse blocker, preventing muscles from contracting. In an extremely dilute form, botulinum toxin has many medical applications.

Botulinum toxin is used to treat ocular conditions such as blepharospasm, an excessive contraction of the eyelid muscles that forces the eyelids closed, and hemifacial spasm, an excessive contraction of the facial muscles on one side of the face. When the toxin is injected directly into the muscles of the face or the eye, it causes the overactive muscles to relax. It usually takes a few days for the therapeutic effects to be noticeable, and the injections may need to be repeated every four to six months.

Botulinum toxin also is used to treat certain kinds of double vision. The toxin is injected directly into the eye muscle opposite the paralyzed muscle.

Botulinum toxin can also be used for cosmetic purposes to soften wrinkles around the eye. It can also weaken the brow muscles in order to diminish the deep furrows or frown lines that may appear in the middle of the forehead.

Side effects of the injections are temporary. They can include a droopy upper eyelid, double vision, and being unable to close the eyelids.

Eyelid Surgery

Eyelid surgery is a common method of treatment for entropion (inward turning of the eyelid), ectropion (outward turning of the eyelid), ptosis (drooping of the eyelid), and some eyelid tumors.

Eyelid surgery is usually an outpatient procedure performed under local anesthesia. Risks of surgery are rare but can include bleeding, infection, and eyelid asymmetry due to uneven wound healing. Differences in healing between the eyes may cause some unevenness after surgery.

After eyelid surgery, bruising or a black eye is common but resolves quickly. It may be difficult to close your eyelids completely, making the eyes feel dry. This irritation generally disappears as you heal. Serious complications are rare but can include vision loss, scarring, and infection. To most people, the improvement in vision, comfort, and appearance after eyelid surgery is very gratifying.

Browlift Surgery

Sun, wind, and gravity affect the skin and muscles of the face over time. One of the most noticeable aspects of aging is the progressive drooping of the eyebrows. This can cause wrinkling of the forehead from raising one's eyebrows as well as vertical wrinkles or furrows between the eyebrows. Sometimes the eyebrows or excess eyelid tissue can obstruct vision.

A browlift (also called a forehead lift) elevates the brow, smooths forehead skin, and can remove vertical lines between the eyebrows. Incisions are made in inconspicuous places, either behind the hairline, in one of the forehead wrinkles, or immediately above the eyebrows. If an endoscope (a small tube with a fiber-optic light) is used, the incisions can be very small. After the muscles are tightened and excess skin is removed, the incision is closed with sutures. The operation is usually performed on an outpatient basis under either monitored anesthesia care (MAC) or general anesthesia.

Swelling and bruising, common after a brow- or forehead lift, begins to subside in seven to 14 days. Numbness and itching are common during the healing process. Sutures, staples, or clips are removed within seven to 14 days after the surgery. Incisions in the hairline may damage hair follicles and result in some hair loss.

Lacrimal Drainage Surgery

Keeping the eyes moist and healthy requires tears. Tears are produced in the lacrimal glands, some of which are located under the upper eyelid. Tears drain from the eye into the nose through the nasolacrimal duct, or tear duct.A blockage of this drainage duct can cause wet eyes or excessive tearing. A blocked tear duct can also cause mucus buildup in the eye or ongoing infections in the lacrimal sac where tears collect. Infections are noticeable as a swelling of the inner corner of the lower eyelid.

Nasolacrimal duct obstructions can happen with no obvious cause. Sometimes previous sinus or nose surgery, or facial trauma with broken facial bones, can obstruct the tear duct.

Lacrimal drainage surgery is called dacryocystorhinostomy (DCR) and can be performed in different ways. One type of operation is an external DCR where an incision is made on the side of the nose, where eyeglasses might rest. A small amount of bone is removed to permit a new connection between the lacrimal sac and the inside of the nose. Small plastic tubes are sometimes inserted at the time of surgery to help keep the newly created opening from scarring shut during the healing process. The tubing is removed a few months after surgery.

Another type of operation uses a special instrument called an endoscope. The endoscope is a small tube with a fiber optic light that facilitates the creation of a new opening into the nose. Various types of lasers have also been used to perform the DCR operation.

In extreme cases where the tear duct cannot be reopened or repaired, an artificial tear duct can be implanted. The artificial tear duct is called a Jones tube and is implanted behind the inner corner of the eyelid to drain tears into the nose.