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Plastic Surgery

What is Oculofacial and Aesthetic Plastic Surgery?

Who Does Plastic Surgery For Pacific Eye Associates?

Oculofacial Plastic Surgery Problems

Thyroid Eye Disease

Orbital changes frequently occur associated with thyroid problems. This is also termed thyroid associated orbitopathy and Grave's eye disease. These changes are caused by antibody reactions rather than the thyroid hormone levels directly. These changes can include proptosis (bulging eyes), strabismus (double vision), eyelid swelling and retraction, dry eyes, and, rarely, decreased vision. Acute management includes correction of the thyroid abnormality and possible use of anti-inflammatory agents. Problems that remain once the thyroid levels are normal can often be improved with surgery. The oculofacial plastic surgeons at Pacific Eye Associates is a world renowned expert in this area. http://www.asoprs.org/files/public/InfoThyroid.pdf

Orbital Disease

Orbital diseases frequently include tumors of the orbit. These can arise within the orbit itself or come from other parts of the body. These typically manifest with proptosis (bulging of the eye). Other orbital conditions include inflammatory diseases such as thyroid eye disease and pseudotumor. Infections can also affect the area around the eye. Inflammations and infections can cause redness and swelling, as well a proptosis. The orbital and oculofacial plastic surgeons at Pacific Eye Associates are recognized experts in managing orbital disease.

Orbital Trauma

The bones around the orbit protect the eye and can generally withstand a lot of force. However, that energy can cause fractures of the bones around the eyes and sinuses. These fractures may include blow out fractures, zygomatic fractures, and Le Fort fractures. Not all of these fractures need to be repaired but they can often cause double vision and a sunken eye. Eye injuries can also be associated with such trauma. The orbital and oculofacial plastic surgeons at Pacific Eye Associates are experts in knowing which fractures require repair and in the various techniques of repair, if needed.

Eye Removal and Socket Problems

Eyes with chronic disease can become blind, painful and disfigured. Patients may benefit from removal of such eyes. Trauma can also lead to the recommendation that an eye be removed to prevent sympathetic ophthalmia, a rare condition where an injured eye can cause a "sympathetic" inflammatory reaction in the unaffected eye. An eye can be removed partially (evisceration) or completely (enucleation). In such cases, a sphere is implanted in the orbit and covered with orbital tissue that looks like the inside of your mouth. A large contact lens, called an ocular prosthesis, is made by an ocularist. This is worn over the sphere implant and looks like the normal eye.

In some cases, it is appropriate to place an implant that can have a peg placed in it to couple with the ocular prosthesis. This can increase the movement of the prosthesis, but can also increase the risk of complications. The oculofacial plastic surgeons at Pacific Eye Associates are expert at managing all of these options.

Sometimes, it is possible to retain a damaged eye safely, but it remains blind and cosmetically unappealling. In such cases, it may be possible to use a scleral shell to enhance the appearance. Once again, an ocularist can help with this upon referral by your Pacific Eye Associates oculofacial plastic surgeon.
American Society of Ocularists
http://www.asoprs.org/files/public/InfoEnucEvis.pdf

Tear Drainage (Lacrimal Outflow) System Problems

Tears are made by tear glands lining the surface of the eye and by the large main tear gland in the upper outer portion of the orbit. Tears are used to moisten the eye. They have a salt water, oil, and mucous component. They also help the eye fight infection. Tears are eliminated by evaporation and by outflow through small ducts in the eyelids near the nose. Each eyelid generally has such an opening (punctum) and duct (canaliculus). These lead to a tear bladder (tear sac) and down the nasolacrimal duct, to drain tears into the nose. Blockage, complete or partial, can occur anywhere along this system. This cause tearing and/or infection. The oculofacial plastic surgeons at Pacific Eye Associates are expert at managing these types of problems in adults and children.
http://www.asoprs.org/files/public/InfoCongenLacOb.pdf
http://www.asoprs.org/files/public/InfoDcr.pdf

Eyelid Problems

Eyelid Lesions and Tumors

Most eyelid lesions are benign, although there are several forms of skin cancer that frequently involve the eyelids. These include basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, and melanoma. One of the most common eyelid lesions, a chalazion, is a chronic stye caused by plugging of an eyelid oil gland. The oculoplastic surgeons at Pacific Eye Associates are expert at managing these problems.
http://www.asoprs.org/files/public/InfoSkinCancer.pdf

Upper Eyelids That Droop (Ptosis)

When the upper eyelid margin begins to droop down toward the pupil, this is termed blepharoptosis, or simply, ptosis. This is to be differentiated from dermatochalasis, which is extra eyelid skin hanging down over the eyelashes. Both ptosis and dermatochalasis can pose cosmetic problems or actually block vision. The most common cause of ptosis in adults is a levator aponeurosis dehiscence, or tendon tear. In children, the most common cause is poor development of the levator muscle. Adults can also have ptosis caused by nerve or muscle problems. The oculofacial plastic surgeons at Pacific Eye Associates are recognized around the world for their abilities to manage ptosis in adults and children.
http://www.asoprs.org/files/public/InfoPtosis.pdf

Lower Eyelids That Droop (Lower Lid Retraction)

Lower eyelids that hang below the bottom of the iris are said to be retracted. This is most commonly caused by involutional (age-onset) laxity of the lower lid. However, it can also be seen in cases of orbital inflammation (eg thyroid eye disease) or after trauma. It can be corrected by tightening the lower lid and/or placing a spacer graft on the inside of the lower lid. The oculofacial plastic surgeons at Pacific Eye Associates are expert at managing lower eyelid retraction.

