..: All Cosmetic & Reconstructive

Cosmetic Blepharoplasty

Surgery to improve the appearance of the eyelids is called blepharoplasty. The goal of blepharoplasty is to give the eyes a more youthful look by removing excess skin, bulging fat, and/or lax muscle from the upper or lower lids. If the sagging skin obstructs peripheral vision, blepharoplasty can eliminate the obstruction and expand the visual field.

Excess skin, muscle and/or fat arc removed from the upper lid through an incision hidden in the natural eyelid crease. If the upper lid is droopy, the muscle that raises the lid can be tightened. The incision is then closed with fine sutures.  Many patients have special procedures to tighten their skin or to improve their eyefold positions.

Fat in the lower lid can be removed or repositioned through an incision hidden on the inner surface of the lid (transconjunctival blepharoplasty). Laser resurfacing  can be performed at the same time if desired, to smooth and tighten the lower lid skin.  If there is excessive skin in the lower lid, the incision is made just below the lashes. Fat can be removed or repositioned through this incision, and the excess skin is removed. The incision is then closed with fine sutures.

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Asian Blepharoplasty

Upper eyelid surgery is frequently requested by our Asian patients to enhance the upper eyelid fold and create a smooth but natural double eyelid.  There is no single “correct” appearance of the eyelids.  At  your consultation, Dr. Levin will consider any pre-existing crease or fold, the amount of skin in your upper eyelids, the position of your eyebrows, and your own feelings of  what makes eyes attractive and natural.  Lower eyelid surgery is most commonly performed to smooth out the lower eyelid bags that increase with age.  Lower eyelid surgery may be performed without a visible incision (transconjunctival blepharoplasty) in many Asian patients.

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Special Blepharoplasty Techniques

Some patients benefit from transfer of the bulging lower eyelid fat into areas of relative depression in the area around the eyes.  (Fat Transfer).  Other patients benefit from surgical elevation of their cheeks or cheek fat pads. (Midface or SOOF Lift). Dr. Levin will discuss special techniques beyond traditional blepharoplasty that might improve your appearance.

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Male Blepharoplasty

Men should look rested, attentive and energetic.  The eyes can make a man look tired and elderly.  In general the goals of upper eyelid surgery in men is to lift the eyelid skin off the lashes, without making the eyes look hollow or feminized.  In the lower eyelid, many men want reduction of the bags and smoothing of the line between the eyelid and the cheek.  These concerns are particularly common among active and working men who are often interacting with men and women years or even decades their junior.  Dr. Levin will discuss your particular features and possibilities with you.

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Brow Lift (Forehead Lift)

Eyelid surgery will not elevate a drooping brow or compensate for heaviness in the forehead. A procedure to elevate the brows may be appropriate, instead of, or in addition to upper lid blepharoplasty.

Correction of brow ptosis can be accomplished through incisions directly above the brows, in the forehead creases, or at the hairline.

To raise the brows and forehead, Dr. Levin usually performs an endoscopic brow lift.  The endoscopic brow (forehead) lift is performed through small incisions hidden behind the hairline, using an endoscope and special dissection instruments. The  muscles that pull the brow down and crease the forehead skin are relaxed, allowing the brow to be raised into a more youthful position. The brow is held in position with the Endotine, a dissolvable fixation devise.  Today's brow lift (forehead lift) is far simpler than that of 15 years ago.

Cold compresses are applied for 24 hrs. to reduce swelling and bruising. Antibiotic ointment is prescribed. Strenuous activity should be minimized for 10 days.

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Ptosis Surgery

Ptosis is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes. When the edge of the upper eyelid falls, it may block the upper field of your vision.  Symptoms of ptosis include a decreased ability to keep your eyes open, eye strain and eyebrow fatigue from the increased effort needed to raise your eyelids, especially when reading. In severe cases, it may be necessary to tilt your head back or lift the eyelid with a finger in order to see out from under the drooping eyelid(s). You may also complain that your eyes have a tired appearance from "droopy eyelids" even though you are well rested.  Often other people perceive you as looking “tired” or “old”.

Acquired ptosis is most commonly due to stretching of the levator muscle in the eyelid. The levator muscle is the major muscle responsible for elevating the upper eyelid. Another cause of acquired ptosis is interference with the nerve supply to the muscle. Acquired ptosis may occur as a result of aging, trauma, or muscular or neurologic disease.

As you get older, the tendon that attaches the levator muscle to the eyelid stretches and the eyelid falls, covering part of the eye. It is not uncommon for a patient to develop upper eyelid ptosis after cataract surgery, which can sometimes cause the weak tendon to stretch.  Long standing contact lens wears may also develop ptosis.

