Plastic Surgery (Oculoplastics)

Serving Kingston, Scranton, Wilkes-Barre and all of Northeastern Pennsylvania (NEPA)

Oculoplastic surgery is the cosmetic, corrective, and reconstructive surgery of the eye. It manages and repairs problems primarily related to the tissues or structures surrounding the eye, rather than the eyeball itself. These structures include the eyelids, the tear ducts, and the orbit (bony socket surrounding the eye). Ophthalmic plastic surgeons are board-certified ophthalmologists who have completed several years of additional, highly specialized training in plastic surgery.

Dr. Richard Roth has specialty training in Ophthalmic & Facial Plastic Surgery. A brief description of several of the conditions treated at Eye Care Specialists is listed below.

BOTOX® Cosmetic

BOTOX® Cosmetic is utilized to treat blepharopspasm which is a condition in which the eyelid muscles around the eye close involuntarily.

BOTOX® Cosmetic is a protein that weakens muscles that wrinkle the skin. It is injected under the skin into areas surrounding the eyes, forehead and mouth to reduce “worry lines,” “crow’s feet” and “frown lines.” The procedure is quick and usually done in an examination room.

The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance. Studies have also suggested that BOTOX® Cosmetic is effective in relieving migraine headaches, excessive sweating and muscle spasms in the neck and eyes.

Brow Lifts

Brow lift surgery cosmetically corrects drooping eye brows, upper eyelids, and sagging skin on the forehead. It dramatically helps improve the horizontal lines and furrows that can make a person appear angry, sad, or tired. A brow lift is commonly performed on patients in the 40-60 range, helping to minimize the visible signs of aging.

Eyelid Surgery

Blepharoplasty

Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat–usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision. However, it won’t remove crow’s feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift.

Ptosis

Ptosis is drooping of the upper eyelid. The lid may droop only slightly or it may cover the pupil entirely. In some cases ptosis can restrict and even block normal vision.

Congenital ptosis, or ptosis that is present at birth, requires treatment for normal visual development. Uncorrected congenital ptosis can cause amblyopia, or lazy eye. If left untreated, amblyopia can lead to permanently poor vision. Except in mild cases, the treatment for childhood ptosis is usually surgery to tighten the levator muscle that lifts the eyelid. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so the forehead muscles do the lifting. Children with ptosis, whether they have had surgery or not, should be examined annually by an ophthalmologist for amblyopia, refractive disorders, and associated conditions.

Adult ptosis is commonly caused by separation of the levator muscle from the eyelid as a result of aging, cataract or other eye surgery, an injury, or an eye tumor. Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as diabetes.

If treatment is necessary, it is usually surgical. Sometimes a small tuck in the levator muscle and eyelid can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very infrequently. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return.

Eyelid Laxity

Ectropion is the medical term used to describe sagging and outward turning of the lower eyelid and eyelashes. The margin of the eyelid and the eyelashes revert (turn out) . This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye.

Entropion is the medical term used to describe sagging and outward turning of the lower eyelid and eyelashes. The margin of the eyelid and the eyelashes invert (turn in) . This rubbing can lead to excessive tearing, crusting of the eyelid, mucous discharge and irritation of the eye.

Trichiasis is the medical term used for lashes pointing to the eye. Floppy eyelid syndrome is the medical term used for when the eyelid spontaneously inverts.

Radio Wave Removal of Benign Lesions and Skin Cancers

Large or small moles, growths, spots, skin tags, undesirable bumps, blemishs, and spider veins can be removed without scars, stitches or injectable anesthesia. A fine wire, using radio waves can literally shave off these lesions one layer at a time, without leaving a mark.

Tear Duct (Lacrimal) Surgery

The lacrimal gland produces tears which enter into the “duct” that drain the tears from the eye into the nose. The most common symptoms are excess tearing (tears may run down the face) and mucous discharge.

If one has a plugged up “tear duct,” not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected. This may lead to recurrent red eyes and infections. The excessive tearing can also produce secondary skin changes on the lower eyelids.

Graves’ Eye Disease Evaluations

Graves’ disease is a condition in which the thyroid gland is hyperactive and the eyes are affected. Although Graves’ disease may develop at any age and in either sex, it most often affects women 20 to 60 years old.

