Most of the aging changes occur around the eyes. An ophthalmic plastic surgeon or plastic surgeon of the eyes can best address the cosmetic issues in the face as they are familiar with the eyelids, microincisions, working under microscopes and precise suturing techniques. Dr. Ramesh Murthy has the experience of performing innumerable surgeries to improve the appearance of the face.
Blepharoplasty is the removal of under eye bags and eyelid hooding, which give a tired look to the face. It involves the removal of excess sagging skin, protruding fat and rarely muscle from the upper or lower lids. In older individuals it may be needed to improve the visual fields. The incision for the upper lid is through the skin and lower lid through the conjunctiva so that there are no visible scars.
The brows are refixated to a higher position giving a younger look and smoothening the lines between the eyes. It can be performed endoscopically or via small incisions given above the eyebrow or near the hairline.
Fat is natural filler which can be used to fill the hollows around the eyes, cheeks and eyebrows. The fat is harvested from the abdomen and injected.
Working around the eyes needs a lot of skill and expertise as there are many structures in the orbital space. A thorough knowledge of the anatomy of the eye and orbit and experience in performing oculofacial surgeries is essential to get a good functional and cosmetic outcome. This involves correction of deformities of the lid, orbit and socket which can be present since birth or occurs later in life due to trauma or tumor. This also involves the management of tumors on the lids, orbit and around the eyes and correction of defects of the lacrimal system which can cause watering and discharge.
Drooping of the lids can be present from birth or can occur later in life due to trauma, aging or neurological problems. Apart from obstructing the vision, it gives a sleepy and dull look to the face. If present since birth, it can obstruct the development of vision leading to lazy eye. Hence it is important to correct this problem both for functional and cosmetic reasons. Surgery is performed through a natural lid crease or from the inner aspect of the eyelid and involves tightening of the lid lifting muscles or use of a tarsofrontal sling. Surgery does not create any cosmetic blemish.
There is in turning of the lid margin with rubbing of the lashes against the cornea in this condition. This can occur due to aging or chemical injuries. Surgery is performed from the inner aspect of the lid and gives excellent results.
Out ward turning of the lids can occur due to facial nerve weakness or Bells palsy or burns following acid or alkali burns. This can be corrected by tightening of the supports of the lid.
Facial paralysis leads to incomplete lid closure, sagging of the brow and angle of the mouth. Incomplete lid closure can lead to dryness and corneal exposure. A gold weight implant can correct the lid height and facilitate upper lid closure. In addition the lower lid can be tightened and the brow lifted up. A face lift is also needed to ensure the face does not sag.
Tear ducts can be blocked since birth and this may resolve on its own in most cases or may need simple procedures like probing. In an adult with blockage of the tear ducts, the block can be bypassed by creating a new channel (dacryocystorhinostomy) by an incision near the corner of the eye or using an endoscope through the nose. This procedure has a high success rate.
Active thyroid eye disease can cause protrusion of the eyeball and widening of the apertures of the eyes with swelling of the tissues. The protrusion of the eyes and the unsightly appearance may remain even after the disease has subsided. This may need orbital decompression surgery so that the eyes fall back into their normal position followed by squint surgery for the double vision and finally lid surgery for correcting any residual deformities of the lid.
Involuntary contractions can occur on one side of the face (hemifacial spasm) or in both eyes (blepharospasm) with or without contraction of the neck muscles. Isolated twitching of one muscle can occur called myokimia. Most of these will respond to botulinum toxin injections though this may need to be repeated every few months. Muscle surgery is generally not advocated except in rare situations.
The common tumors in the conjunctive include the benign nevus and dermolipoma. These tumors can be removed successfully for cosmetic purpose. Squamous cell carcinoma occurs as a result of sun exposure and can be successfully removed. With proper approach recurrences are uncommon.
Eye lid tumors can be benign like warts or nevi or can be malignant like sebaceous gland carcinoma, squamous cell carcinoma or basal cell carcinoma. Most lid malignancies do not spread beyond the lid. Complete excision needs to be performed. Reconstruction can be done with flaps or grafts or by lid sharing procedures. These techniques give excellent results both as regards cure and cosmesis.
The orbit can be afflicted by many kinds of tumors. Some of the tumors respond to medical treatment. Surgery (orbitotomy) if needed is performed by minimally invasive and cosmetic approaches like the lid crease approach or from the inner aspect of the lid and has an excellent outcome.
Trauma can affect the eyelids and can lead to laceration of the canaliculi. This needs to be repaired by the placement of a tube in the canaliculus. The lids need to be sutured carefully and apposed. In case of orbital fractures, the defect needs to be repaired if there is double vision or a sunken look to the eye. It is repaired by silicon or medpor or titanium supports and gives a satisfactory outcome.