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eyelid surgery melbourne eyelid surgeon melbourne

Eyelid Surgery

  • Blepharoplasty (excess upper eyelid skin reduction)
  • Ptosis (droopy eyelid surgery)
  • Ectropion (lower eyelid turning out)
  • Entropion (lower eyelid turning in)
  • Tear duct surgery
  • Botulinum toxin (Botox) for facial and eyelid spasm

  • About
  • In House Procedures
  • Post Operative Information
  • Faq

About

Introduction

dr pakrou oculoplastic surgeon melbourne

What is an Oculoplastic Surgeon?

An Oculoplastic surgeon (sometimes called an ophthalmic plastic and reconstructive surgeon) is an eye surgeon (ophthalmologist) who has further specialised in various types of eyelid and upper facial plastic surgery.

As Dr Pakrou is an Oculoplastic surgeon, he has extensive knowledge of, and experience with the delicate anatomy and function of the eyelids and surrounding structures. Prior to performing eyelid plastic surgery, Dr Pakrou will request an initial consultation where a thorough assessment and examination of the health of the eyes and the function of the eyelids will be undertaken.

Dr Pakrou is a dedicated eyelid plastic surgeon and understands and can manage potential risks and complications to both the eyelid and the eye itself.

Procedures that Dr Pakrou commonly performs:

  • Upper eyelid blepharoplasty – removal of excess upper lid skin and fat (blepharoplasty procedure)
  • Lower eyelid tightening/blepharoplasty.
  • Ptosis surgery (droopy upper eyelids)
  • Ectropion repair (eyelid turned out away from the eyeball)
  • Entropion repair (eyelid rolled in towards the eyeball)
  • Removal of benign and malignant eyelid tumours and lesions
  • Botox treatment for blepharospasm (eyelids blink too often)

Blepharoplasty (excess upper or lower eyelid skin reduction)

blepharoplasty surgeon melbourne

Changes in the appearance of the eyelids is said to be one of the first noticeable signs of aging. The skin of the eyelid is very thin in comparison to the rest of the face. In the upper lid, this can result in drooping skin above the eyelashes which in severe cases overhangs the eyelashes. This can affect vision or cause irritation or a feeling of constant eye fatigue. In the lower lid these changes can result in bags and folds under the eye resulting in a “tired” look.

Excess eyelid skin and/or fat removal is referred to as blepharoplasty. Whilst it is often a cosmetic procedure, in cases where the upper lid skin overhangs the lashes and/or starts to affect the vision, it can be considered a medical procedure.

In such cases your health fund and Medicare may provide assistance with the cost of having a blepharoplasty procedure. Lower eyelid skin and fat removal is almost always considered cosmetic. It involves removing excess skin and fat and sometimes redistributing the fat to help fill out hollows.

blepharoplasty upper eyelid surgery
Bilateral upper eyelid skin obstructing vision and overhanging eyelashes
pictures after upper eyelid surgery
2 weeks post upper eyelid reduction surgery

Who performs a Blepharoplasty?

These procedures are frequently performed by eye surgeons specialising in plastic and reconstructive surgery (oculoplastic surgeons). General plastic surgeons can also perform such procedures.

How safe is Blepharoplasty?

Whilst any surgery carries potential risks, eyelid reduction performed by an oculoplastic surgeon is considered very safe.

Complications such as infection, marked scarring, or eye ulcers due to inadequate eyelid closure are considered most serious, but are very rare. Slight wound ooze, bruising, swelling and mild scar thickening are normal and will mostly resolve over 2-3 weeks. More subtle swelling and scarring can take several more months to improve. Noticeable asymmetry is rare and may require further surgery.

Vision may be blurred for several days and the eyes can feel irritated and dry for several weeks. Regular lubricants are advised and will help.

General recommendations

Follow the below steps to maximise your chance of a smooth recovery following eyelid surgery:

melbourne blepharoplasty
  • Rest for the first 24 hours after surgery.
  • Use your eyedrops/ointment as prescribed.
  • Cold compresses can be used for 10 minutes every two hours for the first two days.
  • Apply antibiotic ointment to the wounds and sutures for one week.
  • Avoid swimming for two weeks.
  • Do not smoke for at least three weeks.
  • Sleep in an elevated position, using an extra pillow for at least one week.

Ptosis (droopy eyelid)

What is Ptosis?

Ptosis refers to droopy eyelids, as opposed to excess skin hanging down. However, ptosis and sagging skin from above the eyelid can coexist. Ptosis can affect vision, particularly when reading, and can be unsightly, leading to embarrassment. Some patients report headaches and eyebrow ache due to the constant strain on raising the brows to try to hold the lid up.

Ptosis is classified in many ways, based on a variety of characteristics. It can be congenital or acquired in adult life.

