Oculoplastic Surgery, also known as Ophthalmic Plastic and Reconstructive, Oculofacial or Eye Plastic Surgery, is a surgical subspecialty of Ophthalmology that deals with the medical and surgical management of deformities and abnormalities of the eyelids, lacrimal (tear) system, orbit (bony socket) and the adjacent face. An Oculoplastic Surgeon is an Ophthalmologist (medical doctor and eye surgeon) who has completed additional advanced training in plastic surgery as it relates to the eyes and surrounding structures.
Below are the different areas of Oculoplastic Surgery that Dr Phil Peirce specializes in :
The folds of skin and bags around the eyes are removed and smoothed out. Although this is often done for cosmetic and aesthetic reasons, these folds and bags can interfere with the function of the eyelids and can interfere with vision, by blocking the vision to the top and the sides.
These bags can be removed in order to reduce the weight of the eyelids and improve eyelid and visual function.
The bags are typically caused by orbital fat prolapsing forward. In the past this fat was removed, but with modern techniques the fat is re-draped giving a smooth and fresh appearance without the associated hollowed out look around the eyes, which tends to get worse as ageing progresses. If the bags are particularly severe, a combination of excision and re-draping is used. The international trend in Blepharoplasty surgery is strongly against excision of fat and towards re-draping of fat. Dr Peirce advocates and uses this approach.
The surgery is typically done in a sterile operating environment under sedation or general anaesthesia. Sutures are left in for 10 to 12 days and bruising typically lasts 7 to 10 days.
Blepharoptosis means a droopy upper eyelid. Children can be born with it, or it can develop in later life due to the ageing process, injury, severe or continuous swelling of the eyes, manipulation of the eyelids as in contact lens wearers, or rubbing, or a disease process affecting the nerves or muscles of the eyelid. The cause can usually be determined at the first consultation.
No matter the cause, the droopy eyelid can almost always be improved with surgery. Depending on the severity and cause of the droopy eyelid, surgery may involve repositioning or strengthening of one of the muscles of the eyelid, or utilising other muscles to elevate the lid.
In adults, this surgery is performed under sedation with sutures being left in position for 10 to 12 days, and bruising and swelling typically lasting 10 to 14 days. Some patients may require a second operation to obtain the best possible eyelid position and shape.
Certain types of thyroid disease, typically Grave’s disease, can profoundly affect the appearance and function of the orbit and eyelids. This can include protrusion of the eye itself (exophthalmos), eyelid retraction affecting the upper or lower eyelid, and puffiness and swelling of the eyelids. This can severely alter the appearance of the face and eyes, as well as potentially causing discomfort of the eyes due to exposure. This can also be vision threatening, with associated scarring of the corneas or optic nerve compression.
Many surgical procedures are possible to either save the sight, or improve the comfort and appearance of the eyes. These range from orbital decompression, to allow the eyes to become less protruding and to relieve pressure on the optic nerve, to strabismus surgery, to improve double vision or eyelid surgery to reduce exposure and improve the aesthetic appearance. It is important that these procedures are carried out in a step wise fashion and in the correct order to achieve optimal results.
Facial palsy may be temporary as in Bell’s palsy, or be permanent due to damage of the facial nerve as in a stroke or certain tumours or surgical procedures. As far as the eyes are concerned, this results in an inability to adequately close the eye, drooping of the lower eyelid, brow ptosis and watering of the affected eye.
Many procedures are possible to improve the function and appearance of the eye, from simple tightening procedures, to elevation of the brow and insertion of gold or platinum weights in the upper eyelid to assist in closure.
An Ectropion is when the lower eyelid droops down and away from the eye itself. A good position of the lower eyelid is essential to protect the eye from exposure, which can cause discomfort, pain, redness and watering of the eye.
Droopiness of the lower eyelid can occur as part of the aging process, with laxity of the tendons which hold the lid in position. It can also be caused by sun damage to the skin of the cheek, or an injury to the eyelid or skin beneath the lid.
A droopy lower eyelid should be surgically repaired to enable the lid to protect the eye adequately and improve the aesthetic appearance.
The most common eyelid cancers are the skin cancers, basal cell carcinoma (rodent ulcer) and squamous carcinoma.
These tend not to spread elsewhere in the body and usually do not cause sickness or death. However, they do destroy the tissues around them, and can destroy the eyelids or the eye itself. It is essential that any cancerous growth around the eyelids is treated as early as possible.
Depending on the size of the cancerous growth, the eyelid can be reconstructed with simple sutures or by one of numerous reconstructive techniques. In almost all cases it is possible to achieve a functional, comfortable eyelid, that has an aesthetically pleasing appearance with good eyelid position and shape.