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Oculoplastic Surgery

Oculoplastic surgery is an umbrella term that covers several procedures focused on repairs of the eyes and face. This type of surgery involves advanced medical techniques that include plastic and reconstructive measures to correct eye and facial disorders. Procedures range from common cosmetic touch-ups to extensive facial reconstruction. Aesthetic eyelid surgery and facial plastic surgery are also considered oculoplastic surgical procedures.

Before you decide to have this type of surgery, check with your insurance company to determine whether your plan covers oculoplastic surgery. Your procedure may be considered cosmetic instead of medical. If you need the procedure to correct a non-cosmetic problem, the surgeon can prepare a report stating the medical necessity of the procedure.

Recognizing the difference between Ophthalmic and Oculoplastic Surgeons

Ophthalmic surgeons and oculoplastic surgeons are both board certified medical eye doctors. The ophthalmic surgeon works with patients who have eye diseases, such as retinal problems, cataracts, and glaucoma.

Oculoplastic surgeons are ophthalmic surgeons with additional training of one to two years to learn cosmetic and reconstructive procedures of the eyes and face. This additional training involves extensive oral and written tests to verify the surgeon’s knowledge. Fewer than 20 surgeons advance through the training course each year.

Defining types of oculoplastic surgery

Oculoplastic surgery covers non-surgical and surgical procedures. Non-surgical procedures are generally done in your doctor’s office with a local anesthetic. The non-surgical treatments include facial injections to reduce the sign of wrinkles, laser treatments, and chemical peels.

Surgical procedures

Surgical procedures usually require sedation and are performed in a hospital. Surgical procedures include

  • Eyelid surgery includes blepharoplasty, eyelid reconstruction, entropion, ptosis, ectropion, and removal of eyelid tumors. The most commonly sought-after eyelid surgery is blepharoplasty. In this procedure, excess fat, skin, and muscle are removed through incisions made on the natural curve of your eyelid. The surgeon then closes the incision with sutures. This procedure can take one to two hours.
  • Tear duct surgery is typically performed to repair a blocked tear duct. An incision will be made in the corner of the eye or on the nose to enable the surgeon to place a drain tube. The drain tube will remain until the blockage is clear. Some patients may need a permanent tear duct drain inserted in the corner of the eyelid.
  • Orbital surgery is performed when trauma, tumors or eye defects are present. Before having this procedure, you will have to have a CT scan and an eye biopsy using a long, thin needle. Your doctor will determine the best surgical procedure for you based on the results of the test.
  • Pediatric oculoplastic surgery is performed on children for conditions like congenital tear duct obstruction and congenital ptosis. Both procedures require general anesthesia. A pediatric ophthalmologist will perform the procedure if the child has special conditions that complicate the surgery.
  • Eyebrow and forehead lift procedures use one of two techniques. The first technique involves one long incision made in the scalp, where excess skin is removed. The eyebrow and forehead are then raised up to the hairline. The second technique uses several small incisions in the scalp and the forehead; then the skin is then tightened.
  • Facelifts and implants are usually cosmetic but may be reconstructive. The surgeon makes Incisions at the temple and along the hairline behind the ear. He or she may remove fat, tighten the underlying muscle, and tighten any loose skin. Once finished, the surgeon uses metal clips or sutures to secure the skin. Facial implants, if used, are placed under the skin during the procedure.

Conditions Treated with Oculoplastic Surgery

These surgical procedures correct issues in the eyelids, eye sockets, and eyebrows. They may also affect the cheeks, tear ducts, and face or forehead.

Surgical procedures

Oculoplastic surgery treats a variety of conditions, including

  • Eyelid retraction caused by birth defects or Grave’s disease
  • Entropion, which causes lower eyelids to turn inward; may also affect upper eyelids
  • Ectropion causes eyelids to turn outward
  • Ptosis, or droopy upper eyelids
  • Skin cancer and growths in or around the eyes
  • Weakness around the eyes or eyelids caused by Bell’s palsy
  • Tear duct problems
  • Injuries to the eye or eye area
  • Congenital disabilities of the eyes or orbital sockets
  • Cosmetic problems

Preparing for Surgery

You should make an appointment with your primary care physician before having surgery. Your current doctor may need to clear you for surgical procedures, especially if you are on any medications. If you are seeing a cardiologist, contact them and discuss your medication routine if you are taking blood-thinning medications. Also, ask your surgeon for a list of medications that you should avoid before and after your surgery.

You probably will not be able to drive following the procedure. Make sure you have a ride home. You should also ask a family member or a friend to stay with you for at least eight hours after the surgery.

Understanding oculoplastic surgery risks

Anyone undergoing surgery is potentially at risk for complications. Surgery that involves anesthesia can sometimes cause an allergic reaction to the anesthetic. Also, you may not be satisfied with the results of reconstructive surgery; even the small procedures may not produce the exact results you want.

Pre-surgery consultation

Your doctor and surgeon will review your patient file to determine if there are certain risk factors before your surgery. The doctor should explain possible negative results and your personal expectations versus actual results. Understanding the procedure and the unexpected issues that may arise will help prepare you for the outcome.

Medical risks

Medical complications may occur. Post-operative swelling and infections are both possible risks. Sometimes these complications can result in further procedures at a greater expense. Possible risks include

  • Scarring
  • Asymmetry
  • Drooping eyelids
  • Wound dehiscence; also called wound eruption
  • Globe perforation, an injury to the eyeball
  • Excessive correction
  • Vision impairment or loss of vision

Recovering from your oculoplastic procedure

Oculoplastic surgeries are performed in a doctor’s office or outpatient surgery clinic. This means you can expect a short recovery time. A few procedures require a minimal stay in the hospital. Your surgeon will prepare a care plan for you following the surgery. Most patients are asked to reduce their activity temporarily to avoid swelling, discomfort, and bruising. Patients often use cold compresses after most surgeries to provide more comfort and reduce swelling. If you have stitches, the doctor will remove them at your post-surgery visit, about a 7 days after the procedure.

Expect to rest and heal for the first two days post-surgery. After this time, you will have to avoid strenuous exercise for 1-2 weeks. Quitting smoking for 2-3 weeks before and after surgery will also help you recover faster. Do not drink any alcoholic beverages for at least one week post-surgery. Not following these instructions may result in post-operative complications, which could require further surgery to correct any affected areas.

Pain management

The surgeon may prescribe pain medication for some procedures, but acetaminophen is usually enough to take care of the post-surgical pain. The type of pain medication you use depends on the level of your discomfort and the extent of the surgery. Propping your head up with extra pillows at night can help prevent swelling; do this for about a week after surgery. Full recovery time depends on your body and the type of surgery you have. Most people recover quickly, but others may require more down time.

When planning oculoplastic surgery, being informed and prepared for the unknown issues that can arise is important. Make sure you understand what to expect and whether your insurance will cover your procedure.

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