Most commonly it is age related, and due to a weakening and stretching of the upper eyelid supporting tendons and muscles. More rarely, it can be due to muscle or nerve conditions, or due to a mass or tumour pressing down on the eyelid. Long-term contact lens wear is another cause.

ptosis eyelid surgery
Left upper eyelid droop
post upper eyelid ptosis surgery
Post upper eyelid ptosis surgery

Surgery for Ptosis

Surgery is generally considered if the eyelid droops more than 2 mm from its normal position. It is considered severe and visually disruptive if it covers the pupil.

Ptosis surgery involves shortening and tightening the muscles or ligaments that raise the lid. A small incision is made along the upper eyelid within the natural crease. The muscle and tendon is tightened to hold the lid in the correct position. Any excess upper eyelid skin is removed to make sure it does not hang over the eyelid in the future.

How safe is Ptosis surgery ?

About 85% of patients have a great result with a single operation, but ptosis surgery is technically challenging. Due to individual variations, there is no guarantee of success. About 15% of patients may require a second operation to improve the position of the eyelid. The droopy eyelid can also reoccur at any time in the future, and may require further surgery.

eyelid surgery complications

Complications of Ptosis surgery

Other complications can include:

  • Infection
  • Bruising and swelling of the eyelids
  • One lid higher or lower than the other
  • Eyelid being too high or too low
  • Alteration to the curve of the eyelid
  • Inability to close the eye after surgery
  • Worsening of dry eye symptoms.

Ectropion (Lower eyelid turning out)

What is an Ectropion?

An ectropion is a turning out of the lower eyelid resulting in poor drainage of tears. It can produce an irritated eye and a chronically “red and raw” looking lower lid. If the eyelid has been turned out for a long period the opening to the tear duct can close over. This can exacerbate the watery eyes.

what is an ectropion

What causes it?

Age related weakening of the lower eyelid support structures, as well as stretching and laxity is the most common cause. There is often associated sun damaged and thickened lower lid skin, which contributes to the pulling down of the eyelid.

Scarring of the lower eyelid and upper face area. This can also pull down on the lower eyelid causing it to turn out. This can occur following facial surgery or other scarring conditions.

Treatment & Surgery?

If left untreated, there is a risk of eye infections and chronic conjunctivitis due to poor tear drainage. The eyes can also look red, be watery and feel irritated and sore. Surgery involves shortening and tightening the eyelid and strengthening the support structures of the lower eyelid. In severe cases a skin graft may be needed to address the scarred skin. If the opening to the tear duct has closed over, it can also be fixed as part of the same operation.

ectropion surgery melbourne

Complications

Other complications can include:

  • Infection
  • Bruising and swelling of the eyelids
  • One lid higher or lower than the other
  • Eyelid being too high or too low
  • Alteration to the curve of the eyelid
  • Inability to close the eye after surgery
  • Worsening of dry eye symptoms.

Entropion (Lower eyelid turning in)

What is an Entropion?

An entropion is the rolling inward of the eyelid margin, usually the lower lid. This can result in the eyelashes contacting the surface of the eye (cornea). If this occurs, the eye will become chronically irritated, sore and watery.

what is an entropion

What causes Entropion?

Age related weakening of the lower eyelid support structures, as well as stretching and laxity is the most common cause.

Scarring diseases of the thin lining on both the inner eyelids and surface of the eye ball (otherwise known as the conjunctiva), are a much rarer cause.

How is Entropion treated?

If the eyelashes are scratching the cornea, intervention is required as soon as possible. This is done to relieve the discomfort associated with an entropion but also to reduce the risk of corneal infections and/or scarring, and possibly even blindness.Surgery involves shortening and tightening the eyelid as well as re-attaching the loosened support structures back onto the eyelid margin.

entropion surgery melbourne

Timing of surgery

If for any reason surgery cannot be performed in a timely manner, temporary measures can be tried, such as:

  • Temporary sutures to turn the eyelid out (can last 4-6 weeks)
  • Botox injections to weaken the outer eyelid muscles to help rotate the eyelid out (typically lasts 3 months)
  • Regular lubricants 3-4 times a day and ointment at night.

Possible complication of surgery?

Risks during and after surgery are low.

Main risks include:

  • Postoperative infection
  • Bleeding and bruising
  • Scarring of the eyelids.
  • Over or under correction
  • Irregularity between the eyelids

Most complications can be managed and corrected. A second operation may rarely be required. The risk to eyesight is very low.

entropion complications
How an eyelid should look when unaffected by an entropion

What is Botox?

Botox™ is a purified toxin that is used to weaken muscles by blocking nerve impulses transmitted from the nerve endings of the muscles. It is delivered by an injection to the overacting muscles.

what is botox

What is Botox used for?

