Surgery

Surgery | Cosmetic Procedures | Skin Resurfacing

Surgery

Surgery | Cosmetic Procedures | Skin Resurfacing

Oculoplastic and Reconstructive Procedures:

Most cosmetic and reconstructive facial procedures are intimately connected with your ability to see because they involve the eyes, eyelids, or the eyebrows. Oculoplastic facial and reconstructive surgeons, like Chet Reistad MD, are extensively trained in facial plastic surgery and ophthalmology, thereby taking into account the eye’s function and structure. These surgeons are highly qualified to treat the delicate tissues of the eye and provide safe and effective restoration, rejuvenation or repair. Dr. Reistad specializes in plastic surgery procedures that treat medical conditions that affect vision and eye health, and restore or enhance appearance and provide better vision.

Upper Eyelid Blepharoplasty

Upper eyelid blepharoplasty is eyelid surgery to remove excess, loose skin and reduce prominent fat pads when present.

This surgery can help reduce the fatigued appearance that comes with excess skin folds on the eyelids. Blepharoplasty is one of the most common plastic surgery procedures performed. Age, allergies (eyelid swelling) and genetics (often runs in families) are contributing factors to the development of excess eyelid skin. Blepharoplasty can be performed on the upper and lower eyelids and the surgery should be customized for each individual. Dr. Reistad has performed thousands of blepharoplasty surgeries on both men and women. Additionally, Dr. Reistad has experience with Asian blepharoplasty and the variations found in the anatomy of the Asian eyelid. Upper eyelid blepharoplasty is sometimes covered by insurance if the excess skin significantly blocks vision.

Ptosis

Ptosis (pronounced toe-sis) is a drooping or lowered position of the upper eyelid margin or edge (where the lashes come out), as opposed to drooping of excess skin over the lashes (dermatochalasis).

When the lid margin/edge begins to cross the pupil with eyes open, vision can become obstructed.

There are a variety of causes for this condition. Most commonly, there is a slippage or dis-insertion of the muscle that elevates the upper eyelid (called the levator). This can occur with age, stretching of the eyelid after swelling, contact lens wear or ocular surgery. The correction of this type of ptosis involves a delicate outpatient surgery.

Patients born with ptosis (other than that caused by birth trauma to the eyelid) can have what is termed congenital ptosis. In this condition, the muscle that elevates the eyelid (levator) is not formed normally. This can be an urgent problem if the eyelid covers the pupil while the child is awake because visual input to each eye can lead to permanent poor vision in the occluded eye (amblyopia).

Other causes of ptosis include neurologic problems such as third cranial nerve palsy, Horner’s syndrome, eyelid trauma, Myasthenia gravis (ocular or systemic), inadvertent Botox placement and orbital tumors. Clinical evaluation is necessary to determine the cause of the ptosis and choose the appropriate treatment.

Entropion

Entropion is a turning or rolling in the eyelid edge or margin towards the eyeball.

This may be noted initially only in the mornings on awakening and then become more constant over time. In this condition the eyelashes and even the eyelid skin can rub on the eyeball causing irritation, pain, redness and even infection. The common cause is a looseness of particular eyelid muscles. Other causes include scarring from surgery, tumors and autoimmune conditions (ocular cicatricial pemphigoid or OCP). Surgical correction, again, depends on the specific cause.

Retraction

Retraction is a shortening of the vertical position of the eyelid, such that it’s edge or margin rests too high (upper lid) or too low (lower lid) on the eyeball in relation to the pupil.

This can even be severe enough that the eyelids do not close when sleeping (lagophthalmos). Causes include thyroid-related eye disease, prior eyelid surgery (overzealous cosmetic surgery) or trauma and skin cancers.

Laxity

Laxity occurs with stretching or weakness of the tendons holding the eyelid in place.

The tension of the eyelid on the eyeball plays an important role in getting the tears to go into the tear drain ducts and getting pumped into the nose.

