Cosmetic Eye Surgery

Botox for Blepharospasm

Blepharospasm is a condition in which one or both eyelids spasm forcefully and uncontrollably closed in repeated fashion. This involuntary closure of the eyelids may sometimes even result in temporary loss of vision. The cause of blepharospasm is unknown. Botox injections, when administered in tiny dosages by injection in the upper and lower eyelids of the involved eye, may result in effective resolution of the condition. The effect of the treatment usually begins in 1 to 14 days and lasts for 3 to 6 months. Repeat injections may be required every 3 to 6 months depending on recurrence and severity of the condition.

Botox for Hemifacial Spasm

Hemifacial spasm is a condition which involves spastic contractures of one half of the face that are forceful, uncontrollable, and may be agonizing to the afflicted. Hemifacial spasm may be due to vascular compression of the facial nerve or an intracranial tumor and, therefore, neuroimaging is often considered.

Treatment of hemifacial spasm may include surgery for the underlying cause, selective ablation of branches of the facial nerve, or Botox injections. The Botox injections would certainly be considered appropriate symptomatic treatment (for hemifacial spasm) if an underlying cause cannot be found or is otherwise not treatable. The Botox injections may be given in select locations of the face with a tiny needle; retreatments are typically required every 3 to 6 months.

Functional Eyelid Surgery

Botox for Facial Wrinkles

Botox has more recently been found to have application in the treatment of facial wrinkles as well. It is especially useful for wrinkles adjacent to the eyes and in the forehead. Tiny doses of Botox are administered with a very fine needle in the areas of concern, often alleviating the wrinkles for about 3 to 6 months. This alternative is a welcome one to many individuals who have concerns about more invasive cosmetic surgical procedures

Ptosis Surgery

In most cases, a drooping upper eyelid results from aging of previously normal structures. Typically, the tendon that attaches the "lifting" muscle to the eyelid stretches and the eyelid falls too low.

Since the muscle that lifts the eyelid has normal strength, surgical correction of a drooping upper eyelid that was once normal involves repairing the stretched tendon. Causes of the droopy eyelid may be damage to nerves that direct the muscles that lift the eyelid, or the muscle itself. Occasionally a rare condition that affects the connection between the nerve and the muscle may cause intermittent droopiness.

When a droopy eyelid is causing problems with vision, such as limitation of the top part of your visual field, or even blocking the central vision when the pupil is covered, treatment may become necessary. Other reasons for treatment may be cosmetic.

The surgery aims to correct the top eyelid position to a desired level. This is not always possible as there may be factors that will prevent a safe lifting of the eyelid. That is why it is important to assess before the operation what level of the eyelid will not result in major eye problems. The operation is normally done with a local anaesthetic, sometimes with mild sedation.

Most of the time it is possible to shorten the tendon of the muscle that lifts the eyelid, but sometimes it will be necessary to "connect" the eyelid indirectly to the eyebrow to enable the eyelid to be lifted.

Ectropian Repair

An ectropian is an outwardly turned eyelid. The condition most often is associated with ageing, though it may also occur congenitally, as a result of scarring or other surgeries, or secondary to facial nerve paralysis (Bell's palsy). If not repaired, the condition may lead to thickening of the mucosal surface on the inside of the eyelid (conjunctiva) with consequent inflammation of and danger to the health of the eye itself.

Usually only a few stitches are placed in the skin at the lateral corner of the eye, and these are often removed 7 to 14 days later. There is typically almost immediate resolution of the condition. Most patients have little if any discomfort with the procedure. There may be mild bruising and swelling following the procedure. This should resolve within about two weeks.

Entropion Repair

An entropion is an inwardly turned eyelid. The condition occurs primarily as a result of advancing age with consequent weakening of certain eyelid muscles. The imbalance between eyelid muscle groups results in the inward turning of the eyelid. The condition almost always affects the lower, rather than the upper, eyelids.

Repair of involutional entropion (associated with ageing) may be completed with a variety of procedures. Most cases are completed with an incision in the lateral corner of the eye or an incision just beneath the lower eyelashes. In either case, a tightening of tissues is required to resolve the imbalance between the muscle groups of the lower lid.

Most patients experience immediate resolution of the problem once surgery is completed with little if any post-operative discomfort. Most cases will require subsequent removal of sutures located along the lower eyelashes or the lateral corner of the eyelid. Minor bruising or swelling may be expected and will likely resolve in one to two weeks following surgery.

DCR (Dacryocystorhinostomy) for Tearing

When an individual develops tearing due to acquired obstruction of the nasolacrimal (tear) duct which normally drains away the tears, a DCR procedure is usually offered. However, diagnosis of the condition must be made first, and this usually requires one or more in-office tests by the ophthalmologist, which usually involves a diagnostic irrigation of the tear drainage pathways which involves placing a small, blunt irrigating syringe just inside the initial opening of the tear duct, and irrigating fluid (water or saline) through the tear drainage system. If the nasolacrimal duct is determined to be relatively or completely obstructed, a DCR procedure is often appropriate.

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