They say the eyes are the windows to one’s soul, showing expression without saying a word. Yet, as people age, there are a number of medical and cosmetic conditions that can negatively affect the eyelid and adjacent facial areas. What many may not be aware of, however, is that there is a very unique and specialized field of medicine that surgically treats such conditions.
Known as oculoplastic surgeons, these physicians are ophthalmologists who complete an additional two-year intensive surgical fellowship that concentrates on all aspects of eyelid surgery, including cosmetic eyelid procedures and brow lifts, as well as medical conditions such as droopy eyelids, tear-duct obstructions, eyelid tumors and eyelid reconstruction.
Although the field has been in existence for decades, the “club” is very exclusive. In fact, there are only approximately 500 oculoplastic surgeons in the United States. Residents of the greater Philadelphia area are fortunate to have a highly skilled specialist, John J.W. Lee, M.D., FACS, who completed his fellowship at Wills Eye Hospital, which has one of the country’s top oculoplastic programs.
“This is a very specialized area both in terms of the field of medicine but also the area of the face,” says Dr. Lee, who performs more than 1,000 eyelid surgeries each year. “While general cosmetic surgeons learn to operate on the entire face and body, oculoplastic surgeons concentrate their training exclusively on eyelid and brow surgery.”
Refreshed Expression
Many patients search out Dr. Lee’s expertise with a purely cosmetic motive. Starting at age 40, people begin to see signs of aging around the eyes. For example, the eyelids begin to droop, creating a “hooded” appearance, and there is also an increase in puffiness on the lower lids caused by herniated fat pads.
“Women and a growing number of men want to look younger longer,” says Dr. Lee. “At the same time, they don’t want to look different but refreshed.”
Eyelid surgery should be the first procedure that someone considers if he or she is thinking of facial cosmetic surgery. It is the focal point of one’s face and is the most cosmetically effective procedure to create an overall visual change with minimal downtime. Upper blepharoplasty surgery, which is a simple procedure to remove excess skin and fat on the upper eyelids, can be performed in the office under local anesthesia in approximately 30 minutes.
Many people have heard the horror stories in which people are unable to close their eyes after eyelid surgery. Dr. Lee provides assurance that this would be extremely unlikely in the hands of a properly trained oculoplastic surgeon. “During the pre-operative marking stage,” he says, “removing too much skin can simply be avoided by grasping the excess eyelid tissue with forceps until the eyelashes evert. This way the patient will always have enough skin to close their eyes, while removing the appropriate amount of skin.”
When it comes to treating the puffiness of the lower eyelid, the fat can be removed from inside the lid with no visible scarring and rapid recovery. In cases with excess skin, a tightening procedure with excess skin removal will create the best possible outcome.
“The best results with lower-eyelid surgery are achieved when patients have the surgery as soon as extruding fat pads are noticeable,” Dr. Lee states. “Deep indentation of the skin caused by excessive puffiness causes the skin to stretch and can create permanent wrinkles that are difficult to completely resolve. The goal is to create a smooth look, but being overly aggressive and pulling the skin too tight can cause complications that are difficult to reverse.”
Unlike other cosmetic procedures, upper and lower blepharoplasty surgeries are equally popular for both male and females, according to Dr. Lee. Both men and women realize that this procedure is not purely driven by aesthetic considerations but rather to portray a sense of alertness and vitality. Both eyelid procedures fit into most people’s active lifestyle with minimal downtime—a week, on average for recovery.
An Unobstructed View
According to Dr. Lee, some of the patients he treats are experiencing a medical-based condition. One of the most common conditions is ptosis, or droopy upper eyelids. Often a result of aging, trauma or congenital illness, droopy eyelids can impair one’s ability to read or drive, and also cause headaches and eyebrow strain.
“Depending on the individual case, there are two ways we treat ptosis,” Dr. Lee explains. “Sometimes it is a matter of having too much skin and the excess skin needs to be removed. Other cases are a result of muscle stretching or weakness. We then proceed to tighten the muscle to open the eyes wider.” Although droopy upper eyelids can be disabling, they generally do not permanently threaten one’s vision. However, if patients experience visual obstruction, the surgery may be covered by health insurance.
Oculoplastic surgeons’ scope of work also encompasses all aspects of eyelid reconstruction. Some patients’ lids begin to droop downward and turn outward as a result of aging. Medically referred to as ectropion, the lid no longer protects the eye, which causes tearing, dryness, redness and sensitivity to light or wind. Likewise, there are times when the eyelid rolls inward (entropion) and as a result the eyelashes and surrounding skin begin to rub against the eye. In addition to many of the same symptoms, there are times when an infection may develop on the cornea and ultimately hurt one’s vision if left untreated.
Dr. Lee also treats cases involving malignancies on the eyelid, commonly resulting from excessive sun exposure. Once diagnosed by a biopsy the malignant area can be removed by Mohs surgery, which often requires follow-up reconstruction by an oculoplastic surgeon due to their thorough understanding of the eye and eyelid anatomy.
Dr. Lee prefers to perform most of his procedure in an outpatient setting under local anesthesia or conscious sedation. Recovery times vary based upon the particular surgery, but most patients can return to work within one week.
“While I was in medical school, it became clear that I couldn’t be the best at everything,” he says. “It was then that I chose to specialize in a very specific field so my surgical ability could be honed and I could provide the level of service to patients that I felt they deserved. This has afforded me the opportunity to establish strong patient relationships based on trust, realistic expectations and quality results.”
John J.W. Lee, M.D., FACS
2050 West Chester Pike, Havertown
Phone: 610-789-6701
Web: www.drjohnleesurgery.com
Glori Gayster is a freelance writer based in South Jersey.
Rob Hall is a photographer based in Plumsteadville.