Botox can be used on the face to temporarily treat:

  • Blepharopspasm (squeezing of eyelids)
  • Hemifacial spasm
  • Excessive tearing
  • Facial twitch
  • Enhancing facial aesthetics (reducing crow’s feet and frown lines).

Botox for Blepharospasm

Blepharospasm is involuntary spasms of the muscles around the eye. Early symptoms can include irritation and discomfort of the eyelids, increased blinking, dry or watery eyes, as well as light sensitivity.

With time it can progress to uncontrolled blinking, narrowing, and even complete closure of the eye. It can be a severely debilitating and embarrassing condition, which affects quality of life. We do not know the exact cause of blepharospasm. Botox for blepharospasm is partially covered by Medicare.

botox for blepharospasm

How Botox is administered?

  • The injection site will vary, depending on the problem areas.
  • No anaesthesia is required.
  • The surgeon cleans and marks the site of injection.
  • You can resume activities immediately.
  • Maximum effect is seen at 2 weeks post injection and can last for 3-4 months.

Botox for aesthetic purposes?

Botox can be used as a non-surgical, cosmetic treatment for moderate/severe frown lines. It has also proven to be a safe and effective treatment for wrinkles.Medicare does not contribute to the cosmetic use of Botox.

Contraindications to Botox

Do not have botox treatment if you:

  • Have an infection where botox will be injected
  • Are allergic to any of the ingredients
  • Are pregnant or think you might be pregnant
  • Have a neurological disorder (eg. Myasthenia Gravis)

botox contraindications

In House Procedures

In-house procedures and surgeries

Many procedures can be performed in our purpose built procedures suite on site. In most cases if a private health insurance provider does not cover your procedure in a day hopsital, you will save a considerable amount by choosing to have the surgery performed on site. Local anaesthesia is used to minimize discomfort.

Dr. Pakrou will discuss your potential suitability for an in-house procedure during your consultation.

Post Operative Information

Post Operative Information

Minor (lumps & bumps) Eyelid Surgery

eyelid surgery aftercare

Aftercare Post Minor Procedures

What to expect and what you can do after your procedure.

  • Rest or take things easy after your procedure for at least 24 to 48 hours.
  • You may have minor discomfort after surgery. There may also be some ache or tightness of the eyelids.
  • Remove your eye pad the following morning after the procedure, or follow your doctor’s instructions (if applicable).
  • Use half a cup of cooled, boiled water and cotton balls to clean the eyelids if necessary.
  • You can use 3–4 drops of a newly opened eye lubricant to help flush out and clear the eye surface.
  • If you are experiencing pain, take regular paracetamol as per the package instructions. Also, try applying a cool compress (for example, pre-wetted and fridge-chilled face towels), or frozen peas in a zip-lock bag wrapped in a clean cloth.
  • Cool compresses will help to reduce oozing, bleeding, swelling and bruising. These can be applied for 10–15 minutes every 2 hours for 48 hours.
  • Most swelling resolves over 3–4 days. Discoloration and bruising will diminish gradually over 7–10 days.
  • Occasionally, swelling may lead to incomplete eyelid closure for a few days. This will resolve as swelling diminishes. If this occurs, use lubricant eye drops 3–4 times a day and a gel/ointment into the eye before going to sleep.

General recommendations

Simple steps to relieve discomfort and minimise swelling and bleeding and speed up the recovery process:

  • Use Your Eyedrops or lubricants to help ease any discomfort or irritation (if prescribed).
  • If given an antibiotic ointment, gently apply this 3–4 times a day over the wounds and/or sutures for one week.
  • Avoid straining and heavy lifting for a few days following the procedure.
  • Avoid strenuous exercise for one week post procedure.
  • Do not smoke for three weeks after surgery. Smoking severely slows the healing process and increases the risk of infections
  • Sleep in a more elevated position (using an extra pillow) for the first three nights.
melbourne eyelid surgery recommendations

Major Eyelid Surgery

Pain

Severe pain is unusual after eyelid surgery, especially after the first 24 hours. If cold compresses do not provide sufficient relief from the discomfort, take regular paracetamol. Avoid aspirin and ibuprofen.

Visual disturbances

Mild blurring of vision for several days is normal, and is due to both swelling and the ointment being used. Worsening vision should be reported to your surgeon.Do not drive if your vision is significantly affected.

Glasses and contact lenses

Eyeglasses may be worn immediately. Contact lenses should not be worn for at least one week.

Personal grooming

You may shower and gently wash your hair the second day after surgery. Try to avoid water directly hitting the wound, and do not immerse or soak the wound.

