Over 80% of surgeries can be done safely, effectively, and comfortably in our state of the art in-office surgical suite under local anesthesia. When necessary, Dr. Ray utilizes the out-patient surgery center at UMC for surgical procedures requiring a hospital setting or anesthesiology assistance.

Most of the time, YES! While purely cosmetic procedures are not covered by insurance, most eyelid conditions are – especially those affecting vision or causing discomfort of the eye. Either way, insurance will cover your Oculofacial Plastic Surgery evaluation for eyelid and orbital conditions.

Eyes are the first things that people notice about us, and are an important aspect of our overall appearance. In youth eyelid skin is elastic and smooth, but it thins over time. With loss of elasticity, we begin to see fat that bulges forward. With loss of volume and soft tissue weakness, eyebrows can fall (called droopy brows). Age, heredity, and sun exposure all contribute to this process. Excess skin and loss of volume in the eyelid area can detract from a healthy appearance. Excess skin hanging over the eyelid area and drooping of the brows can cause obstruction of vision. Blepharoplasty and brow lift surgery can provide a more youthful appearance and functional improvement.

Fat in the lower lid can be removed or repositioned through an incision hidden on the inside of the lower eyelid (transconjunctival blepharoplasty). Skin tightening can be performed at the same time or later to smooth and tighten the lower eyelid skin, if desired/needed.

The main goals of ptosis surgery are elevation of the upper eyelid to improve the field of vision, permit full visual development in children, or to establish more symmetry with the opposite upper eyelid. Blepharoptosis repair may also be performed to improve appearance. Ptosis surgery usually involves tightening the levator muscle to elevate the eyelid to the desired position.

Ectropion is an outwardly turned eyelid. The lower eyelids are more commonly affected, but ectropion may occur in an upper eyelid as well. The sagging lower eyelid leaves the eye exposed and dry, and as a result, excessive tearing is common with ectropion. If it is not treated, the condition can lead to crusting of the eyelid, mucous discharge, and irritation of the eye. Serious inflammation could result in damage to the eye.

In the type of ectropion associated with aging, most surgeons elect to shorten and tighten the lower eyelid. This typically is completed with an incision of the skin at the outside corner of the eyelid and reattachment of the eyelid to underlying tissues and the upper eyelid. Sometimes, there are scars from chronic sun exposure, following trauma, cosmetic surgeries, or the surgical removal of skin cancers. Your surgeon might need to use a skin graft taken from the upper eyelid or from behind the ear. Both the donor site for the graft and the surgical site will usually heal nicely within a few weeks following the surgery. The surgery to repair ectropion is usually performed as an outpatient procedure under local anesthesia.

Entropion is a condition where the upper or lower eyelid turns inward, rubbing the lashes against the eyeball, causing the eye to become irritated, red, and sensitive to light. The condition can cause pain, tearing, discharge, and irritation. If entropion is severe or left untreated for a long period of time, it can lead to permanent corneal damage and decreased vision.

Thyroid eye disease is a disorder of the immune system. It is not understood why our body’s protective defenses begin to attack the body’s own tissues. In thyroid eye disease the tissue around the eye is attacked by inflammatory cells and the result is inflammation, swelling, and bulging of the eye. Common symptoms of thyroid eye disease include swelling around the eyes, bulging of the eyes, irritation, redness, and a pressure sensation associated with headache. There can be pain with eye movement and/or restriction of eye movements causing double vision. If the inflammation involves the muscles, or if the swelling is severe enough, the pressure in the orbit (eye socket) can become extremely high. This can cause compression of the optic nerve, resulting in progressive loss of vision, and possibly blindness if the condition is not treated promptly.

The most common symptoms of blocked tear ducts include mucus buildup at the inside corner of the eye and/or along the lashes, excessive watering down the cheek (causing a need to wipe almost constantly throughout the day), and distorted vision. Depending on where along the passageway from the punctum to the nose the blockage occurs, you may also have redness, tenderness, and swelling between the inner corner of the eye and the side of the nose. An assessment by your oculofacial plastic surgeon can usually identify if a narrowing or blockage exists and if so, where along the passageway it is.

Yes! Benign essential blepharospasm (BEB) is uncontrolled contraction of muscles around the eyes. The condition affects both sides and may result in a variety of problems including difficulty opening the eyes, rapid fluttering of the eyelids, or forced contraction of the lids and brows. Hemifacial spasm (HFS) is uncontrolled contraction of the muscles on one side of the face, usually including the eyelids. Botulinum toxin is FDA approved for the treatment of these disorders. The toxin is injected into the muscles at several sites around the eyelids and brow to prevent unwanted contractions. The effects of botulinum toxin last an average of two to four months, and injections may be repeated as needed. This treatment has been found to be safe and effective.

The outer layer of skin is called the epidermis. Epidermal cells include flat squamous cells, round basal cells, and pigment-producing melanocytes. The dermis is the deeper layer of skin and contains the hair follicles, oil and sweat glands, and blood vessels. Skin cancers can arise from any of these skin cells. A biopsy is usually required to confirm the diagnosis of skin cancer.