Ectropion

Ectropion is a turning or rolling out of the eyelid edge or margin away from the eyeball.

This can lead to tearing, red, irritated and inflamed eyes and even eye infections. Causes include age-associated looseness or tightness of facial skin from sun-damaged or scarring from burns/trauma/prior eyelid surgery/skin cancer excision. Other causes include paralysis of the facial nerve and repeated rubbing or stretching of the eyelid. Surgical correction technique depends on the cause and commonly involves tightening of loose eyelid tendons, but may require skin grafting or more extensive surgery.

Reconstruction

Patients who have suffered a traumatic eyelid injury and/or face injury or had prior eyelid or periorbital surgery and have residual malposition may benefit from oculoplastic reconstructive surgery.

Additionally, patients who have eyelid or facial skin cancers may require excision and reconstruction of the defect.

Patients who have suffered a traumatic injury to the eyelids or periocular region from such things as motor vehicle accidents, dog bites, flying projectiles and falls often seek Dr. Reistad’s expertise for eyelid reconstruction, particularly when there is concomitant trauma to the tear drainage system.

Cancer Reconstruction

Cancers include the most common skin cancer, basal cell carcinoma, as well as squamous cell carcinoma, melanoma and melanoma in-situ.

Less common eyelid cancers include sebaceous cell carcinoma and Merkel cell carcinoma.

Mohs surgery is a technique used to remove basal or squamous cell skin cancers from the eyelids, nose, lips and ears. Dr. Reistad often works in close coordination with dermatologists and Mohs surgeons for patients with eyelid skin cancer. Eyelid reconstructive surgery is often required following Mohs surgery.

In order to achieve the best structural, functional and aesthetic result possible, reconstructing the defect left by the removal of the skin cancer is often performed by a reconstructive and oculoplastic surgeon. Dr. Reistad has extensive training in aesthetic wound closures for scar minimization and he specializes in the eyelids, orbit and tear drain system.

Excessive Tearing

Excessive tearing can occur from many causes, including but not limited to eyelid malposition (ectropion/entropion), misdirected eyelashes, eyelid laxity, plugged or blocked tear drain passages in the eyelid or nose, chemotherapy, nasal or facial fractures, old punctal plug placement and even dry eyes (yes, that is correct!). Proper evaluation is necessary to identify the cause and determine the proper treatment.

Surgical treatments, when necessary, include tear duct surgery (dacryocystorhinostomy – DCR), conjunctivodacryocystorhinostomy (CDCR – Jones tube placement), tear duct stenting, plastic repair of the canaliculi and punctoplasty. Dr. Reistad commonly performs DCR surgery endoscopically (through the nose without making an incision on the face), although occasionally an external incision is necessary.

Orbit/Eye Socket Surgery

Dr. Reistad is a trained orbital surgeon. The orbit or eye socket is a boney cavity that contains the eyeball, fat, blood vessels, as well as the muscles (6) that move the eye, the optic nerve and other nerves.

Conditions that can necessitate orbit or eye socket surgery include orbital tumors (biopsy or excision), blind painful eyes or eyes with intraocular tumors (enucleation or removal of the eyeball), thyroid eye disease (orbital decompression) and eye socket fractures (orbital fracture repair). Dr. Reistad also treats inflammatory and infectious conditions of the orbit.

Misdirected Eyelashes

Some patients are afflicted with lashes that grow from the wrong area on the eyelid (distichiasis) or in the wrong direction (trichiasis) and brush against the eyeball.

An examination is necessary to ensure an eyelid cancer or growth is not causing the lash distortion. Plucking of hard to remove eyelashes can be performed under magnification (epilation), but requires repeat treatments as the lashes re-grow. Dr. Reistad performs electrolysis on misdirected eyelashes under the microscope when appropriate, to effect a more permanent lash removal. Treatment is chosen depending on the nature and severity of the condition. If eyelid malposition is responsible for lashes rubbing on the eyeball, this must be corrected.