Many patients have prominent eyes, but this does not necessarily preclude you from having a cosmetic procedure. Having prominent eyes can potentially make cosmetic eyelid procedures more challenging, and can be associated with a higher tendency for scleral show, dry eyes or problems with eyelid closure. There are several options available in these cases. For example, performing the cosmetic procedure inside the eyelid (i.e. transconjunctival blepharoplasty) may be a safer approach. In addition, performing a procedure to secure the corner of the eyelid (i.e. canthopexy) may assist with preventing lower lid position deformities. Dr. Pacella will critically examine your eyelids and determine the best procedure for you with the utmost safety in mind.
In general, you should wait at least six months from the time of the Lasik procedure prior to undergoing any cosmetic eyelid procedure. During Lasik surgery, a cut in the cornea is made and it can sometimes take months to heal. Your vision will also stabilize during this time. The swelling from cosmetic blepharoplasty can often cause temporary vision changes which may impede the natural healing of the cornea, thus it is not recommend to undergo any eyelid procedure until the cornea is healed. In addition, Lasik can sometimes be associated with a tendency to develop dry eyes and tear production is usually not stabilized until the Lasik procedure is fully healed. It is very important for your surgeon to assess your tear function and production prior to cosmetic blepharoplasty.
If you feel that your upper eyelids are causing impairment, your surgeon can attempt to obtain insurance preauthorization. This usually involves a complete physical exam as well as an objective test called a visual field exam. In addition, photographic documentation of the deformity may also be needed to submit to your insurance carrier. If your insurance carrier determines that this is causing functional impairment, then the procedure may be a covered benefit depending on your particular carrier. Lower eyelid procedures that are performed for appearance alone, without any functional impairment, are routinely not covered by insurance carriers. It is possible to perform both procedures during the same operative session, but you will be responsible for any surgical fees, operating room time or anesthesia fees attributed to the lower eyelid surgery. Dr. Pacella and his staff will work closely with your insurance carrier to determine which procedures may be covered. If you chose to have a cosmetic procedure, any out-of-pocket costs will be clearly itemized for you.
You may have a condition called “scleral show”. This occurs when the lower eyelid position is located far below the iris. In advanced cases, this is called ectropion. Scleral show or ectropion can occur after cosmetic blepharoplasty if too much tissue was removed. Patients with prominent eyes have an increased tendency for scleral show. If the lower lid position is slightly low, sometimes a simple lid tightening procedure called a canthopexy can improve the condition. In advanced cases, a tissue graft or a “spacer graft” may need to be placed inside the eyelid to maintain support. Because this is a highly specialized problem, it is important to find a plastic surgeon who feels comfortable performing these types of procedures.
The lower eyelid is a common place to develop skin cancer because it is often under direct sun exposure. In most cases, surgical excision (either direct excision or through Moh’s surgery) is the best option. Reconstruction after skin cancer is best performed by a board-certified plastic or oculoplastic surgeon with specialized training in repairing eyelid defects. Depending on how much tissue needs to be removed, there are many surgical options to repair the deformity, maintain eyelid position and enable closure, while minimizing any scarring. Scarring is an unfortunate necessity with any surgery, but optimal planning of incisions can often make the scar inconspicuous. Radiation is often reserved for patients who cannot medically tolerate cancer surgery. Radiation can regress the cancer, but it is not a cure. Furthermore, radiation causes very unnatural stiffness to develop in tissue, which can make any attempt at surgery afterward very unsuccessful.
The questions above are represented for informational purposes only. They do not constitute actual medical advice. Dr. Pacella is pleased to discuss your unique personal circumstances at your consultation.