Dr. Levin treats acquired ptosis with a surgical procedure with the specific operation based on the severity of the ptosis and the strength of the levator muscle.

The main goals of ptosis surgery are elevation of the upper eyelid to restore normal field of vision and an attempt to achieve symmetry with the opposite upper eyelid. These goals depend on many factors and, therefore, may not always be possible to achieve. Surgery is usually performed with local anesthesia, which numbs the upper eyelid with minimal sedation.  It may be combined with other eyelid procedures.

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Botox ® Cosmetic

Botox® is a non-surgical treatment that can temporarily smooth moderate to severe frown lines between the brows in people from 20-65 years of age.  It is a physician administered treatment approved by Food and Drug Administration (FDA).

Botox® is a purified protein, which reduces the activity of the muscles that cause those frown lines between the brows.  During a 10-minute treatment, a few tiny injections are given in the muscles that cause wrinkles and frowns. Within days there is a noticeable improvement in moderate to severe frown lines which can last up to 4 months. 

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Corrective Blepharoplasty

Dr. Levin  sees many patients who have had previous eyelid surgery. Some patient were pleased with their results, but the effects of surgery have faded with time.

Other patients have complications from previous surgery and require corrective procedures.

It is rarely possible to predict what you might require without a face-to-face consultation with Dr. Levin.

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Thyroid (Graves) Eye Disease

One of the most common thyroid diseases is hyperthyroidism, in which there is an overproduction of thyroid hormones. People with hyperthyroidism may experience some degree of eye difficulty. Eye problems are most commonly caused by abnormal swelling of the soft tissues surrounding the eyes, and enlargement of the muscles that move the eyes and open the eyelids. As a result, the eyes may protrude forward, there may be retraction of the upper eyelids which forces the lids apart, there is an inability to fully close the eyelids, and an abnormally large amount of the front of the eyes is exposed. This results in wide prominent eyes, a fixed staring expression, and infrequent blinking of the eyelids.

Some patients start experiencing eye problems as soon as their thyroid becomes hyperactive. In other cases, though, the eye changes develop slowly, sometimes not occurring for years after the beginning of abnormal thyroid activity. There may be pressure around the eyes, double vision, excessive tearing, and irritation of the conjunctiva (the mucous membrane that lines the eyelids). In the early course of the thyroid disease, only one eye may be affected, but as the disorder progresses, both eyes may become involved.

Overexposure of the eyes during the day and an inability to completely close the eyelids at night can result in injury or damage to the cornea (the front of the eye). Dryness of the cornea can cause considerable discomfort and visual problems, such as blurred vision, foreign body sensation, or light sensitivity. As the muscles slowly enlarge, movement of the eyes may become restricted. This restriction in movement may cause misalignment of the two eyes, resulting in disabling double vision. If the swelling is severe, the pressure in the orbit can become extremely high. This can cause compression of the optic nerve. If this happens, the person may experience a slow loss of vision and even blindness if the condition is not corrected.

Medical treatment of the hyperactive thyroid gland may sometimes relieve the associated eye problems, but often it does not. In cases of mild eye problems, treatment is directed at minimizing the symptoms. Sleeping with the head elevated and using diuretics can reduce swelling. Topical ointments and artificial tears may soothe the eyes. The use of plastic shields at night can help prevent drying of the cornea if the eyelids cannot close during sleep. Tinted glasses with side guards will help protect the eyes.  Corticosteroids or orbital radiation may also be of benefit to selected patients.

The  eyes can usually be improved by reconstructive eyelid and/or orbital surgery. The particular surgical technique used will depend on the type and severity of the eye problems. Orbital decompression (removal of part of the bony orbit or fat that surrounds the eye to relieve pressure within the eye socket) can prevent damage to the optic nerve. It also allows the eyes to move back into a more normal position within the sockets. Eye muscle surgery, in which the enlarged muscles that control eye movement are repositioned, may be performed to properly align the eyes and correct the double vision.  Eyelid surgical procedures to adjust the position of the eyelids usually helps minimize retraction of the lids.  Removal of excessive orbital fat in the eyelids can improve the patient's appearance.   Dr. Levin will discuss these options with you.

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Reconstructive Surgery

There are many patient who have benefited from Dr. Levin’s reconstructive surgery.  Some patients are pictured in our web site.

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Skin Cancer Repair

Skin cancer often involves the skin of the eyelid or adjacent face. Eyelid skin cancers occur most often on the lower eyelid, but may be found anywhere on the eyelid margins, corners of the eye, eye­brow skin, or adjacent areas of the face.  Usually, they appear as painless elevations or nodules. Occasionally, the eyelashes are distorted or missing. There may be ulcerations of the involved area, along with bleeding, crusting, and/or distortion of the normal skin structure. Such findings need to be evaluated and may require a biopsy to confirm the diagnosis of skin cancer.

