Plastic surgery

Surgeries to restore the normal function of eyelids

Degenerative changes on the eyelids are not only an aesthetic problem, they can often cause serious and permanent changes of the anterior eye segment . Our surgeons perform all types of surgeries on eyelids in order to enable the normal function of the eye. The procedures are performed under local anesthesia, and patients are discharged from the hospital the same day.

During the process of aging, the skin of the eyelids becomes thinner, less elastic; the loss of support of connective tissue causes the fat tissue to prolapse; thinning of the muscle tendons leads to drooped lids (Ptosis). Excess skin that hangs over the lid margin couses dermatochalasis of upper and lower eyelid; loss of support tissue leads toexcessive outward and inward overturn of the eyelid margin called ectropion and entropion. Everyday action of the facial muscles (frown, amazement, laughing) creates wrinkles on the forehead, between the eyebrows, on the outer angle of the eye. 

We operate blepharochalasis of the upper and lower eyelids and ptosis of different origins. The incision is made in the natural grooves (skin crease) of the eyelid so t the scar is invisible and the excess of skin is removed and if necessary lid is fixed in the required position (ptosis). Given all this, there are a lot of opportunities to look good and feel young for a long time.

We operate blepharochalasis of the upper and lower eyelids and ptosis of different origins. The incision is made in the natural grooves (skin crease) of the eyelid so t the scar is invisible and the excess of skin is removed and if necessary lid is fixed in the required position (ptosis). Given all this, there are a lot of opportunities to look good and feel young for a long time. .

Blepharoplasty

The most common surgical procedure on eyelids that restores their freshness and youthful appearance is called blepharoplasty.  Blepharoplasty surgery is performed in the case of excess skin on the eyelids (dermatochalasis) which is usually due to aging when the skin loses its elasticity and starts hanging over the edge of the eyelids and can also be associated with prolapse of fat tissue from the orbit resulting with formation of fatty pads and dark circles. Functional Blepharoplasty is performed in cases when together with te skin excess muscles in the upper lid are weakened as well and the eyelids start sliding downwards with inability to raise the eyelids (ptosis). During the surgery under local anesthetic  the excess skin, fat and stretched muscle fibers from lids are removed and if necessary with creating a new muscle insertion.

Incision is made inside the natural crease of the eyelid or below the eyelashes and is closed by stitches which are removed in seven days, the recovery after the procedure is fast and the scar almost invisible.

Correction of Ptosis (eyelid dropping)

Ptosis is the medical term for a dropped eyelid. A patient who has ptosis is not able to fully open the eye, and the upper eyelid covers the pupil. In addition to causing an aesthetic problem, it can also cause functional vision problems, in children it can delay the development of vision and in adults ptosis can interfere everydays activities. When present at birth,  it is called congenital and develops due to malformations in the development of the child while still in the womb. If a child is born with ptosis, the drooped lid will prevent normal vision development so congenital ptosis requires surgery as soon as possible to enable normal development of the child’s eye. If the treatment is not performed in time the child will remain visually impaired for life.

Contrary to the congenital ptosis the so called acquired ptosis in adults occurs as a result of a injury or degenerative changes in the muscles and tendons of eyelids.. Ptosis can be treated surgically, there are a few types of surgery. The choice of procedure depends on the type and degree of ptosis. If a muscle that raises the eyelid (levator palpebrae) has preserved a part of its function, the operation is performed by the shortening of this muscle. In the case when muscle function is too week, it is necessary to perform a special procedure of suspending the eyelid to the frontal muscle which take over the function of the lid (brow suspension). The ptosis correction surgery is performed under local anesthesia and the patient goes home the same day and the recovery isfast. Although the process of this surgery in children is usually the same, the surgery has to be done under general anesthesia.

