Ocular Plastics

What is an Oculoplastic surgeon?

Oculoplastic surgeons are ophthalmologists (eye specialist), who have specialised in eyelid and facial plastic surgery. They are specially trained in all aspects of eyelid and facial surgery, from complex reconstructions to the simple removal of lid lumps and bumps.

Why not a plastic surgeon?

While a plastic surgeon is capable of undertaking surgery around the eye, they do not have the specialist knowledge of the muscles and functions of the eye that an Oculoplastic surgeon has.

What does an Oculoplastic surgeon do?

Oculoplastic surgeons are able to treat many different conditions around the eye, but the most commonly carried-out privately are blepharoplasty and the removal of lid lumps and bumps.

What is blepharoplasty?

As we get older our skin loses its elasticity and our muscles can loosen. This is often obvious in the upper eye lids where an accumulation of loose skin causes folds of skin to overhang the eyelid (“eye bag”) which can give an appearance of being tired or having puffy eyelids. It can also make the eye lids feel heavy and difficult to keep open by the end of the day, sometimes causing headaches. It can also have an effect on vision and reduce your peripheral vision.

Sometimes the thinning of tissues causes the fat around the eye to bulge forward as well, creating pale lumpy areas. Often the problem is worse in the morning with fluid accumulation.

What is upper eye lid blepharoplasty?

This is an operation usually performed under local anaesthetic, to remove the excess upper lid skin. The skin is removed from along the crease in the upper lid which allows the scar to sit within the natural crease of the eye lid. If fat removal is required, the surgery is more involved and requires deeper stitches. The recovery period is 1-2 weeks for the bruising to resolve and the stitches are removed at 2 weeks.

Is upper eye lid blepharoplasty suitable for me?

Upper lid blepharoplasty can be an effective treatment to make you look younger and improve vision. Sometimes there is drooping of the eyebrow which causes sagging of the eyelid. The muscle lifting the upper eyelid can also stretch, causing the lid itself to droop which cannot be corrected by blepharoplasty. The surgeon will assess you and decide if you are suitable for surgery.

Upper eye lid surgery

This is usually carried out under local anaesthetic and takes 60 minutes. The recovery period is usually 1 week but it can take up to 2 weeks for all of the bruising to resolve. It will not alter the general features of your face, but will leave you with a natural, less tired appearance.

What are the risks and limitations?

• The treatment is only to the eyelids.

• Any folds of skin extending onto the cheek will not be improved.

• Wrinkles in the area of the crow’s feet often remain.

• The surgery does not change any skin colouring.

• The eye lid height is not altered.

If too much skin is removed, you may have difficulty closing the eye lid and develop dry eyes. This is dependent on technique and is a rare occurrence. There is a limit to the amount of skin that can be taken to allow the lid to close, which can result in a small remnant skin fold.

With removal of fat there is a 6 in 40,000 chance of developing bleeding which can cause loss of vision. Scars can take up to 6 months to fade.

What are lid lumps and bumps?

Eyelid lesions (eyelid lumps and bumps) are very common. There are many different types, with some more serious than others. Many lumps and bumps can be itchy, restrict vision and look unsightly, so it is not uncommon for them to be removed. However, many of the less serious lesions are no longer routinely removed under the NHS, even when they have a significant impact on a patient.

Types of lid lumps

• Comodome

• Pyogenic granuloma

• Seborrheic keratosis

• Keratin horn

• Actinic keratosis

• Xanthelasma

• Meibomian cysts

• Skin tags

• Squamous papilloma

• Benign Naevus

• Chalazion

Lid lump surgery

Removal of lid lumps is very common and generally very straight forward, leaving little or no visible scarring and often not requiring stitches.