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A blog about cosmetic and reconstructive surgery of the face, including non-surgical procedures and skin cancer.

Cosmetic Orbital Decompression Surgery

Proptosis is a condition that causes the eyes to appear large and disproportionate to the rest of the face. Bulging eyes receive too much air exposure and are susceptible to harm from foreign objects. Some people are born with proptosis, but people can also develop it later in life. This condition can affect one or both eyes and is more prevalent among certain ethnicities.

What Causes Bulging Eyes?

  • An orbital tumor
  • Thyroid eye disease
  • Sunken cheekbones
  • Shallow eye sockets
  • Genetics

How Do Doctors Treat Bulging Eyes?

Most patients need to visit a board-certified oculofacial cosmetic surgeon to undergo orbital decompression surgery. Bulging eyes often cause irritation, redness and tearing. In addition, some patients are unable to close their eyes fully. To treat the problem, the surgeon must perform orbital eye socket surgery to set the eyeballs in a better position. The surgeon makes tiny incisions to remove bone or fat from behind the eyeballs during this outpatient procedure.

Orbital decompression surgery can also improve a person’s cosmetic appearance. For example, the surgery can make the eyes look more proportional to the rest of the face. If a patient only has one bulging eye, the surgery can make his or her eyes appear more symmetrical. Orbital decompression surgery is especially beneficial for those who are unable to close their eyes fully.

The Surgical and Recovery Process for Bulging Eyes

Patients can visit Dr. Schwarcz, a reconstructive facial surgeon in the New York area to undergo an orbital CT scan. This scan will allow the surgeon to analyze if the patient is a good candidate for orbital decompression surgery. The surgery takes anywhere from 45 to 90 minutes to complete per eye. Surgeons perform the procedure while patients are under general anesthesia. To hide the incisions, the surgeon places them in discrete areas. For example, surgeons often place the incisions inside the eyelid.

After surgery, patients can resume normal activities within 7 to 10 days. Any bruising and swelling that the patient experiences should subside within two weeks. Patients may experience some moderate pain after surgery, but they can manage the pain by taking oral pain medication. If the surgeon used non-absorbable sutures, then the patient can have the sutures removed after one week. Those who wear contact lenses may need to wait 7 to 10 days before using them again.

Droopy Eyelids and Revisional Eyelid Ptosis Surgery

When droopy eyelids are caused by unsatisfactory results from a previous surgery, the patient can opt to undergo revisional ptosis reconstructive surgery. To tighten or move the levator muscle of the orbit, an oculoplastic surgeon can lift the upper eyelid. Depending on the condition’s severity and patient’s surgical history, the success rate of this procedure varies.

However, if an experienced oculofacial plastic surgeon conducts a revisional ptosis surgery, the surgeon’s extensive background can improve the patient’s chances of a favorable outcome even with the presence of scar tissue. Dr. Robert Schwarcz is a board-certified oculoplastic surgeon who has performed numerous eyelid surgeries. He is a facial surgeon who has the ability to correct droopy eyelids caused by a brow lift, previous blepharoplasty, or canthoplasty. During the consultation, Dr. Schwarcz will recommend the best treatment option depending on the patient’s facial structure, concerns and goals.

Revisional Eyelid Ptosis Candidates

Scar tissue or other complications from a prior eyelid surgery can contribute to the complexity of a revisional ptosis procedure. However, patients with these issues may still be candidates for corrective surgery. Additionally, the surgical area after an eyelid surgery often takes 3 months to 6 months. As the healing progresses, some problems may resolve themselves. Therefore, patients should wait until they have fully recovered before consulting with an oculoplastic surgeon.

Revisional Ptosis Surgery

In order to repair the flaws created by a previous procedure, cosmetic surgeons utilizes a specialized revisional technique for the eyelids. This type of surgery is performed as an outpatient procedure in Dr. Schwarcz’s New York offices. Before starting the surgery, the patient is given local anesthesia. When the operation is finished, the patient can look forward to symmetrical, youthful eyelids.

