The function of the eyelids is pure and simple: to protect the eyes and vision. The eyelids have five layers, each of which is important to allow the eyelids to function well and optimize our gift of sight.
Problems with eyelid function and appearance can occur at any age, from birth until late into adulthood. The purpose of many eyelid surgeries is to correct these problems in order to allow the eyelid to appear and function normally again. Dr. Escaravage performs dozens of different types of eyelid surgeries, each of which is carefully planned and customized to the person (and often each individual eyelid) in order to provide the results that you need. Surgical repair of a fair number of eyelid problems are often covered by many insurance plans.
BLEPHAROPLASTY (UPPER AND LOWER)
Many eyelid problems arise as we age. Similar to other areas of the body, eyelid tissues (and those of the brow and surrounding face) sag and droop which can lead to an older and tired appearance, but also can impair the eyelids’ function. Due to the decreased light entering the eyes, drooping eyelids can impair vision which can affect reading, driving, and other daily activities.
Blepharoplasty is the surgical procedure designed to remove or reposition excess tissue of the upper eyelids. It is commonly considered a cosmetic procedure by the general population as it can significantly improve one’s appearance and youthfulness. It can certainly be performed for this purpose, but it can also be performed to improve vision. Specific insurance plan criteria must be met for them to consider covering this surgery as a medically necessary procedure. Dr. Escaravage and his staff are very experienced in this regard and will work for you to provide the information to your insurance carrier to determine if your condition meets their criteria.
Lower lid blepharoplasty is commonly performed to remove the “bags” that form and give one an aged and tired appearance. It can dramatically rejuvenate the face and can be performed either by itself or in combination with other cosmetic or functional procedures to achieve multiple goals. Unfortunately, insurance plans consider lower lid blepharoplasty a cosmetic surgery and do not cover it. Please see the cosmetic surgery section of our site for more information on cosmetic blepharoplasty.
Of note, it is important to recognize the upper eyelid is continuous with the eyebrow, just as the lower lid flows into the cheek. To obtain desired results, certain situations may require a brow lift or cheek lift, either instead of or in addition to eyelid surgery.
Out of respect for the privacy of our patients, we do not provide before and after photographs of our patients on our website. We do have a collection of photographs of those patients who have given permission for review during your consultation.
Ptosis is a condition that occurs when one or both upper eyelids droop and the edge of the upper eyelid falls towards or over the pupil. In its most common form, ptosis occurs in adults and is usually caused by stretching or thinning of the tendon between the muscle that raises the eyelid and the eyelid itself. With stretching or thinning, the muscle that normally raises the eyelid has to work harder to lift it. This leads to symptoms of eyelid and forehead muscle fatigue and eyelid heaviness which can impair one’s peripheral vision.
Ptosis can also occur in childhood. Children can be born with ptosis (congenital ptosis); in this setting, the muscle is abnormally stiff and does not function well. This condition usually lasts until it is surgically corrected. As vision develops over the first nine years of childhood, it can impair the development of normal vision
Ptosis surgery is not the procedure of choice for removing excess fat and skin in the upper eyelid. It can be combined with blepharoplasty when fat and skin removal is an added goal of surgery.
There are many different reasons for ptosis to occur and the technique to repair this problem must be carefully chosen to address the underlying problem. Dr. Escaravage will be able to determine which type of ptosis surgery would best correct the ptosis.
Patients with ptosis report that it makes them look and feel “tired.” When the eyelid is raised in ptosis surgery, patients usually prefer the new eyelid position, and feel it improves their appearance as well as their peripheral vision.
As for upper lid blepharoplasty, insurance plans have strict criteria that must be met in order for them to consider ptosis surgery a covered service. Dr. Escaravage and his staff will work for you and submit this information to the insurance company. Ptosis surgery can also be performed for cosmetic improvement when the eyelids are asymmetric but do not meet insurance criteria for visual impairment.
When the eyelids do not function properly, it can cause tearing, eye irritation, eye redness, infection, pain, discharge, blurred vision, and even loss of vision. The eyelids can turn inward toward the eye, outward away from the eye, be too loose, or even not close properly or completely. In addition, eyelashes can grow backward and damage the eye. Any of these problems will limit the eyelids’ ability to function properly and protect the eye.
An ectropion occurs when the eyelid turns outward away from the eye. The opposite is the case of an entropion, when the eyelid turns toward the eye, scratching the surface of the eye with eyelids and eyelid skin. Both of these conditions can occur for various reasons and often have multiple contributing factors. Surgery to repair them must be customized carefully to the underlying problem(s) to return an eyelid to its normal position and function.
Various other eyelid conditions can impair their function or cause symptoms. Eyelashes can turn backward and scratch the eye (trichiasis). In other conditions, the eyelids appear normal but do not blink, move, or close properly. The most appropriate treatment, whether surgical or non-surgical, will be recommended to fix the underlying problem once Dr. Escaravage is able to evaluate you.
EYELID CANCERS AND OTHER LESIONS
The skin of the eyelid is the thinnest skin of the entire body. In addition to having multiple layers, eyelid skin has hair follicles, sweat glands, oil glands, blood vessels and nerves just like the skin of the rest of your body. An overgrowth or malfunction of any of these components can cause a tumor (solid lump) or cyst to form on the eyelid or skin surrounding the eyelids. They can grow rapidly or change after many years of stability. They can cause no symptoms or be very irritating for various reasons.
Entire textbooks have been written about the various types of lesions that can occur on the eyelids, but they can primarily be divided into benign and malignant lesions. Benign lesions can cause a lot of symptoms but often resolve completely once removed. Malignant eyelids lesions are most likely to be a form of skin cancer. The most common common eyelid skin cancers encountered in the United States are (in order of frequency): basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma. Each of these and additional more rare forms of eyelid cancer have unique characteristics and behavior. Confirmation of the type of cancer by a biopsy is critical in determining the most appropriate treatment options and risks for spread and recurrence.
Certain lesion characteristics raise concern and should be evaluated as soon as possible:
- rapid growth
- change in color, texture or other appearance of a pre-existing lesion
- repeated bleeding or scabbing
- an area that will not heal
Only a biopsy can confirm what a lesion is, whether it is benign or malignant, and if any additional treatment is needed. However, not all lesions must be biopsied. Dr. Escaravage can often perform any recommended biopsy in the office. This is usually not performed during the first visit as an evaluation is required to determine the likely diagnosis, appropriate setting for the biopsy and if any changes in your medications would be recommended.