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Plastic surgery to improve your looks—and your sight

Posted March 7, 2013

Gail Chiasson’s “puffy eyelids” had gotten so heavy she felt as if they’d become permanently half-shut. Not only did she look sleepy, she felt sleepy. She couldn’t read a book for long and grew especially concerned when a doctor trying to perform an eye test had to tape her lids out of the way.

She visited the Yale Eye Center, where a surgeon performed a blepharoplasty, a surgical procedure to lift the upper eyelids and improve vision. He also removed extra fat from her lower lids to improve her appearance. The results, says Chiasson, are “unbelievable, like night and day, from being sleepy to wide awake. I didn’t even realize how much the droopy lids had affected my peripheral vision.”

From irritating to life-threatening

Chiasson is one of 2,000 patients who have visited the Yale Eye Center in the last two years for surgeries to correct or provide reconstruction in conditions ranging from dermatochalasis, or excess of skin in the upper or lower eyelid, to cancers in and around the eye. The center also provides cosmetic procedures, and uses Botox injections, cosmetically to erase wrinkles and therapeutically to treat excessive blinking and spasms.

Flora Levin, M.D., and Javier Servat, M.D., the center’s two opthalmic plastic and orbital surgeons, have specialized training in both oculoplastic surgery and ophthalmology, and use the most advanced techniques. In addition, Dr. Levin has the rare advantage of training in neuro-ophthalmology.

Both doctors feel their knowledge of the eye and its anatomy can make a difference in the success of any plastic surgery procedure involving the eye. “We work with very delicate tissue using fine instruments,” says Dr. Levin. ”We look at a multitude of factors when evaluating eyelids: the position of the eyelid, the symmetry with the other side, the contour, the position of the crease of the eyelid and its relationship with the surrounding structures such as the eyebrows.”

Fixing the ‘visor effect”

Dermatochalasis is one of the most common conditions the doctors see. While some patients are surprised to find surgery for the condition is more than a cosmetic procedure, the doctors take it very seriously. “Patients with dermatochalasis (or excess upper eyelid skin) can get a kind of visor effect, where the peripheral vision is affected,” says Dr. Levin. In severe cases, the problem can obstruct as much as 50 percent of the visual field.

Some conditions result in an inability to shut the eyelids properly, so that the eyes don’t get proper lubrication. “Every time they turn on the air conditioner or heater, their eyes burn,” Dr. Servat says. Failing muscles and nerves may also be at the root of the problem, he adds.

Treating cancer near the eye

Cancers, along with infections and injuries, call for more drastic measures. Erin LaFleche of Ellington, Conn., was shocked at the news that her 3-year-old son, Justin, had a cancerous tumor in his left eye. Because of the size of the tumor, it was recommended that the eye be removed.

Dr. Levin performed Justin’s surgery and he is now cancer-free. An implant was placed into the orbit and secured to the muscles that allow movement. Justin was then fitted with a silicone prosthesis that was hand drawn by an an ocularist, who made a copy of the good eye down to “even the small arteries,” Dr. Servat says.

“When he moves to the left, it moves,” LaFleche says. “Nobody needs to know he has a fake eye because it’s so realistic looking.”

The two doctors work closely with Miguel Materin, M.D., Yale’s director of ocular oncology, to help patients like Justin and provide plastic surgery in cases of cancer. They perform excision and/or reconstructions after excision of tumors near the eyes. “The treatment is individualized, depending on the size, the location, and the needs of the particular patient,” Dr. Levin says.

A spectrum of other eye conditions

In addition, doctors at the Yale center provide both major and minor treatments for a spectrum of other eye conditions, including endoscopic surgery to fix damaged or scarred tear ducts. Thyroid conditions such as Grave’s disease can change a patient’s appearance, causing eyes to bulge and eyelids to retract; and produce double vision and rarely, loss of vision. The doctors treat the condition using surgical and medical therapies to rehabilitate the patients.

Because so many conditions can affect the eyes, Drs. Levin and Servat often consult with Yale dermatologists, endocrinologists, oncologists, ear nose and throat surgeons, plastic surgeons, neurosurgeons and other specialists.

Chiasson, who was treated by Dr. Servat, had a routine procedure, but she doesn’t think she is overstating it to say her surgery was life-changing. She says her heavy eyelids had the psychological effect of making her whole body feel tired, and she now feels re-energized. “Even my driving vision is great. I can see around corners and am more aware of oncoming cars. When I drive, I’m even noticing deer and ducks and wildlife that I had probably been missing for a long time.”

Source: Yale University

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