Eyelid Surgery

What is functional eyelid surgery?

When the eyelid loses its natural shape and ability to protect the eye, eyelids become dysfunctional and surgery may be needed to restore function.

What is the normal function of the eyelid?

The eyelid works to protect and lubricate the eye. One way eyelids lubricate the eye is by housing the glands that make the components of your natural tear film: mucous, oil, and saline. The eyelid must be able to open and close both to protect and lubricate the eye. Blinking helps spread and refresh the tear layer. The eyelid must also provide a drainage system for tears to flush away, otherwise you would always be crying. The eyelid must also reflexively close to protect the eye beneath. The lashes work to trap dust and debris from entering the eye. Some studies also show that if lashes are too long, it may lead to increased evaporation of tears, aka evaporative dry eye.

What problems lead to functional eyelid surgery?

Ptosis/Droopy Eyelids

Imagine… if your eyelid cannot properly open, it may partially or totally block your ability to see. This is called eyelid ptosis or blepharoptosis. If your eyelid cannot close securely, it may lead to dryness and other more serious complications over time. There are many causes of ptosis. Commonly, excess skin weighing down the lid may change the functional position of the lid. When the lid partially blocks the pupil, peripheral vision is reduced. Through procedures that address the cause, the eyelid can be repaired. The most common surgery for this is upper eyelid blepharoplasty which includes removal of excess skin above the eyelid crease. Sometimes the muscles inside the lid need to be tightened to raise the lid height above the pupil.

Improper Eyelid Closure

Examples include non-closure due to Lagophthalmos, Eyelid Ectropion, Floppy Eyelid Syndrome, Bell’s Palsy, Paralysis, Thyroid Eye Disease etc. All of these conditions can lead to poor eyelid closure. Surgery can be used to help tighten floppy or stretched tissue, reposition damaged lids, repair weak muscles with tightening or reapproximation.

Eyelid Lesions/Tumors

Sometimes growths occur on the eyelid. They can be benign moles or skin tags or cysts, or they can be precancerous or cancerous. An evaluation and sometimes a biopsy is needed to determine the identity of the lesion and the best treatment. If you ever have a growth near your eye it is important for it to be monitored for changes just like you would monitor changes of growths on other areas of the body.

What is Cosmetic Eyelid Surgery?

Cosmetic eyelid surgery is surgery done to improve the appearance and beauty of the eye area.. Cosmetic surgery can also have functional benefits, and should always preserve eyelid function above beauty. The most common cosmetic eyelid surgeries are removal of benign growths such as xanthelasma, skin tags, and moles (nevi), and removal of excess skin that may not affect vision substantially, but is bothersome to the patient. Many times, cosmetic eyelid surgery addresses the result of aging changes. Sometimes cosmetic lid surgery is done to improve the eyelid contour or natural features based on beauty standards in different cultures. Asian blepharoplasty is a type of cosmetic eyelid surgery that creates a more prominent eyelid crease.

What Eyelid Procedures Do You Specialize In?

Dr. Creekmore has performed hundreds of cosmetic and functional upper lid blepharoplasties. She also performs ptosis repair, ectropion and entropion repair, canthal tendon repair, punctoplasty, and the excision of benign eyelid lesions as well as eyelid lesion biopsy. She did additional training in oculoplastic surgery during residency and continues to seek opportunities to advance her surgical skills, as well as offering nonsurgical, laser, and minimally invasive techniques.

What is the first step in addressing an eyelid concern?

The first step is to have an eyelid evaluation with your ophthalmologist. Many ophthalmologists screen patients for eyelid problems at their annual exams. If there is a concern, your doctor can help determine if surgery is the right choice, and also may suggest what to do to help until the time of surgery. If surgery is not the best option, there may be nonsurgical options to consider. After obtaining an MD or DO degree from Medical School, Ophthalmologists spend a minimum of four additional years training to address many of the most common types of functional and cosmetic eyelid concerns. Sometimes the eyelid problem is rare, very complex, or requires a specialized skill set. In these instances, we will refer patients to our oculoplastic colleagues for additional care.

What to expect at your initial consultation?

At your initial consultation, if you have not had a recent eye exam, you will likely have a complete eye exam and be scheduled for testing at your next appointment. If you had a recent eye exam and are referred for an eyelid eval, testing may be done on the initial visit, and a dilated exam will be done at the second visit. Once testing is done, the results are submitted to your insurance company to see if you “meet functional criteria” for eyelid surgery coverage. Once insurance issues an authorization or a denial for the procedure, you will have a second visit to complete your eye exam and make plans for surgery. Expect two office visits prior to surgery.

What if insurance says I do not meet criteria for surgery?

Depending on your insurance, you may call your insurance company to dispute their statement. However, if you do not meet criteria for functional surgery, you can still pursue surgery on a cosmetic basis. A quote can be provided for cosmetic surgery.