Revisional Ptosis Recovery Period

After the procedure is completed, the patient may experience bruising, mild discomfort and swelling. The patient must keep the incision site clean at all times per the surgeon’s instructions. For the first few weeks, superficial healing will occur. However, the total recovery time takes up to several months.

An Eyelid Specialist

The results of a cosmetic eyelid surgery should look natural and preserve the eyelids’ function. Individuals who have an eyelid procedure performed by an inexperienced surgeon are at a higher risk of experiencing unwanted results such as an unnatural appearance, dry eyes. eyelid damage, visual problems and other issues. As a board-certified oculoplastic surgeon with a strong background in ophthalmology, reconstructive facial surgery and revisional eyelid surgery, Dr. Schwarcz has the experience to produce optimal results for his patients who suffer from droopy eyelids.

Thyroid Orbitopathy and Thyroid Eye Disease Surgical Treatment

Thyroid orbitopathy is a type of eye disease that affects the eye socket and surrounding tissues. For example, the condition can affect a person’s eye muscles and eyelids. Some doctors refer to this autoimmune inflammatory condition as thyroid eye disease. Those who have this condition may also develop problems with their thyroid gland.

What are the Symptoms of Thyroid Eye Disease?

The symptoms from thyroid eye disease usually develop gradually. In fact, it can take nearly a year for the symptoms to become severe. Patients may experience dryness, redness, eye pressure and irritation. Some of the more severe symptoms include double vision, blurred vision, protruded eyes and loss of vision.

As the symptoms worsen, patients usually experience a burned out phase. During this phase, a person may need to undergo rehabilitative surgery. For instance, the patient may need to visit an oculofacial plastic surgeon for orbital decompression surgery. Cosmetic and reconstructive surgery can help repair bulging eyes.

How is Thyroid Eye Disease Treated?

Most patients need a multidisciplinary form of treatment. For example, they may need the help of an endocrinologist, a thyroid surgeon and an oculoplastic surgeon. Simply treating the eyes will not fix the issue. Doctors must treat the underlying problem before more damage occurs. For example, the patient may need medication, radioactive iodine or thyroid surgery.

During the inflammatory stage of thyroid eye disease, doctors treat patients by giving them eye lubrication and steroids. They must monitor their patients closely to ensure that no optic nerve damage occurs. Smoking can make thyroid eye disease worse, so doctors usually encourage their patients to kick the habit.

Orbital Decompression Surgery

Once the inflammation subsides, patients may need to visit a oculoplastic surgeon like Dr. Robert Schwarcz in New York, to have their eye abnormalities corrected. A surgeon can correct the patient’s bulging eyes so that he or she can see again. Orbital decompression surgery expands the eye socket, which allows the eyeball to move back into position. Besides correcting a person’s vision, this surgery also helps improve the patient’s cosmetic appearance.

Click here to learn more about other types of reconstructive surgery including eye socket repair, eyelid ptosis repair and more.

Orbital Blowout Fracture Surgery

Injuries to the eye socket and surrounding eye structures are a common occurrence. Blunt force trauma and sharp force trauma due to assaults, athletic activities and falls can lead to canalicular lacerations, eyelid lacerations, orbital fractures and orbital hemorrhages. An oculoplastic surgeon will examine and treat the eyeball in addition to the socket as the eyeball is an injury-prone area. During the consultation, New York oculoplastic surgeon Dr. Robert Schwarcz will examine the patient’s face and eyes and assess the patient’s orbital CT scan results to determine the injury’s severity.

Orbital Blowout Fractures

The fragile nature of the orbital bones and adjacent sinuses make it highly likely for eye and orbit trauma to result in an orbital blowout fracture. Often, the fracture occurs in the orbital floor or medial wall. While some orbital fractures do not require surgery, large fractures or fractures that cause enophthalmos or diplopia do necessitate a surgical procedure.

Surgical Repair of an Orbital Blowout Fracture

To prevent scarring and increase the procedure’s success rate, an orbital blowout fracture should be repaired no later than 2 weeks after the trauma occurred. In some cases, the surgeon may be unable to repair the site immediately. For example, a sunken eye may appear or become more severe over time; therefore, the patient will need enophthalmos surgery or a filler injection to improve the appearance of the sunken eye.

