Oculoplastic Surgery — What To Expect

Oculoplastic surgery is a general term used to represent a variety of procedures that involve the orbit, eyelids, tear ducts, and the face. Ocular reconstructive surgery, aesthetic eyelid surgery, facial plastic surgery, and cosmetic procedures fall into this category.

Some types of oculoplastic surgery are considered both medically necessary and cosmetic. For instance, certain eyelid and periocular issues can affect a person’s appearance as well as their vision, eye comfort, and eye health.

Before you can undergo such surgery, your surgeon will check with your insurance company to determine whether your procedure is covered. An oculoplastic surgeon is an ophthalmologist who has completed additional training that focuses on the management of eyelid abnormalities, tearing problems, and orbital disease.

Because of the potential out-of-pocket cost of an oculoplastic procedure for the patient, it is important that you ask your surgeon to thoroughly explain the benefits of your procedure.

According to one study (Eye [London], 2012), patients who had undergone one of four commonly performed oculoplastic procedures derived significant quality-of-life benefits from it. These procedures included:

  • Entropion repair, which corrects eyelids that fold inward
  • Ectropion repair, which corrects eyelids that turn outward
  • Ptosis repair, which corrects drooping of the upper or lower eyelid
  • External dacryocystorhinostomy (DCR), which restores the flow of tears

Most oculoplastic surgeries can be performed on an outpatient basis, which means you go home the same day and recovery is fairly quick.

It is difficult to estimate the number of oculoplastic procedures performed in the United States each year. Oculoplastic surgery is performed on people of all ages for many different reasons.

According to the American Society of Plastic Surgeons, blepharoplasty (repair of droopy eyelids by removing excess skin, muscle, and fat) is one of the top five cosmetic plastic procedures performed. In 2012, over 200,000 blepharoplasties were performed in the United States.

Types of Oculoplastic Surgery

Oculoplastic surgery covers a wide range of procedures, including:

  • Eyelid surgery, including blepharoplasty and eyelid reconstruction, for ptosis, entropion, ectropion, and eyelid tumors
  • Tear duct surgery
  • Orbital surgery to manage thyroid and eye disorders, tumors, and trauma
  • Pediatric oculoplastic surgery to correct congenital defects and manage eye disorders in children
  • Eyebrow and forehead lifts
  • Facial rejuvenation (midface lift, lower face lift, facial implants)

Non-surgical treatments performed by oculoplastic surgeons include:

  • Skin rejuvenation (laser skin treatments, chemical peels, home skin care regimens)
  • Facial filler injections (Juvederm, Perlane, Restylane, Radiesse) to reduce wrinkles

How to Prepare for Oculoplastic Surgery

According to the American Society of Ophthalmic Plastic and Reconstructive Surgery, you can take the following steps to prepare for your surgery:

  • See your primary care physician or internist before your surgery for standard preoperative clearance. Patients who are taking daily doses of aspirin and warfarin under the care of a cardiologist may need to see their specialist, in addition to seeing their regular primary doctor, before being cleared for surgery.
  • Avoid certain medications (such as non-steroidal anti-inflammatory agents and warfarin) and over-the-counter supplements per your surgeon’s instructions.
  • Schedule a preoperative visit with the surgeon. This is separate from your initial consultation with the surgeon and is scheduled after you are cleared for surgery by your primary doctor.
  • Make arrangements for someone to pick you up the day of your surgery and stay with you for at least the first eight hours.

Oculoplastic Surgery Procedures

Most oculoplastic surgeries can be performed in your doctor’s office with local anesthesia. Patients who are having the procedure completed at a hospital or surgical center will probably receive intravenous sedation.