Upper Eyelids That are Too High (Upper Lid Retraction)

Upper eyelids that rise above the superior border of the iris are said to be retracted. This is most commonly a sign of thyroid eye disease, although other causes can be seen. The oculofacial plastic surgeons at Pacific Eye Associates are experts at managing eyelid conditions such as this.
http://www.asoprs.org/files/public/InfoThyroid.pdf

Baggy Eyelids (Dermatochalasis)

Redundant skin and fat may form in the upper and lower eyelids as a result of aging or inheritance. This can appear in the early twenties. The redundancy most frequently is a cosmetic problem but the upper lids can occasionally block a patient's superior visual field and affect vision. The redundancy can be removed surgically, often with laser or radiofrequency techniques. This technique is called blepharoplasty.

Upper eyelid fullness can often be secondary to drooping of the brows and forehead, and modern eyebrow and forehead surgery may be most appropriate. While excessive fullness in the lower lids is typically undesireable, we have learned that modest fullness of the midface is actually a sign of youth. With time, hollowness can encroach on the midface causing an aged appearance. In such cases, resuspension of facial tissues or placement of midface grafts, implants, or fillers may actually be the best approach to lower lid rejuvenation. The oculofacial and aesthetic plastic surgeons at Pacific Eye Associates are experts at performing these reconstructive and rejuvenation procedures through approaches that leave minimal scars.
http://www.asoprs.org/files/public/InfoBlephBrow.pdf

Eyelids That Turn in (Entropion)

Eyelids may become unstable with aging or scarring processes. As a result, the eyelid margins may turn inward, directing the eyelashes against the cornea. This is termed entropion. This is more common in the lower lid than upper, but both can occur. Upper eyelid entropion is more common with scarring processes while the lower eyelid is more susceptible to aging changes. Entropion can lead to severe corneal irritation and vision threatening scarring. The oculofacial plastic surgeons at Pacific Eye Associates are very skilled at managing these problems before the cause serious damage.
http://www.asoprs.org/files/public/InfoEntropion.pdf

Eyelids That Out (Ectropion)

The lower eyelid can rotate outward as a result of aging, trauma, scarring, or facial paralysis. This is called ectropion. Typical symptoms include tearing and eye irritation. The upper lid is rarely affected. The oculofacial plastic surgeons at Pacific Eye Associates are experts in managing ectropion.
http://www.asoprs.org/files/public/InfoEctropion.pdf

Eyelashes Rubbing My Eyes (Trichiasis)

Eyelashes of the upper or lower eyelid may grow inward, causing irritation of the eye. This can be inherited or be caused by entropion (see entropion section above), scarring or inflammation. These aberrant eyelashes can be corrected surgically, with freezing, or electrolysis.

Facial (Seventh) Nerve Palsy (Bell's Palsy)

The seventh cranial nerve, or facial nerve, is responsible for most of the movement of the face. Paralysis of the face, or a facial nerve palsy, can be caused by infection, inflammation, trauma, or tumor. Most commonly, however, the cause is unknown and is termed a Bells Palsy. These usually recover with time but patients may have many symptoms such as droolling, difficulty with speech, problems eating and drinking, and poor eye closure. This can lead to severe corneal complications and discomfort. Artificial tear drops and ointments are a mainstay of therapy but many surgical techniques are available. The oculofacial plastic surgeons at Pacific Eye Associates are recognized around the world for their approach to the management of this problem.
http://www.anausa.org/

Blepharospasm and Hemifacial Spasm

Severe blinking or inability to open the eyes is generically termed blepharospasm. Many patients experience benign twitching of the eyelids at some point in their lives and this typically needs no treatment. However, a syndrome of Benign Essential Blepharospasm can be quite disabling. A related disease, hemifacial spasm, typically affects one side of the face and is often related to underlying facial nerve weakness. Both disorders can be treated with botulinum toxin or surgery. The oculofacial plastic surgeons at Pacific Eye Associates are experts in the management of these diseases.
http://www.asoprs.org/files/public/New.InfoSpasm.pdf
http://www.blepharospasm.org/

  • Doopy Eyebrows and Forehead (Brow Ptosis)
  • Sagging Mid Face and Lower Face
  • Cosmetic Services
    • BOTOX (Botulinum Toxin)
    • Dermal Fillers For Dermal Wrinkles and Hollows
    • Cosmetic Products
      • Prevage and Others You Care to List
    • Upper Eyelids That Droop (Ptosis)
    • Baggy Eyelids (Dermatochalasis)
    • Droopy Eyebrows and Forehead (Brow Ptosis)
    • Sagging Mid Face and Lower Face