Dr. David E. Cowen is a highly trained and specialized surgeon who concentrates on the management of deformities and abnormalities of the eyelids, lacrimal (tear) system, the orbit (bony cavity surrounding the eye) and adjacent facial area.
Baggy Eyelids (Blepharoplasty) and Droopy Brows (Brow Ptosis):
There are many factors that may cause your upper and lower lids to become baggy, including age, allergies, hereditary tendencies, sun damage and smoking. When the eyebrows droop or the forehead sags, excess skin is pushed down onto the upper lids. Proper eyelid position and function are necessary to ensure continued eye health and unobstructed vision. The eyelids must open and close correctly to spread tears to cleanse and moisten the eye. Sagging eyelids may cause the appearance of fatigue or anger.As all facial structures may sag and droop with age, so may the upper lids and brows. A brow lift followed by a lid lift may be required to smooth out the forehead and improve vision. Upper eyelid or brow surgery may be considered reconstructive if vision is obstructed. Insurances, in some cases, will cover the cost of a reconstructive browlift or blepharoplasty if vision is significantly impaired. Many patients desire to have both upper and lower eyelid surgery performed in order to rejuvenate the entire eye area, giving a more rested and youthful appearance.
Lower Blepharoplasty surgery allows us to remove fat pads and excess skin from the lower eyelids.
A blepharoplasty, or eyelid lift, will not raise a drooping brow or remove wrinkles in the crow's feet area. A procedure to elevate the brows may be needed, instead of, or in addition to an upper eyelid blepharoplasty.
Correction of mild to moderate brow ptosis can be accomplished through incisions made directly about the brows, in the forehead creases, at the hairline, or even behind the hairline. These techniques are most effective if the brow ptosis involves predominantly the central area of the forehead.
For more significant brow ptosis, or to address deep frown lines and lateral hooding of the upper eyelids, it may be necessary to raise the brows and forehead through an incision behind the hairline.
An endoscopic brow lift is performed through small incisions hidden behind the hairline, using an endoscope and special instruments. The muscles that cause the brow to droop and crease the forehead skin are relaxed, allowing the brow to be raised into a more youthful position. A coronal brow lift can achieve the same results through a larger incision behind the hairline.
Eyelids That Open Too Widely (Eyelid Retraction):
Hyperthyroidism occurs when thyroid glands overact and may cause a person to experience changes with and around their eyes. The most common abnormalities produces a wide stare and prominent eyes that may result in a drying of the eye. Abnormal antibodies attack the thyroid gland and cause it to become overactive. Patients may experience swelling and inflammation of the soft tissues around the eyes and the muscles that move the eyes and eyelids. As a result, patients can have eyes that protrude, the lids may open too widely, or the eyes may not move together causing double vision.
For many, thyroid eye disease can be treated with topical lubricants, glasses and sleeping with the head elevated. Where there is more severe symptoms, oral cortisone or other anti-inflammatory medications may be prescribed. If swelling behind the eye is severe enough, Dr. Cowen may feel it necessary to decompress the orbit.
Orbital decompression is when Dr. Cowen removes part of the bony orbit behind the eye to relieve pressure in the eye socket. As with all surgeries there are risks and potential complications. Patients can experience minor bruising or swelling for the first few weeks. Bleeding and infection, which are potential risks with any surgery, are uncommon.
Eyelids That Turn Outward (Ectropion):
When a lower eyelid turns outward and no longer touches the eye it cannot properly spread the tear film across it. The exposed inner lining of the eyelid becomes dry and inflamed causing chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting of the eyelids and mucous discharge, infection irritation of the cornea (front of the eye) and impaired vision. An ectropion is usually due to relaxation of the tissues of the eyelid as the result of aging. Thus it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid. It can also arise as the result of an undetected skin cancer pulling the eyelid downward, trauma and contraction of scar tissue (from wounds, burns or surgery) involving the skin around the lower eyelid.
Eyelids That Turn Inward (Entropion):
Entropion causes the skin of the eyelid and its lashes to constantly rub against the eye’s cornea (the front of the eye) and the conjunctiva (the mucous membrane that protects it). Entropion is usually due to relaxation of the tissues of the eyelid as the result of aging. It may be caused by inflammation or scarring of the inner surface of the eyelid, eyelid injuries and tumors, or sometimes as a congenital disorder present at birth.
Eyelid Cancer and Facial Skin Cancer
Eyelid cancer (malignancy) is becoming more common. Most often it occurs on the lower eyelid, but may be found anywhere on the eyelid margins, corners of the eye, eyebrow skin, or adjacent areas of the face. All new or growing eyelid bumps and sores that will not heal must be evaluated to ensure they are not cancerous. Doctor Cowen has many specialized methods to surgically rebuild the affected area. He often works with specialist in Dermatologic surgery (Mohs surgeons). This multi-specialty approach to skin cancer reflects our commitment to excellence in patient care.
Trauma may result in injury to the eyelids and lacrimal (tear) system. Precise evaluation and repair of injuries are necessary to insure the best possible function and appearance especially when it involves the eyelids. Oculoplastic surgeons are uniquely and highly trained to reconstruct these damaged structures.