Correction of distortion of the eyelids (ectropion, entropy)

In older people due to the aging changes in the structure of the eyelid margins caused by changes in the muscles their tendons and the surrounding skin sometimes the edge of the eyelid starts to turn in or outwards. Sometimes these changes can be caused by eye injuries as a result of scarring, or after a stroke or similar conditions in the brain as a consequence of an injury of nerves innervating the muscles that moves the eyelid. The surrounding muscles are no longer able to keep the eyelid in correct position fitting correctly with the eyeball. The edge of the eyelids can start turningoutwards (ectropion), causing that the condition when the patient can not close the eye with tears running over the edge of the eye and drying of the cornea and the anterior segment of the eye, or can be turned inwards (entropion) causing the eye lashes to scratch over the anterior eye segment creating the painfull sores on the cornea, which is often the reason for patient to come to the doctor’s office. Surgeryis performed under local anesthesia to strengthen the edge of the eyelid and to adjust to the position the eyelid or form new grips for the muscle to return to the eyelid its original form and function. Stitches are removed at the first control, usually one week after the operation, and that is also the time usually necessary for the swelling at the affected area to subside.

Surgery of tear ducts

A well-distributed, high-quality tear film is necessary for the correct functioning of the eye. In the tear apparatus a good function of all of its parts is necessary; more specifically the lacrimal glands, eyelids and tear ducts. The eye and nose are connected by a gentle duct serving for the drainage of excess tears into the nose. In some cases, due to frequent inflammations, injury or congenital narrowness this duct gets obstructed. This condition is manifested in excessive tearing (epiphora) and associated infections due to blockages in the lacrimal bag which is located at the beginning of the duct.

In cases where the inflammation can not be resolved by antibiotic therapy and the flow of the ducts can’t be restored an operation called dacryocystorhinostomy (DCR) can be performed. This is a surgical procedure that re-establishes continuity in the nasolacrimal duct allowing the drainage of excess tears from the eye in the tear bag through tear ducts into the nasal cavity. During the procedure a silicone tube is incorporated in the duct and left in the eye during six months. The procedure is done under general anesthesia, and the first control is usually scheduled next morning. In seven days the patient can usually return to work.

In the cases of congenital nasolacrimal duct obstruction if the tear duct does not open spontaneously with a massage and proper hygiene, in the second year of life probing under general anesthesia has to be performed. If the duct fails to open after the surgery if performedt, probing is repeated with the installation of a silicone tube.

Removal of tumors

Tumors of the eyelids as well as in any other place on the body must be considered seriously. The most common tumors found are benign ones (such as cysts, wards and inflammatory changes) and can be treated by simple medications or surgeries. Unfortunately in some cases the changes may have a malignant character. Apart from the fact that some types of cancer can spread to the surrounding and remote areas when found too late these tumors found on the delicate and sensitive areas such as the eyelids and the area around the eyes, require removal with special care catering for the surrounding area of the skin and all the other structures in order to preserve both the proper function of the eyelid and the aesthetic appearance of the patient.

Among the most common malignant tumors that require surgery are the basal cell carcinomas, squamous cell carcinoma or less frequently the melanoma. Tumor resection is performed under local anesthesia; the first control is most often scheduled after seven days when the patient can safely to return to daily activities. 

Dysthyroid eye disease

In some cases, patients with thyroid dysfunction have eye problems (redness, tenderness, feeling of pressure, “bulging” look, double vision). These changes occur because of the interaction of the thyroid antibodies with the structures of the eye, primarily muscles and fat tissue in the orbit which leads to fibrotic changes and can cause pushing the eye outward. Changes in the muscles lead to disturbances in the motility of the eye which causes double vision. Besides the subjective complaints and symptoms caused by the illness, such a condition consequently causes changes in the eyes. The most typical changes are bulging of the eyes that apart from the bad aesthetic appearance of the patient may also cause permanent damage to the surface of the anterior eye segment caused by unnatural exposure so the eye dries out due to the inability of normal blinking and eye closure.

Also, the patient may have problems with double vision as a result of changes in the eye muscles. Changes in the muscles cause uncoordinated movement of both eyes so the patient can have double vision.  Ophthlamological treatment is combined with mandatory internal medicine treatment of thyroid disease.. When medications and botox are not helping to improve the status, surgeries on the eyelids and eye muscles can be performed. Such operations are usually performed under local anesthesia. During eyelids surgery we correct shortening and collecting of tissue caused by thyroid hormones disorders. During surgery on eye muscles, strabismus is corrected and the impared motility resulting from the loss of elasticity is improved s. After surgery on the muscles the patient has to use prescribed eye drops and avoid physical exercises and smoky places for several weeks.