You may blow dry your hair on the cold setting. Avoid face makeup for 3–4 days, and along the sutures for 7–10 days.

eyelid surgery post care

Early post-surgery period

  • If you live alone, arrange for someone to stay with you overnight.
  • DO NOT drive or operate machinery for 24 hours post surgery.
  • DO NOT consume alcohol for 24 hours after surgery.
  • If you have an eye pad, you may remove it the next morning, unless told otherwise.
  • Use half a cup of cooled boiled water and cotton balls to clean the eyelids.
  • You can use 3–4 drops of a newly opened eye lubricant to help flush out and clear the eye surface.
  • Cool compresses will help to reduce oozing, bleeding, swelling and bruising. These can be applied for 10–15 minutes, every 2 hours for 48 hours.

Swelling/bruising

Following surgery, the eyelids or the area around the eyelids are usually swollen and may show marked bruising.

eyelid surgery swelling

Most swelling resolves over 3–4 days (this may take longer if you suffer from allergies, or take blood-thinning medication. Discoloration and bruising will diminish gradually over 7–10 days.

There may be minor swelling and discoloration, which can take 6–12 months to resolve. You may notice that one eye is slightly more swollen than the other. This is normal. A feeling of tightness is also normal.

Occasionally, swelling may lead to incomplete eyelid closure for a few days. This will resolve as swelling diminishes. If this occurs, ensure you use lubricant eye drops four times a day, and put lubricating gel into the eye at night.

Watering and eye irritation usually resolves as the swelling decreases. You may experience discoloration or redness of the whites of your eyes. This is generally painless, it is NOT sight threatening, and it will go away in 7-10 days

Post-operative bleeding

If you experience bleeding from the wound, do not rub it. Apply gentle pressure for 20 minutes, followed by a cold compress for 20 minutes. If this does not work and you have repeated it three times, inform your doctor.

A common reason for bleeding is elevated blood pressure. Blood pressure is elevated during strenuous exercise, bending, lifting, coughing, sneezing and straining. It is important to refrain from strenuous activities for 10 days after surgery.

FAQ

Consultations can vary greatly from patient to patient. At the first visit, Dr Pakrou will examine and assess the health of your eyes and eyelids and discuss the functional/cosmetic goals. He will provide education and information about the areas of concerns and explore potential procedures and surgical options.

There is often only mild post operative pain associated with eyelid surgery. You may experience dull ache, throbbing and/or tightness in the eyelids, especially during the first 24-48 hours. It is very unusual to have severe, and worsening pain, especially after the first 24 hours. If cold compresses do not provide sufficient relief from the discomfort take regular paracetamol according to package directions. DO NOT TAKE ASPIRIN, NUROFEN, ADVIL or similar NSAID products.

Many procedures can be performed in our purpose built procedure suite on site. In most cases if you are not covered by a private health insurance provider, you will save a considerable amount by choosing to have the procedure on site. Local anaesthesia is used to minimise discomfort.

If you are covered by your health fund for the proposed procedure(s) or if the procedure is more extensive, you may choose to have the procedure at the PANCH day surgery centre, a private hospital located a short drive from MCES.. In these cases you may choose to have a light sedation anaesthetic.

In more cosmetic cases where botulinum toxin (Botox) or facial fillers are used, recovery is usually very quick. You may have some swelling and bruising for the first few days following such procedures. In many cases you can resume normal activity after 2-3 days.

Following more major surgery of the eyelid area, a longer period of healing is required. Generally bruising and swelling can take 1-2 weeks to resolve. Bruising and swelling are temporary. More subtle swelling can take a further several weeks or even longer to completely resolve. Scars can be slightly raised and pink for the first 6-8 weeks. Scars mature and fade slowly for up to 12 months after any plastic surgery.

Cosmetics can normally be applied after the first week following many procedures to mask and camouflage any bruising or redness. It is recommended to check with Dr Pakrou to determine the expected recovery time for your specific procedure.

For majority of patients undergoing surgery of, or around the eyelids, recovery time is between 7-10 days. You can usually resume light duties within several days, such as telephone or computer use.

Scarring is a natural reaction to any skin trauma and can be quite variable between patients. Dr Pakrou will take every care to try and minimise scarring and aim to hide incisions in natural eyelid and facial creases. Scarring tends to mature and fade for up to 12 months or longer. Once the wound has healed (usually 7-10 days post surgery), firm massage and pressure over scars can help flatten and soften scars. Such massage should be performed for 2-3 minutes several times a day for the first few months following surgery.

Functional or reconstructive surgeries are usually partially covered by insurance if they are considered to be medically necessary. Some procedures (such as blepharoplasty) may need photographic evidence for medicare and health insurance rebates. Pre-authorisation by your health insurance may be necessary. Cosmetic surgeries and procedures are not covered by Medicare or health insurance.

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Melbourne Comprehensive Eye Surgeons (MCES) provides holistic eye care. Our modern purpose-built facility has been designed to provide a comfortable and relaxing place for our patients to receive modern ophthalmic care. Call (03) 9455 1714 to book a consultation.

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