When Graves’ disease affects the eyes, it is called Graves’ ophthalmopathy. Eyes may bulge or appear red and swollen. The space between the lids (palpebral fissure) may widen. Excess tearing and discomfort may occur in either or both eyes. Patients may experience sensitivity to light, blurring or double vision, inflammation, or decreased movement.

Orbital Tumors

The orbit is defined by the anatomic site that contains the bones of the eye socket, the eyeball, the muscles responsible for eye movement, the optic nerve and the fat which fills the spaces in between. Any of these structures may degenerate into a tumor. In addition, tumors arising from the surrounding sinuses, brain and nasal cavity may grow through bone and invade the orbital confines. Metastatic tumors may also travel to the orbit. Orbital tumors may affect both adults and children. Fortunately, in both age groups most orbital tumors are benign.

In children most tumors are the result of developmental abnormalities. The most common benign tumors in children are dermoids (cysts of the lining of bone) and hemangiomas (a blood vessel tumor). Children also commonly suffer from orbital cellulitis, an infection that usually starts as a severe sinusitis secondarily invades the orbit and results in prominence of the eyeball. Malignancies in childhood are unusual (most common is rhabdomyosarcoma), but any rapidly growing mass is cause for concern.

In the adult population the most common benign tumor is also a blood vessel tumor (hemangioma, lymphangioma and arteriovenous malformation). Tumors of the nerves (schwannoma), fat (lipoma), as well as those that evolve from the surrounding sinuses (mucocele) occur less commonly. Frequently pain and prominence of the eyes can be mistakenly attributed to the growth of a tumor. However, further evaluation often reveals a benign non-infectious inflammatory process termed pseudotumor (as an indication of the diagnostic confusion associated with this entity). Alternatively the inflammation may result from a systemic process such as Graves’ thyroid disease. The most common malignant orbital tumors in adults are lymphomas. Often they are initially confined to the orbit without any systemic manifestations. Metastatic tumors most frequently arise from the breast and prostate. Direct invasion of the orbit from the surrounding skin and sinus cavities can occur from squamous and basal cell cancer. Other malignancies that arise from tissues within the orbit are least common (hemangiopericytoma, chondrosarcoma, malignant neurofibroma). The evaluation of a patient with a prominent eye begins with a careful history and examination by a specialist trained in the field of orbital diseases. In addition to progressive prominence of one or both eyes, troubling symptoms include pain, loss of vision or double vision, redness and swelling of the eyelids and the presence of a palpable mass. Most often either a CAT scan or MRI will be ordered to more carefully define the condition. If suspicious, a diagnostic biopsy may be required. Some conditions require no treatment. Others are best treated medically or with the use of radiation therapy. The remainder require surgical excision. Fortunately, surgery has become safer through the use of CAT scans and MRI for preoperative planning and the intraoperative use of operating microscopes and surgical lasers.

Skin Tumors

There are many different types of tumors that can occur in and around the orbital area. The surgeon may remove the tumor and have a pathologist check the tissue margins (“frozen section”) to be sure the tumor is completely removed. Alternatively, a dermatologic surgeon may excise the tumor in a special way (“Mohs technique”) to ensure total removal.

Once the tumor has been completely removed, reconstructive surgery is sometimes necessary. Reconstructive surgery is performed to make a new eyelid or repair the defect.

Needless to say, the goal is to reconstruct the eyelid so that it functions properly, protects the eye, preserves vision, and has a satisfactory cosmetic appearance. The patient must keep in mind that any form of therapy for eyelid skin cancer will leave a scar. However, an effort is always made to minimize scarring and obtain optimal cosmetic results.

After surgery, the healing process may take six months to one year. Once the wound has healed, follow-up with your physician is necessary to be sure that the skin cancer does not recur. Should there be development of a new cancer, it can then be detected early and treated promptly.

Trauma

Approximately 500,000 serious eye injuries occur each year; 25,000 lead to total blindness – especially in young adults. The eyelids, tissue around the eyes, and the bones of the orbit may be damaged by many types of trauma including car accidents, fights, sports injuries, or fireworks.

Please contact Eye Care Specialists today to schedule your oculoplastics consultation. We serve patients in Scranton, Wilkes Barre, Kingston, and throughout Northeastern Pennsylvania.