Oculoplastic and Reconstructive Surgery

Oculoplastic surgery is a highly specialized field that encompasses cosmetic and reconstructive surgery of the eyelids and surrounding areas. It includes a wide range of aesthetic and medical services, such as surgery of the upper and lower eyelids, eyebrows, and orbital areas (including tear duct surgery, thyroid eye disease, orbital fractures and tumors). It also encompasses facial rejuvenation procedures such as Botox®, facial fillers and various skincare treatments. Whether a patient is seeking medical or cosmetic services, our goal is to address each person’s particular needs while simultaneously achieving a natural, harmonious look to complement each individual’s features. Because of the unique function and anatomy of the orbital area, it is essential to have a skilled oculoplastic surgeon perform these services.

It is important to seek the expertise of a skilled, reputable oculoplastic surgeon to appropriately evaluate and treat the underlying problem, whether cosmetic or medical. Dr. Orin Zwick is a board-certified ophthalmologist whose specialty is cosmetic and reconstructive surgery of the structures surrounding the eye. He is one of fewer than 650 surgeons in the United States to complete a full fellowship devoted entirely to eyelid and orbital surgery.

Using his deep knowledge of the delicate tissue and intricate support structures of the eyes and surrounding area, Dr. Zwick is able to assess the impact of the eyelids on the health of the eye itself. His unique combination of vast medical knowledge, superior surgical skills and artistic talent allows patients to achieve a natural, harmonious look that complements their features. Because of the highly specialized nature of the eyelids and his extensive experience, Dr. Zwick is often called upon by other surgeons to address a variety of complicated cases. 

Personalized Evaluation and Attention

Dr. Zwick offers each patient a thorough evaluation to identify any medical conditions that may be affecting the eyelids or surrounding area. After assessing each patient’s specific needs and desired outcome, he then develops a personalized plan of treatment. Patients are encouraged to ask questions and are provided with detailed information about their recommended procedure and the results they may anticipate.

Dr. Zwick performs the majority of his surgery in our private, surgical suite. In most cases, these are outpatient procedures that use sedation and local anesthesia. Our goal is to provide the most advanced technology, treatments and skilled surgical care in a comfortable, convenient setting.

The eyelids and their surrounding area are a delicate part of the face. Given time and gravity, the thin layer of skin and muscles that surround the eyes weaken and begin to sag. These changes can often impede vision and make one look tired and older. Prior to surgery, Dr. Zwick will conduct a thorough evaluation to assess the cause of drooping eyelids. It may be a result of excess skin (dermatochalasis), weakened eyelid muscles (ptosis) or even weakened eyebrow muscles. There are several outpatient surgical procedures that can help open the eyes and improve the overall appearance of the upper face.

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Upper Eyelid Blepharoplasty (Eyelid Lift)

Over time, the thin layer of skin that surrounds the eyes may sag. This often results in making one appear tired and older. The drooping skin may also interfere with the field of vision. To recapture a refreshed, youthful appearance, and ensure full peripheral vision, an eyelid lift, also known as blepharoplasty, may be performed to remove excess skin from the upper eyelids, lift sagging eyelids, or address fatty pockets and excess skin under the eyes. A blepharoplasty may be performed alone or in conjunction with other procedures to achieve rejuvenation of the periocular region and improve a patient’s field of vision.

Blepharoplasty is an outpatient procedure performed in our private surgical suite. Typically, the procedure is done with sedation and local anesthetic. An incision is made in the creases of the natural upper eyelid to remove excess skin and fat. If the eyelid is drooping due to muscle laxity, the muscle can be tightened to raise the eyelid. Bruising is usually minimal and patients may expect to return to work in approximately one week. A thorough discussion with Dr. Zwick will create a tailored approach to each patient and answer any questions related to the procedure.

