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Reconstructive Surgery

Eyelid Surgery

Drooping or sagging of one’s eyelids and/or eyebrows, if severe, can dramatically impair one’s vision by blocking out part of one’s field of vision. Often times this process has developed slowly over time such that one may not even notice this to be the case, even though up to one half of one’s vision may be missing. This loss of peripheral vision can greatly affect one’s ability to perform daily activities, such as driving. An eyelid lift (blepharoplasty) can restore one’s vision if the problem is due to eyelid drooping. Sometimes, drooping of the eyebrows can be the primary problem thereby affecting the position of one’s eyelids. In these cases, raising the eyebrows with surgery can significantly improve vision. Often times these two conditions co-exist, thereby requiring a combination of the two procedures (performed at the same surgery) for maximum improvement. In any of these scenarios, the eyelid lift and/or eyebrow lift is considered a procedure for medical indications and is therefore covered by insurance companies and medicare. In order to establish whether this could be the case, a visual field test is performed in the office. See ‘Eyelid Lift’ and ‘Eyebrow Lift’ in the Cosmetic section for further details.


Eyelids can droop from age related skin and fat changes. However, sometimes the problem lies in weakening of the muscles which raise and lower the eyelids. Most often this is also due to aging, although in some cases, people may be born with this condition or it can develop from injury or neurologic conditions. Drooping eyelids due to weakened lifting muscle is called ‘Ptosis’. When your eyelids droop into your vision due to weakened eyelid muscles, many things may ensue. Patients may notice eye fatigue, loss of vision, and sometimes headaches (due to straining of one’s forehead muscles to raise the eyelids to see better).

Surgery to tighten the eyelid lifting muscle is done as an outpatient using a local anesthetic. The results from this procedure can be very dramatic as patients often notice a significant improvement in their symptoms and their vision.

Entropion and Ectropion

The position of your eyelids is very important for the overall health of your eye. Ectropion is medical condition in which the lower eyelid turns outward which can cause the surface of the eye to be too exposed. This leads to irritation, redness, crusting, and discharge. This is also a common cause of watery eyes or excessive tearing. Ectropion is most often caused by age related changes, but injury, skin cancers, scars, paralysis, and birth defects can also lead to this condition. Entropion is a condition in which the lower eyelid turns inward. This also affects the health of the eye as the eyelashes can touch and rub against the surface of the eye itself. Common symptoms of entropion include redness, irritation, crusting, discharge, and a foreign body sensation.

Both ectropion and entropion can cause scarring of the eye and are a risk factor for eye infections. Severe cases can cause loss of vision. Both of these conditions are treated by a tightening procedure to reposition the lower eyelid and restore its natural relationship with the eye. An Oculoplastics specialist is best suited for this type of surgery due to his/her specialized training in both plastic reconstructive surgery and ophthalmology.

Eyelid Lesions and Skin Cancers

There are numerous types of lesions which can be found around the eyes on the forehead, eyebrows, eyelids, or midface. A majority of these lesions are benign (not harmful) but they can grow to become unsightly or even impair vision depending on their location. In addition, skin cancers (harmful due to risk of spread) can affect these same areas and commonly affects patients in different ethnic groups, especially those with significant sun exposure. When skin cancers affect the eyelids, they may cause loss of eyelashes, ulceration, bleeding, or change in the natural architecture of the eyelids. Dr. Kavanagh can evaluate lesions around the eyes and recommend whether the lesion could be followed with close watch or whether a biopsy and/or removal of the lesion would be best. In severe cases, this may require reconstruction of the eyelid. The eyelids are a unique place in the body to reconstruct due to their intricate structure, function, and relationship to the overall health of the eye.


Injury to the eyelids often requires repair and reconstruction performed by a physician trained in Ophthalmic plastic surgery due to the intricate structure of the eyelids as well as their importance functionally for the health of the eye. If left untreated or inadequately repaired, eyelid injuries can lead to scarring, poor function or drooping of the eyelids, poor position of the eyelashes, and irritation of the eye itself. Furthermore, injuries occasionally also affect the tear drain system due to its relationship with the eyelid. Reconstruction of the eyelid by a specialist trained in these areas offers the best chance of minimizing these adverse effects of the injury.

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