  • Eyelid surgery – Blepharoplasty, the most common type of eyelid surgery, is done through incisions following the natural lines of your eyelids. The surgeon makes the incision and then separates the skin from the underlying tissue to remove the excess fat, skin, and muscle. Sutures are then placed in the upper eyelids to close the incisions. The lower lids may not require sutures, depending upon the technique used. The procedure usually takes about two hours if both upper and lower eyelids are done together.
  • Tear duct surgery – To perform a dacryocystorhinostomy, your surgeon will make a small incision through the nose or through the skin on the inside corner of your eye and your nose. A new tear drain opening is created from the blocked sac directly into the nose. A stent may be left in the new tear drain temporarily to keep the duct open. In some cases, the obstruction remains blocked and a permanent artificial drain is placed behind the corner of the eyelids.
  • Orbital surgery – Before your orbital surgery, you will have to undergo radiographic testing (such as a CT scan) of your eye, and your surgeon will perform fine-needle aspiration. The results will help determine the surgical approach that will be taken. There are many different types of orbital surgery, and the surgical approach that will be chosen in your case depends on the location, size, and extent of disease present. In some instances, only a small skin incision — or no incision at all — is required. In others, large incisions are needed and visible scars may result. Your surgeon will remove or repair damaged tissues as necessary while carefully preserving eye function and vision.
  • Pediatric oculoplastic surgery – Unlike adults undergoing oculoplastic surgery, children undergoing eye surgery will nearly always require general anesthesia. Two common conditions in children that can be corrected by oculoplastic surgery are congenital ptosis and congenital tear duct obstruction. Many children who undergo oculoplastic surgery have associated syndromes and perioperative requirements. For this reason, oculoplastic surgery on a child is performed by a pediatric ophthalmologist trained in pediatric oculoplastic surgery.
  • Eyebrow and forehead lift – This procedure can be done through several small incisions in the scalp behind the hairline (endoscopic approach) or through one longer incision concealed in the hair of the scalp. Excess skin is removed to raise the forehead and eyebrow. Blepharoplasty of the upper eyelid may be done in conjunction with the eyebrow and forehead lift.
  • Face lift and implants – Regardless of the technique your surgeon uses, all face lifts remove excess fat, tighten underlying muscle, and redrape the facial skin. An incision is made in the area of the temple hair, just above and in front of the ear, and is continued under the earlobe to the back of the ear, where it blends into the hairline. Your surgeon lifts the skin and repositions and tightens the underlying muscle and connective tissue. Some fat may be removed, as well as excess skin. The incision will be closed with sutures or metal clips. This procedure is then repeated on the other side of the face. Facial implants are specially formed solid, biocompatible materials designed to enhance or augment the physical structure of your face. Determining the precise type and size of implants best suited for you requires an evaluation of your goals and the features you wish to correct, and your surgeon’s judgment.

After Oculoplastic Surgery

Your post-operative care will depend on the type of oculoplastic procedure you had. You will be provided with instructions to follow at home.

Your surgeon will likely ask you to take it easy and apply cool compresses on your eyelids for the first few days after surgery. Minimal activity is usually recommended to help minimize swelling, bruising, discomfort, and postoperative complications. After the first 48 hours, you can get up and move around.

However, exercising or heavy lifting should be avoided for at least one week after surgery, and in some patients for up to two weeks after surgery. If you have stitches, they will be removed in the office a week or two after your surgery.

Acetaminophen is usually recommended for any discomfort. Your surgeon may prescribe a stronger pain medication based on the treatment protocol for the surgery and his or her experience.

The time necessary to recover from oculoplastic surgery depends on the type of procedure performed, and can vary for each individual. Oculoplastic surgeries are generally free of complications, and most patients report little discomfort during their procedure and recovery.

Risks of Oculoplastic Surgery

With any type of cosmetic oculoplastic procedure — or any procedure that can alter your appearance — there is the risk that you may not be happy with the results. It is the responsibility of your ophthalmologist to fully explain the surgery’s limitations.

However, you also need to have realistic expectations about the benefits of the surgery, and you must be willing to accept the consequences of the surgery — and in most cases, the cost. The other major risk with oculoplastic procedures is that they are frequently considered elective surgeries by health insurance carriers and are not a reimbursable medical necessity.

Cosmetic oculoplastic surgery, like any surgery, can result in medical complications. In studies that evaluated claims against ophthalmologists related to oculoplastic surgery, the need for additional surgery was a frequent complaint from blepharoplasty patients.

Other complications included asymmetry, scarring, wound dehiscence (a wound bursting open), ptosis, and globe perforation during local anesthetic injection. Overcorrection was another problem that caused some patients to file claims. Visual impairment and vision loss are the most severe complications that can result from oculoplastic surgery.

Talking to Your Eye Doctor

Here are some questions to ask your eye care professional about oculoplastic surgery:

  • What activities should I avoid during my recovery period?
  • Will my surgery be performed under general or local anesthesia?
  • How much time should I plan to take off work following surgery?
  • What are the possible risks and benefits involved?
  • If I have the procedure, how long will it be before I can resume my normal daily activities?
  • What are the costs?
  • What steps can be taken if I am not satisfied with the results?

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This article was last updated on 09/2017