Oculoplastic Surgeons of Philadelphia

BOTOX® Cosmetic Botox injections are the most commonly performed cosmetic procedure used to reduce or eliminate the appearance of facial wrinkles through minimally invasive injections. These injections are made from botulinum toxin A, a therapeutic muscle-relaxing agent approved by the FDA for several different uses. When injected into the skin, it can block the nerves and muscles that are responsible for the repetitive actions that cause fine lines and wrinkles, smoothing them away for a younger and more refreshed appearance. Dysport® Injectable Prescription Dysport® injectable is a U.S. Food and Drug Administration-approved treatment for temporarily lessening or eliminating moderate-to-severe frown lines between the eyebrows. Like BOTOX® Cosmetic, Dysport injectable is placed directly into the muscle underneath a furrow, weakening the muscle to the point where it cannot contract. Dysport, also known as Reloxin, is made from a neurotoxin produced by the bacterium Clostridium botulinum; it is the same neurotoxin used in BOTOX Cosmetic. Xeomin® Xeomin® is a prescription medication used to effectively treat intramuscular conditions such as blepharospasm, or abnormal involuntary closing of the eyelid. It may also be used with indications similar to Botox® and Dysport® above. Xeomin is composed of botulinum toxin type A, a naturally occurring protein that is produced by the bacteria Clostridium botulinum. Xeomin is injected into the affected muscles in order to reduce their activity. This is achieved by inhibiting a body chemical called acetylcholine from signaling all of the nerves within the muscle to contract. Belotero Balance® The active ingredient in Belotero Balance is hyaluronic acid, or HA, a naturally-occurring substance within the skin. The HA binds to water, plumping the skin tissues and filling in wrinkles and lines around the treatment site. Restylane® Restylane® is an FDA-approved dermal filler made of hyaluronic acid that restores volume to the skin, lifting and smoothing out wrinkles and other fine lines. Restylane produces results that last for several months through its unique ability to bind with water and remain in the skin. The results of this procedure are visible right away, and can last for several months, depending on the condition of the individual patient’s skin. Radiesse® Radiesse® is a synthetic injectable filler that has been approved by the FDA to reduce moderate to severe wrinkles, folds and creases around the nose and mouth by stimulating the natural production of collagen in the skin. This product is made of microspheres composed of calcium hydroxylapatite within a water-based gel and is made from minerals similar to what makes up our bones. Juvéderm® Juvéderm® Injectable Gel is a safe, effective gel that restores volume to the skin and smoothes away moderate to severe facial wrinkles and folds. Juvéderm is the first FDA-approved dermal filler proven safe and effective for persons of color. The Juvéderm gel is made of hyaluronic acid with a smooth consistency, allowing for easy injections and instant, natural-looking results. Juvéderm Voluma™ Juvéderm Voluma™ is a new, FDA-approved dermal filler formulated specifically to add volume to the face around the cheeks and chin. The active ingredient in Juvéderm Voluma is hyaluronic acid (HA), which is a substance naturally produced within the skin. This is the only injectable gel created to provide a subtle, natural enhancement to the mid-face, addressing changes in definition that occur over time. Juvéderm Voluma can help restore more youthful contours by plumping up the area that so often loses volume as part of the aging process. Vitrase Vitrase, also known as hyaluronidase, is a natural substance found within the body, that is used to increase the body’s absorption of fluids or medicines that have injected into the skin. Vitrase should only be injected by a trained medical professional, and should not be injected into patients who are breast-feeding or have a history of severe allergies. Although rare, side-effects of vitrase may include difficulties swallowing, dizziness, irregular heart rates, itching, rashes, and redness of the skin. Thermage® The Thermage® procedure is an advanced way of tightening skin that uses a unique form of radiofrequency energy to allow the physician to tighten loose or sagging skin, producing a kind of “lift” without an incision or prolonged recovery time. It is a wonderful non-invasive method to tighten loose skin. Pellevé® Pellevé® is an FDA-approved wrinkle treatment that uses radiowave technology to improve the appearance of wrinkles, fine lines, and other skin imperfections through an effective and convenient procedure. Performed by our team of highly trained and experienced doctors, Pellevé can rejuvenate the facial skin for a fuller, more youthful-looking appearance that more accurately reflects the way you feel about yourself.