Lower Eyelid Blepharoplasty (Puffy Pockets and Loose Skin)

There are a host of changes that occur to the lower lids over time, exacerbated by genetics, sun damage and other environmental factors. Skin laxity, fat prolapse, eyelid laxity, hollow depressions and mid-face descent all lead to various eyelid appearances. Each patient requires a thorough evaluation to determine which factors contribute to their appearance. A procedure called a lower eyelid blepharoplasty can help to address these various aging changes. Through either an internal and/or external eyelid incision beneath the lashes, skin can be tightened, fat can be removed or contoured and the eyelid can be supported to help improve the overall appearance. In some cases, a medium depth acid peel will be performed in conjunction to help with skin tightening. This surgery can be done in combination with upper eyelid or eyebrow surgery and is typically performed with sedation and local anesthesia. A thorough discussion with Dr. Zwick will create a tailored approach to each patient and answer any questions related to the procedure.

Eyebrow Lift

Frequently, droopy eyelids are related to the upper eyebrows. As the face ages, the brows tend to droop and weigh on the upper eyelid area. If the problem lies in the brow, a brow lift may be the recommended procedure. There are various approaches to raising the brows, including a direct brow lift, a transblepharoplasty brow lift or a trichophytic brow lift. With the trichophytic brow lift, the incision is made just behind the hairline and tissue of the scalp and forehead are lifted. The brow tissues are resuspended upward, resulting in rejuvenation of the upper eyelids, a decrease in crow’s feet formation and a more awake, refreshed appearance. This type of brow lift is best for patients who wear bangs and have a higher forehead so the incision can be hidden. Transblepharoplasty brow lifts can be performed in conjunction with upper eyelid surgery to help stabilize and support the brow. Direct brow lifts are typically recommended for men with bushy eyebrows and deeper forehead lines since the incision is made just above the eyebrow hairs.

Ptosis (Weak upper eyelid muscle)

Ptosis is the drooping of the upper eyelid to the extent it partially covers the pupil. It can affect one or both eyes. As we age, the muscles that hold up our eyelids weaken or loosen and can cause our lids to droop. This results in a tired, sleepy appearance and reduces peripheral vision. Some people experience brow or forehead aches and fatigue at the end of the day from constantly raising their brows to see. Ptosis may also be caused by an injury, birth defect or neurological disorder and is seen in both adults and children. Surgical repair helps improve vision and provides a more vibrant appearance. There are various surgical approaches to address ptosis including an external approach, an internal approach, and even the use of suspension slings in very severe cases. Ptosis surgery is very delicate and requires a thorough understanding of the anatomy and function of the muscle. A thorough discussion with Dr. Zwick will create a tailored approach to each patient and answer any questions related to the procedure.

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Eyelid lumps and bumps come in all different varieties. They can be inflammatory lesions such as styes or chalazions, benign growths such as cysts, moles, keratoses or skin tags, or malignant cancers such as basal cell carcinoma, squamous cell carcinoma or melanoma. Because of the delicate nature of the eyelids, careful evaluation by Dr. Zwick is required to determine the type of lesion and recommended management. Often, if the lesion is felt to be benign, Dr. Zwick can perform an in-office excision. Sometimes a biopsy will be performed to determine the exact pathology.

Chalazion

A chalazion is a cyst that develops as a result of trapped oil secretions in one of the many glands in the upper or lower eyelids. A chalazion can arise initially as a tender, red, swollen bump, resembling a stye or infection of the eyelid. Treatment initially includes warm compresses, massage, and sometimes antibiotic ointment or drops. After a few days, a painless firm bump on the eyelid may form. Typically, a chalazion will spontaneously resolve within a few weeks to a few months. When a chalazion persists, it can be excised by Dr. Zwick. Conditions associated with a chalazion include rosacea and blepharitis.

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Eyelid Cancers

Eyelid cancers are usually painless, but can slowly grow and destroy the normal architecture of the lid. They are typically raised and slowly grow, can be light or dark in color, can cause loss of eyelashes, ulcerate and sometimes bleed. Early detection is critical before the damage becomes devastating. Proper excision and meticulous repair ensures eyelid function remains intact. It is important to have any suspicious lesion on or around the eyelid evaluated by an oculoplastic surgeon. If a biopsy proves cancerous, typically Dr. Zwick recommends excision of the cancer so the margins around it are clear. This is followed by reconstruction of the eyelid to achieve proper function and aesthetics. Often Dr. Zwick works with Mohs surgeons, specialized dermatologists who remove skin cancers by carefully clearing the margins, followed by his surgical repair of the area. This will be discussed at length at the consultation so that all questions are answered and a thorough understanding is achieved.