Due to the small incisions that remain hidden inside of the eyelids, patients tend to recover quickly from orbital fracture surgery. Dr. Schwarcz performs this surgery while the patient is under general anesthesia. This outpatient procedure takes approximately 1 hour for the surgeon to complete, and the patient will have a follow-up appointment at Dr. Schwarcz’s New York office 1 week after the surgery.

Select a Certified Oculofacial Plastic Surgeon

Since the orbit and eyelid are complex structures, oculoplastic surgeons undergo specialized training to learn the nuances of eyelid and orbital treatments. Oculoplastic surgeons who are members of the American Society of Ophthalmic Plastic and Reconstructive Surgery are board-certified ophthalmologists who must complete a cosmetic and reconstructive surgery fellowship to receive training on treating issues that involve the eyelids, lacrimal system, orbits and nearby structures. Dr. Schwarcz is an oculoplastic cosmetic surgeon who is an American Board of Cosmetic Surgery diplomat and board certified by the ASOPRS as well as the American Academy of Ophthalmology.

Prosthetic Eye and Socket Reconstructive Surgery with an Oculoplastic Surgeon

An anophthalmic socket is a term used to describe an eyeless orbit. Usually, anophthalmia is acquired, not congenital. The precipitating event that leads to the eye loss causes the patient emotional distress and insecurities. As an oculoplastic specialist in NYC, Dr. Schwarcz can reconstruct the eye socket and eyelid before an ocularist makes a prosthetic eye. The surgeon uses several techniques to restore function to these structures:

Causes of Anophthalmia

People of all ages can have an anophthalmic socket. Common causes of anophthalmia are blunt injuries, infections, genetic mutations and prenatal deformities. When an injury is to blame, the patient should visit an oculoplastic surgeon who will work with him or her to create a surgical plan. To determine the best course of treatment, the surgeon must first examine the site of injury at the surgeon’s office. Dr. Schwarcz has two practices where he routinely sees his patients in New York.

Post-Operative Care

Patients should expect a recuperation period of several weeks after their anophthalmic socket surgery. Hygiene is crucial during this time. Patients who are given a prosthetic eye must clean it with water and soap every day. Children who have an ocular prosthesis typically require several fittings since their facial structure changes as they grow.

Choose a Certified Oculoplastic Surgeon

People should seek a cosmetic surgeon who specializes in reconstructive facial surgery involving the tear drain system, orbit and eyelids. The surgeon should be an American Society of Ophthalmic Plastic and Reconstructive Surgery member, which demonstrates that the surgeon is a board-certified ophthalmologist trained in the areas of ophthalmic cosmetic and reconstructive surgery. Dr. Robert Schwarcz is a board-certified ophthalmologist and ASOPRS member who has a comprehensive background in socket surgery and knows the structure and anatomy of the orbit and eyelid. Those who want to find out what treatment options are available for their anophthalmic socket should contact Dr. Schwarcz’s office in New York City or Scarsdale.

Orbital Tumors and Cellulitis

Orbital cellulitis is an infection that occurs behind the orbital septum. This infection usually develops when there are issues with the eyelids or sinuses, which are adjacent to the orbits. Orbital cellulitis is dangerous and life threatening, so immediate treatment is essential. Those who have this infection need antibiotics and may require surgery. Dr, Robert Schwarcz is an experienced oculoplastic surgeon in New York City who can treat the problem.

Information about Orbital Tumors and Infections

Orbital tumors are often congenital, but people can also acquire them later in life. The tumors can be either benign or malignant. In addition, they can also be either painful or painless. Both adults and children can suffer from an orbital tumor. Sometimes, orbital tumors are subtle and grow slowly. Unfortunately, they can also grow rapidly and interrupt a person’s life. For example, patients may experience pressure, eye irritation, swelling, double vision and proptosis.

Why Do Eye Socket Tumors Occur?