Blepharoplasty (Eyelid Surgery) By removing excess fat, skin and muscle from the upper and lower eyelids, blepharoplasty can rejuvenate puffy, sagging or tired-looking eyes. It is typically a cosmetic procedure but can also improve vision by lifting droopy eyelids out of the patient’s field of vision. Incisions are made along the eyelids in inconspicuous places (in the creases of the upper lids, and just below the lashes on the lower lids). The surgeon removes excess tissue through these incisions and then stitches them closed with fine sutures. Ptosis Ptosis is the drooping of the eyelid. While ptosis is usually the result of aging, some people develop ptosis after eye surgery or an injury, and some children are born with the condition. Patients may seek treatment for droopy eyelids for cosmetic and/or medical purposes. Severe drooping may obstruct vision as the eyelid gradually droops lower and lower, eventually covering the eye. If ptosis interferes with a patient’s vision, a brief surgical procedure will be performed to eliminate the drooping. Other patients are simply bothered by the appearance of their eyelids and choose to have this common procedure performed. Entropion & Ectropion Entropion is a condition in which the eyelid tends to turn inward, causing irritation to the eye. Entropion can be caused by a congenital defect, aging, spasm, inflammation from another ocular disorder or scarring from a previous trauma or surgery. The cornea can be damaged if this condition is not corrected. Treatment for entropion is a brief surgical procedure with local anesthesia. Ectropion is a condition in which the eyelid tends to turn outward, exposing the inner lid of the eyelid in either one section of the eye or across the entire lid. Ectropion can be caused by the aging process, facial paralysis, a congenital birth defect, or scar tissue from a previous trauma or surgery. Correction of the condition is completed with a brief surgical procedure in which the eyelids are repositioned. Trichiasis Trichiasis is a condition in which the eyelashes turn inward and irritate the cornea or conjunctiva of the eye. Treatment for trichiasis generally involves epilation, or the removal of the incorrectly positioned lashes. When a permanent solution is needed for recurrent or particularly painful eyelash problems, epilation with electrosurgery may be recommended. Epilation with electrosurgery is a procedure that employs a radiofrequency device to permanently remove the follicles of the affected eyelashes. A fine-wire electrode is inserted directly into each individual eyelash follicle that is malpositioned. An electrical current is used to destroy these follicles so that hair growth can no longer occur. Cryotherapy is reserved for cases in which the above therapies fail to cure the trichiasis. Surgically removing the lash-bearing eyelid portion may then be considered in truly refractory cases. Browpexy Internal, Direct & Pretrichial A Browpexy is a procedure which lifts the eyebrows through incisions in the upper-eyelids, returning the eyebrow to an aesthetically-pleasing location on the upper face. Using an internal browpexy technique, descended brow fat is reattached to the forehead through an upper eyelid incision. A direct browpexy is used for small amounts of brow ptosis with a direct incision above the brow. Pretrichial browpexy. Pretrichial browpexy is performed through a longer incision hidden along the hairline, raising the brows and smoothing the forehead. This may be done with endoscopic assistance. Each procedure has it’s benefits and indications, and is therefore customized for each patient accordingly. Tarsorrhaphy, Canthoplasty & Canthopexy Tarsorrhaphy is a procedure in which the eyelids will be partially sewn together in order to narrow the palpebral opening. Tarsorrhaphy is usually performed when the eyelids become weak and can no longer close or blink effectively, which may lead to corneal and other eye problems. Temporarily sewing the eyelids partially together will help protect the eye until more permanent measures can be taken. Permanent tarsorrhaphies may be performed for chronic eyelid or eye problems. Canthoplasty is a surgical procedure which is used to create an upward slant in the outer corner of the eyelid, or to correct a drooping or dystopic appearance in this portion of the eyelid. Canthopexy is a surgery which lifts the external corners of the eye when they are sagging, eliminating a tired appearance, and restoring a more youthful look around the eyes. It is similar to a canthoplasty but involves slightly less intervention.