The most common types of skin cancers are basal cell carcinoma and squamous cell carcinoma. Both types enlarge locally and usually do not spread (metastasize) to distant parts of the body. However, with time, if not completely removed, either type will invade adjacent structures. It is important to know that basal and squamous cell carcinomas are relatively slow growing. Thus, when detected early and treated in a prompt and appropriate manner, there is a better chance of removing the tumor completely and minimizing the amount of tissue affected by the carcinoma. Sebaceous gland carcinoma and malignant melanoma are more serious forms of skin cancer because they may spread (metastasize) to other parts of the body. These types of skin cancer require prompt, aggressive treatment because of the threat of early spread.

There are two very important principles in the management of eyelid skin cancers—complete removal and reconstruction. Complete removal of the tumor is critical to minimize the possibility of' recurrence, which is even more difficult to manage. In most cases, we work with a highly skilled  dermatologic surgeon who excises the tumor in a special way ("Mohs technique") to ensure total removal. On occasion, Dr. Levin may remove the tumor and have a pathologist check the tissue margins ("frozen section") to be sure the tumor is completely removed.

Once the tumor has been completely removed, reconstructive surgery is usual­ly necessary. Many excellent techniques are available to reconstruct almost any surgical defect. The operation will be specifically tailored to the defect that is present following removal of the tumor. Regardless of technique, the goals remain the same: to reconstruct the eyelid so that it functions properly, protects the eye, preserves vision, and has a satisfactory cosmetic appearance.

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 Dr. Levin or your referring doctor 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.

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Entropion Repair

Entropion is the medical term used to describe a condition where the lower eyelid and eyelashes turn or roll inward towards the eye. This causes the eyelid and its lashes to constantly rub against the cornea (the front part of the eye) and conjunctiva (the mucous membrane that protects the eye).

Entropion is usually due to a relaxation of the tissues of the eyelid as a result of aging changes. Thus, it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid which permits the lower eyelid to turn inward.

Entropion may also be caused by inflammation or scarring on the inner surface of the eyelid, eyelid injuries, or tumors. Sometimes, entropion is present at birth (congenital) if the eyelids are not formed normally.

Entropion can cause chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting of the eyelid and mucus discharge, a feeling that something is in the eye, irritation of the cornea, and impaired vision.

Damage to the cornea (the clear part of the eye that allows light to enter the eye), including infection and scarring, may develop due to the chronically turned in eyelid. These are important reasons for having this condition repaired before permanent damage occurs to the eye.

The usual management for entropion involves tightening of the eyelid and its attachments to restore some of its elasticity and to reposition it normally. There are a number of surgical techniques for successfully managing an entropion and Dr. Levin will discuss  his preferred method with you.

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Ectropion Repair

Ectropion is an abnormal lower eyelid that turns outward and no longer touches the eye. As a result, the conjunctiva (the mucous membrane that lines the eyelid) may become red and exposed. This condition usually involves one or both lower eyelids but, rarely, may affect the upper eyelid(s).

Ectropion is usually due to relaxation of the tissues of the eyelid as a result of aging changes. Thus, it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid.  It can also arise as a result of undetected skin cancers pulling down the eyelid, trauma, contraction of scar tissue (from wounds, burns, or surgery) involving the skin surrounding the lower eyelid, and following eyelid or facial surgery. Ectropion may develop following facial nerve palsy (Bells palsy), in which the muscles surrounding the eye (and other facial muscles on that side of the face) are paralyzed. Finally, ectropion may be further aggravated due to constant wiping by the tearing patient, which tends to pull the eyelid further from the eye.

Ectropion can cause chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting of the eyelid and mucus discharge, infection, irritation of the cornea (the front part of the eye), and impaired vision. When the lower eyelid is turned outward and no longer touches the eye, it cannot properly spread the tear film across the eye, which leads to poor drainage of tears through the nasolacrimal (tear drainage) system.  The exposed inner lining of the eyelid becomes dry and inflamed. As a result, the eye may become damaged.

If the ectropion is due to laxity of the eyelid's supporting structures, it is best treated surgically. Depending on the cause, surgery can reposition the eyelid back to its normal position against the eye. This can be accomplished by tightening the eyelid and its attachments to restore some of its elasticity and to reposition the eyelid. The surgical procedures are usually performed on an outpatient basis often within Dr. Levin’s office using a local anesthetic.

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