Eyelid Surgeries

This is an area that Dr. Hudak can claim expertise in, as she has had extensive training and experience in Oculoplastics (plastic surgery of the eyelids, eye socket, brows, and mid-face) under the tutelage of some of our country’s best eyelid surgeons, including:

• John Holds, MD (St. Louis, MO),
• Guy Massry, MD (Beverly Hills, CA),
• Robert Goldberg, MD (Los Angeles, CA),
• and Henry Baylis, MD (Newport Beach, CA).

Her Instructors of the mid-face surgeries include

• Joe Niamtu, DMD (Midlothian, VA),
• Angelo Cuzalino, MD (Tulsa, OK),
• and Drake Vincent, MD, DMD (Ogden, UT).

The eyelid surgery called Blepharoplasty is the most sought-after facial cosmetic surgery, since eyes with redundant amounts of skin and/or bulging fat tend to make the person appear tired and old. The eye area is looked to for much of our facial expression. The skin of the eyelids is different than the skin elsewhere on the face, and needs a surgeon who understands the anatomy of the lids intimately in order to keep any complications to an absolute minimum.

The function of the eyelids is to protect the eyes. Improperly done eyelid surgery can prevent lids from doing their job, and lead to eye disease. It is for this reason that the American Medical Association, representing all fields of medicine, recommends that those interested in eyelid surgery seek the attention of a specialist in this, ie. an Oculoplastics doctor, or at least an Ophthalmology-trained surgeon.

Droopy/ Heavy upper eyelids may be due to several different causes, and are best corrected by addressing the root cause.

Causes:

• excessive skin (dermatochalasis)
• excessive skin with redundant, protruding fat pads (blepharochalasis)
• low eyebrows (brow ptosis)
• due to aging and atrophy of the forehead skin and/or frontalis muscle
• due to Bell’s Palsy, a Cranial Nerve VII Palsy
• due to a lower-than-normal eyelid margin (ie. a true ptosis); in this,the edge of the upper eyelid is displaced lower on the eye than is normal, often covering part of the pupil
• due to thinning or damage of the tendon of the muscle that lifts the lid (ie. dehiscense and/or disinsertion of the levator aponeurosis)
• due to a disorder of the Mueller’s muscles, which are responsible for the first 2-3mm of lid lift,
• eg. as seen in a Horner’s Pupil and Syndrome, which can be due to a disorder in the eye socket (orbit), in the neck, in the top (apex) of the lung (such as a tumor), or with migraine
• due to a disorder of the levator muscle, which is responsible for the majority of eyelid lifting
• eg. as seen in Myasthenia Gravis, the Chronic Progressive External Ophthalmoplegias, and Myotonic Dystrophy
• eg. as seen in some cases of Congenital (ie.”born with”) Ptosis
• due to a disorder of Cranial Nerve III (ie. the nerve to the levator muscle)
• eg. a disorder causing a Cranial Nerve III Palsy, such as a brain aneurysm, stroke, or tumor
• due to high blood pressure, diabetes, collagen vascular disease, congenital (ie.“born with”) blood vessel defect, or acquired problem (as is true with most tumors)
• eg. as seen in some cases of Congenital Ptosis
• due to a “pseudo-ptosis”, a false, untrue ptosis; ie. it looks like a ptosis of the lid, but upon closer inspection, it is not a true ptosis
• due to a spasm of the orbicularis oculi, the muscle group responsible for closure of the eyelids, called a blepharospasm
• eg. as seen in Benign Essential Blepharospasm and Hemifacial Spasm
• due to a movement disorder of the orbicularis oculi muscles
• eg. as seen in Lid Apraxias and Lid Dystonias
• due to a smaller eye (microphthalmos)
• due to an eye that has been displaced downward or toward the back of the head
• eg. as seen in trauma to the bones of the eye socket
• eg. as seen in some tumors of the eye socket
• due to an outward bulging of the other eye
• eg. as seen in thyroid diseases, like Graves’ Disease

Treatments

Depending on the root cause of the droopy lid(s), different options may be recommended.

• They include observation, Botox® injections, pills, eyedrops, laser procedures, eyecreams and surgery.
• Botox® can temporarily paralyze and stop spasming orbicularis oculi muscles (that close the lids) and help lift the inner brow (by temporarily paralyzing the glabellar muscles that pull our brows into a downward frown). The result is less draping of skin over the lashes or in the crease line of the upper lid.
• Pills can occasionally help reduce the ptosis of a patient with Myasthenia Gravis, or the pseudo-ptosis of a patient with thyroid disease/ thyroid-associated-orbitopathy.
• Eyedrops that lubricate can help the patient who has blepharospasm from dry eyes or who has a disorder of the cornea (windowshield of the eye) in which there is breakdown of its surface cells.
• Laser skin tightening of the lids can reduce mildly redundant dermatochalasis.
• Eyecreams our Esthetician can choose for you can help replenish elastin, collagen, and moisture to the dry, mildly redundant skin.