Mohs Surgery Reconstruction Mohs micrographic surgery is a procedure used to remove skin cancer with precision and success. While we remove and reconstruct many eyelid lesions, some are more amenable to being excised with an experienced MOHS surgeon. For these cases we will work with your MOHS surgeon and reconstruct the resultant eyelid defect after he or she has removed the lesion. Despite its high level of efficiency, Mohs surgery often leaves behind large wounds or scars in prominent areas. These deformities can be emotionally upsetting as well as physically damaging to the eyelid and eye. Fortunately, plastic surgery can be performed to repair the wound and restore your skin to a more healthy and natural appearance. While complete tumor resection is the main goal, your doctor also takes your appearance into consideration by leaving as much healthy tissue as possible. Reconstruction uses this remaining healthy tissue to carefully restore the area for both effective and aesthetic results. This may involve moving skin around within the surgical area, or taking skin from other areas (eyelids, behind ears) to graft in place. Blepharospasm Treatment Blepharospasm is a condition in which the eyelids spasm, closing involuntarily, forcing the patient to blink abnormally. Blepharospasm is a form of focal dystonia or abnormal contractions of the eye muscles. Patients with blepharospasm have normal vision, but the disturbance interferes with visual perception and may, in severe cases, result in functional blindness. There is no current cure for blepharospasm but there are treatment possibilities. These include: Oral Medications Several medications have been found to be helpful in some cases of blepharospasm. Some of these medications may include: clonazepam, also known as Klonopin, lorazepam, also known as Ativan, haloperidol, also known as Haldol, diazepam, also known as Valium, and zolpidem, also known as Ambien. These are often prescribed and managed by a neurologist. Ritalin has also been used with success. Injections Injection the affected eye muscles with botulinum toxin (BOTOX®), incobotulinumtoxinA (XEOMIN®), or abobotulinumtoxinA (DYSPORT®) is currently the most successful treatment for blepharospasm. This may be repeated every 3 months as indicated. Surgery If medications and injections prove ineffective in treating blepharospasm, surgery may be recommended. The surgical procedure for this condition is called a myectomy. It involves removing portions of the affected muscles to relieve symptoms. Other problems, such as an inability to open or close the eye, may be managed with ptosis surgery or canthoplasties. Injections of botulinum toxin may be required after the surgery. Deep Brain Stimulation While still experimental, this method of treatment has demonstrated important possibilities in the treatment of blepharospasm. Alternative Treatments Sometimes alternative treatments are used, either alone or combined with prescribed medications or injections, to combat the symptoms of blepharospasm. These treatments may include: acupuncture, chiropractic care, biofeedback and nutritional therapy. Eyelid Crease Formation & Fixation Eyelid creases may change with the aging process, inflammation, and injuries, since the skin around the lids is much thinner than other parts of the face. People of different backgrounds, races, and ethnicities also may have different types of creases from anatomic differences. Fixation and formation of eyelid creases is possible for both cosmetic and functional reasons. Cosmetic blepharoplasty may be performed to remove fat and skin from, and to reshape, either the upper and/or lower eyelid. During this procedure the lid crease will be fixated and the incision created at the desired level. See blepharoplasty above. Floppy Eyelid Syndrome Treatment Floppy Eyelid Syndrome, or FES, is an uncommon ocular condition that occurs when the upper eyelids are loose and may be easily turned inside out. FES is often associated with sleep apnea and metabolic syndrome. While lubrication may be used to treat an affected eye, these treatments are usually not successful at treating the underlying problem, so surgery is usually required for the condition. Surgery will usually involve removing a segment of the eyelid, tightening the eyelid and turning it correctly. Additionally, see your primary care physician if you suffer from FES for a sleep study to evaluate for sleep apnea and a full medical work-up of hypertension and associated cardiovascular risk factors. Excision Of Lesions On Eyelids Lesions on and around the eyelids are extremely common, and may be either malignant or benign in nature. If a lesion is suspected to be benign, patients usually prefer to eliminate the entire growth, a process known as an Excision, or Excisional Biopsy.

Punctal Plugs Punctal plugs, also known as punctum plugs, lacrimal plugs, or occluders, are a method of treating dry eyes. Punctal plugs can relieve dry eye symptoms when eye drops or ointments fail. Punctal plugs are placed in the opening of the tear duct, reducing the natural drainage of tears and keeping the eyes moist. Punctal plugs can be a temporary or permanent solution to dry eyes. Tear Duct Probing, Irrigation, Intubation A nasolacrimal duct obstruction, more commonly known as a tear duct obstruction, is a common condition that affects infants and is present at birth. Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. When an obstruction exists, tears cannot properly drain from the eyes and may well up on the surface of the eye and overflow on the eyelashes and eyelids. The eyelids may also become red and swollen with yellow or green discharge. This pathology in children is usually different than that in adults. While most cases of tear duct obstructions clear on their own during the first year of life, certain measures can be taken to ensure that the eye is kept clean and free of infection, such as a tear duct massage performed three times a day or antibiotic eye drops to relieve discharge. If an obstruction does not clear up by the time the child is a year old, a minimally invasive procedure using a probe to relieve the obstruction may be used. This procedure involves passing a soft probe through the tear duct and into the nose to open any obstruction within the path. The procedure takes about 10 minutes to perform. Adults may also benefit from the probing procedure, however some cases may need to be treated with surgery to clear the obstruction of the duct. Dacryocystorhinostomy If tear blockage cannot be effectively treated through conservative methods, surgery will likely be