Most tumors arise from adjacent structures to the eye socket. If left untreated, the tumor can impair a person’s vision and cause his or her eyes to protrude. The most common orbital tumors that form in children are hemangiomas and dermoid cysts. Adults commonly develop orbital lymphomas, metastatic disease and cavernous hemangiomas. Sometimes, people may have another condition that mimics a tumor. Infections, inflammation and Graves’ disease can all lead to eye problems.

What are the Symptoms?

Those who have an orbital tumor or infection commonly develop exophthalmos, which is protrusion of the eye. Patients commonly experience vision loss, blurred vision or double vision. When the tumor is small, the two main symptoms are headaches and pressure feelings near the eye socket. Small tumors can also cause moderate vision issues.

How do Doctors Detect Orbital Tumors?

Those who are having problems with their eye socket should visit an oculoplastic specialist in New York City. The specialist can take CT or MRI scans of the orbits to detect a problem. If the doctor suspects that a tumor is present, then the patient may need to undergo a biopsy. A biopsy is necessary because it confirms the diagnosis and helps the doctor learn more about the tumor.

Those who have an orbital tumor may require radiation, chemotherapy or surgery. Treatment options vary based on the tumor. For instance, radiation is the main treatment for eye socket lymphoma. Surgical removal is the primary way to treat a cavernous hemangioma. Cosmetic surgeon Dr. Schwarcz discusses all options beforehand so that his patients can make an informed decision.

Almond Eye Surgery

Almond eyes are characterized by a slightly raised outer corner or canthus and a lower eyelid that sits at the lower edge of the iris. While all eye shapes can be beautiful, almond eyes create an attractive, youthful, and somewhat exotic appearance. Some individuals have almond eyes naturally because of genetics or their ethnicity. For those with a rounded outer canthus or a lower eyelid that is rounded or low allowing the sclera to show, surgery may help improve the shape and appearance of the eye.

Who Is a Candidate for Almond Eye Surgery?

Patients considering almond eye surgery should consult a board-certified oculoplastic surgeon to ensure that they have a clear understanding of the type of outcome that they can expect based on their current eye shape and anatomy. In some cases, a lateral canthoplasty is performed to tighten or reposition the outer canthus of the eye. In patients with a lower eyelid that is too low or that is retracted to expose part of the sclera, additional procedures may be necessary to adjust the position and tension of the lower eyelids. It is common for patients to combine almond eye surgery with a brow lift, blepharoplasty surgery, and other cosmetic procedures to achieve their desired result. Almond eye surgery is a very delicate procedure that can be even more complicated in patients who have had prior eyelid surgery or who have protruding eyes, so consulting a specialist in oculoplastic surgery is essential. Dr. Robert Schwarcz of New York is an oculoplastic surgeon and specialist in surgeries involving the eyes. His practices offer surgical services at both the Scarsdale and New York City locations.

What to Expect:

The procedure is performed under local anesthesia, and patients are released the same day. While conscious sedation may be used, the patient still needs to be able to open their eyes during the surgery. Mild discomfort is to be expected for the first day following surgery; however, this is normally easily managed with medication. Some bruising and swelling are normal for the first week to 10 days. While most patients return to their normal activities within a week, complete healing can take several weeks to months.

Cosmetic Treatments for a Sagging Neck & Face

Sagging skin around the face and neck is typically one of the first signs of aging. Over time, the skin becomes less elastic, and the underlying fat that supports the skin of the face and neck can shift or disappear. Heredity, stress, sun exposure, and smoking can also affect the skin and contour of the face and neck. A trained and experienced oculoplastic facial surgeon like Dr. Robert Schwarcz can use a variety of cosmetic surgery techniques to tighten the skin of the face and neck to create a more youthful and aesthetically pleasing profile.

Facelift:

A rhytidectomy, commonly referred to as a facelift, is typically used to reverse signs of aging involving the face and neck. Facelifts can be used to remove excess fat and tighten the skin of the neck to eliminate a “turkey neck” or double chin. The procedure can also reduce the appearance of jowls and nasolabial fold lines between the nose and mouth.

Neck Lift:

A neck lift is often used in combination with a facelift to improve the contour of the neck. The procedure involves removing excess fat in the neck through excision or liposuction and tightening the muscles of the neck. In some cases, excess skin may also be excised. Since a neck lift requires a detailed restoration of the musculature, patients considering the procedure should consult Dr. Schwarcz, a board-certified cosmetic and reconstructive surgeon to achieve the best possible results.

