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About
Introduction
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)
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.
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:
- 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.
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.
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 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.
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 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.
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.
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 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.
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)
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