recommended. A procedure known as dacryocystorhynostomy or dacryocystorhinostomy (DCR) will be performed to construct a new tear drain. This type of surgery is usually performed as an outpatient procedure, either using local anesthesia and sedation or general anesthesia. Given the difference in cause, this is usually the treatment for tear duct obstruction in adults, as opposed to the probing and irrigation noted above for children. Canalicular Reconstruction & Repair Canalicular lacerations are breaks in the normal tear duct drainage system, which originates with the puncta, which acts as a conduit for tears to travel from the eyelid through the nasolacrimal sac into the nose. This type of injury often results from blunt or sharp trauma. If there is obvious damage, surgery is usually more effective within 48 hours of the injury, once the surrounding tissue swelling has healed. The surgical technique used for canalicular reconstruction and repair will depend on the extent of the patient’s injuries, and may be performed under local or general anesthesia Balloon Dacryoplasty Balloon Dacryoplasty, also known as balloon dacryocystoplasty, is a surgical procedure that opens a blocked tear duct without making an incision in the nose or face. During the procedure, a thin wire will be inserted through the hole in the corner of the eye, through which tears drain. The wire, which contains a tiny, deflated balloon, is then threaded through to the obstructed area, and the balloon is inflated with a liquid. The pressure of the balloon will open and expand the blocked duct. The balloon will next be deflated, and removed, along with the wire. The procedure is usually performed under deep conscious sedation or general anesthesia in the operating room. As with most operations, antibiotics will be taken for several days after this procedure, in order to prevent infection. Lacrimal Gland Plication The Lacrimal Gland is a small, almond-shaped structure, which produces tears and is located just above the upper, outer corner of the eye. The lacrimal gland helps keep the surface of the eye lubricated, and moistened. Excess tears will drain into the small ducts, which empty into the nasal cavity. Lacrimal Gland Biopsy A Lacrimal Gland Biopsy may be performed if a lacrimal gland growth or enlargement is noted, to rule out malignancies and provide a diagnosis allowing for treatment. Symptoms of lacrimal gland tumors may include eyelid swelling that lasts for several months or pain in this area. A biopsy is usually conducted based on radiographic tests, which will indicate the size of the tumor in the area.

Orbital Fracture An orbital fracture is a serious break or crack in one or more of the bones of the eye socket. Depending on whether the eye muscles are injured or trapped in the fracture, an orbital fracture can cause double vision. Considerable swelling in the eye area typically accompanies this type of injury. Once swelling recedes, the eye may appear recessed more than is normal. It is often for both cosmetic and functional reasons that surgical treatment of an orbital fracture is necessary. After an injury to the eye area, a thorough physical examination of the eye and its surrounding structures is necessary. In many cases, antibiotics are prescribed to prevent infection, and anti-inflammatory medications are prescribed to promote a rapid reduction in swelling. Imaging tests such as CT scans may be performed to determine the precise location of the injury and its severity. Enucleation And Evisceration Eye enucleation is the removal of an eye due to: Disease Trauma Blindness Eye pain Usually the adjacent supporting structures of the eye socket and eyelids are not removed. An evisceration is a similar process that only removes the contents of the eye but leaves the shell of the eye itself. Indications and contraindications of both eviscerations and enucleations are varied, and will be discussed by your physician. In most cases the enucleated/eviscerated eye is replaced with an orbital implant and a prosthesis, or artificial eye. Orbital Fat/Bone Decompression Orbital Decompression is a common surgery that creates more space within the orbit, allowing the eye to return to a more normal position. The procedure is performed on patients with eye proptosis, a condition which results in eye displacement. Orbital decompression surgery focuses on removing bone from one or more walls of the orbit, and the removal of orbital fat. Orbital Implant Orbital implants are attached to muscles and other structures in the eye socket at the time of surgery, so they feel secure. Patients are therefore able to retain the ability to move the artificial eye. 6 weeks after enucleation or evisceration, after the socket has healed, a prosthesis is designed and placed behind the eyelids by an ocularist. Ocularists are medical artists who fashion a prosthetic eye out of bio-compatible, non-toxic, and non-allergenic materials that look natural. The prosthesis is custom-fitted and colored to match the patient’s other eye. Orbital Mass The orbit of the eye consists of tissues surrounding the eyeball, including muscles that move the eyeball in different directions and the nerves attached to the eye. Orbital masses are lesions behind and around the eye which may impact the nerves, muscles, and blood vessels of the eyes. Common symptoms of these masses include double vision, severe pain, and vision loss. Orbital Reconstruction Orbital Reconstruction is a procedure which repairs various deformities and complications of the orbit, including orbital dystopia, fractures, and exorbitism, which occurs when normal orbital tissue exists, but a small bony orbit results in the eyes bulging outwards. CT scans will help diagnose these deformities, and orbital reconstruction will help correct these deformities through many and various techniques. Thyroid Muscle Strabismus Surgery Hyperthyroidism, also known as an overactive thyroid gland, involves an excessive amount of hormone production that can lead to weight loss, irregular heartbeat, and irritability. One of the most common reasons for an overactive thyroid gland is Graves’ disease, an autoimmune disorder in which antibodies cause the thyroid muscle to produce too much of the hormone thyroxine. Common symptoms of thyroid eye disease include bulging eyes, swollen eyelids, and red eyes. If conservative treatment measures, such as glasses and prisms, are not effective, than surgical treatment may be recommended. Strabismus surgery repositions fibrotic eye muscles to better align the eyes, and corrects the double vision associated with thyroid eye disease.