Mini Facelift:

A mini facelift is a more conservative cosmetic surgery than a traditional facelift. The procedure is focused on reversing signs of aging around the eyes, mouth, and forehead without altering the rest of the face. Although the results are subtle, a mini facelift is often enough to correct minor sagging along the cheeks, neck, and jaw. This procedure is ideal for men and women who want a more refreshed look with less visible scarring and downtime.

What is Thyroid Eye Disease (TED) or Thyroid Orbitopathy

Thyroid eye disease, also known as TED, is an orbital disease closely linked to Hashimoto’s thyroiditis, Graves’ disease, and other immune disorders affecting the thyroid. Although the condition affects all races and ages, it most often occurs in individuals in their 20s to 60s. Women are far more likely to develop TED than men. TED affects approximately 14 out of every 100,000 females. The incidence among males is roughly one-fifth that of females.

Approximately 25 to 50 percent of individuals with an immune disease of the thyroid develop TED that involves the orbit of the eye. This thyroid orbitopathy can lead to optic neuropathy, impaired motility, congestion, and severe inflammation. Although an estimated 90 percent of patients with orbitopathy have a history of thyroid hormone abnormalities, the condition is not caused by the abnormal hormone levels, and the orbital disease does not automatically resolve once hormone levels are normalized.

Patients with thyroid eye disease typically experience an active disease phase in which the inflammatory symptoms are progressive. This is followed by a post-inflammatory phase in which the symptoms stabilize and become inactive. The active phase of the disease can last up to 18 months. During this time, the patient may experience symptoms that include:

  • orbital pain and discomfort,
  • swelling and redness around the eye and conjunctiva,
  • abnormal protrusion of the eye,
  • strabismus, and
  • optic neuropathy.

A small number of patients with thyroid dysfunction and severe orbitopathy go on to develop a skin condition known as Graves’ dermopathy in which the skin of the lower limbs becomes red and swollen and develops an orange peel-like texture. Some of these patients also go on to develop a thickening or clubbing of the nail beds and fingertips.

Treatment for Thyroid Eye Disease:

Once the condition becomes dormant, the patient can consult an oculoplastic surgeon like Dr. Robert Schwarcz to correct the damage caused by the active phase of the disease. This typically involves surgery to realign the eye muscles, reduce pockets of fat in the eyelids, narrow the opening of the eyelid, and lessen the protrusion of the eye. Click here to learn more about thyroid orbitopathy.

Trust An Oculoplastic Surgeon With Eyelid Surgery

Blepharoplasty, or eyelid surgery, is performed to expand the area of view that the eye is capable of seeing. In addition, it is a cosmetic enhancement procedure performed. This procedure has the potential to improve the patient’s quality of life, bringing many benefits with refreshed and rejuvenated eyelids. There are also some side-effects the patient should be aware of before making the decision to undergo blepharoplasty.

The Benefits of Blepharoplasty

One of the primary changes that a patient may notice is an increase in peripheral vision. This is because the procedure reduces excess skin and fat around the eyes. The benefits of expanded vision are many-fold and can positively affect all areas of life. Among its aesthetic benefits, eyelid cosmetic surgery will smooth the area around the eye, making the patient look younger, less tired and more refreshed. Even the forehead muscles can benefit, since after the surgery they will have to expend less energy to hold the eyes open. Much as with expanded vision, having a more youthful appearance can offer many subtle advantages to the patient.

The Healing Process

As with all surgeries, cosmetic or otherwise, there are some potential side-effects that may occur. Following the instructions of the blepharoplasty surgeon can reduce the chances of this risk, so the patient should be sure to discuss it with Dr. Schwarcz before and after the surgery. Infection around the incision of the eyelid is a possibility, as is bleeding, and so care must be taken with this incision to make sure it stays closed and dressed. Scarring is also a risk, but one of the advantages of this surgery is that the scar tends to stay hidden in the crease of the eyelid.