Entropion (Eyelid Turns Inward)

Entropion, a condition in which the lower eyelid turns inward, can cause eye irritation and result in excessive tearing, crusting, mucous discharge and even vision loss. Although most commonly the result of aging and the weakening of the eyelid muscles, entropion may also be caused by a birth defect, eye injury, scarring or tumors.

Patients whose eyelids turn inward can undergo an outpatient surgical procedure to tighten the eyelid and return it to its normal position. For those cases where surgery is not an option, the condition is treated with lubricating drops, ointments and temporary sutures. Since entropion can cause damage to the outer part of the eye, known as the cornea, we strongly suggest an evaluation with our oculoplastic surgeon, Dr. Zwick.

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Ectropion (Eyelid Turns Outward)

Ectropion, a condition in which the lower eyelid turns outward, can cause eye irritation and result in excessive tearing, crusting and mucous discharge. Although most commonly the result of aging and the weakening of the eyelid muscles, ectropion may also be caused by a birth defect, eye injury, scarring or skin cancers. An outpatient surgical procedure can be performed to tighten the eyelid and return it to its normal position. To prevent dryness of the cornea, artificial tears and ointments may be prescribed to help keep the eyes lubricated. Since ectropion can cause damage to the outer part of the eye, known as the cornea, we strongly suggest an evaluation with our oculoplastic surgeon, Dr. Zwick.

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Thyroid Eye Disease

Thyroid eye disease usually occurs as a result of Graves disease, or hyperthyroidism, but it can also affect hypothyroid or euthyroid patients. Infiltration of the muscles and tissues surrounding the eye can cause poor eye movement, proptosis (bulging of the eyes), malpositioned eyelids and sometimes vision loss. The most common sign of thyroid eye disease is eyelid retraction. Management of patients with this disease is often multidisciplinary and includes endocrinologists, internists, strabismus surgeons, ophthalmologists and oculoplastic surgeons. Patients experiencing severe sight-threatening progression of the disease often require high-dose steroid treatment, radiation therapy or surgery to decompress the eye and preserve sight. Patients may also require surgery to straighten the muscles that move the eye and eyelid. A new medication, TEPEZZA®, is now available to improve the signs and symptoms of Thyroid Eye Disease. 

Orbital Trauma

Orbital trauma to the eyelids and bony orbits often results from car accidents, sports or blunt force injuries. Such trauma may require surgical repair by an oculoplastic surgeon for optimal functional and aesthetic results. Restoring the bony orbit around the eye is important for eye positioning and vision. Scar tissue from injury or surgery may be unsightly or deform the eyelids. Scarring can cause poor function and closure of the eyelid, notching of the eyelid margin, drooping eyelids, misdirected lashes and irritation to the eye.

Orbital Tumors

Some cancers in other parts of the body can spread to the orbit, the area behind the eye. Primarily, orbital tumors can occur behind the eyes and can be malignant or benign. Often, patients will present with a bulging eye, a palpable mass, pain or double vision. Radiologic imaging is necessary to help identity the type of tumor and surgical excision can be performed. Depending on the tumor, sometimes a referral to a tertiary care university is indicated. 

Excessive tearing can result from faulty tear drainage into the lacrimal tear ducts or from overproduction of tears from the lacrimal gland. A common cause of tearing is the blockage of the lacrimal ducts located alongside the nose, which may result from inflammation, injury, tumors or other conditions. Excess tearing can be a nuisance; it can also cause infection that may affect vision if untreated. In adults, nasolacrimal duct obstruction often requires a procedure called a dacryocystorhinostomy (DCR) that creates a new opening from the tear duct into the nose. This procedure can be performed both externally and endoscopically. Another option for certain cases requires an artificial glass tear duct implant, called a Jones Tube.

The first step is scheduling an appointment with Dr. Zwick. In addition to seeing patients at our Annapolis clinic, Dr. Zwick is also pleased to see patients once a month in Easton at Dr. Dyer's office, which is located at 4 Caulk Lane. Call us today at 1-877-DR4-2020 to learn more or click here to schedule an appointment in Annapolis.