Eyelid Surgery in Colorado Springs

• Entropion/Ectropion are disorders of the eyelid in which the lid turns inward or outward respectively. Both conditions typically develop in the lower eyelid. Oculoplastic surgeons, like Dr. Burroughs, are the most experienced in surgically improving these eyelid malpositions to avoid eye discomfort, eye damage, and even vision loss.
• Dry Eye may be a temporary or chronic condition that can lead to complications when left untreated. Dry eye can be managed with optimizing the best ocular surface lubricants, minimally invasive with punctal (tear drain) closure, IPL treatments to improve oil gland dysfunction providing healthier tears, BlephEx treatments to improve eyelid health and oil tear secretions, and surgical eyelid improvements to improve eyelid blinking and coverage of the eyes.

Insurance will often pay, less your specific copays and deductibles, for eyelid surgery that is performed to improve vision. For instance, if your upper eyelids are drooping and this is blocking your vision, your insurance company may pay for upper eyelid surgery. If the upper eyelids are blocking vision, insurance companies require a visual field test be obtained to demonstrate that the eyelids block the peripheral vision and that the vision is improved by elevating the eyelids. If your lower eyelids are droopy and this is causing eye irritation or watering of the eyes, your insurance company may pay for correction of this problem. Insurance companies typically require that the medical need be documented with photographs, which are reviewed by the insurance company during the preauthorization process. Some problems like bags in the lower eyelids do not affect vision and are never paid for by insurance companies. Other problems like excess skin in the upper eyelids that effect vision when severe enough are paid for by insurance companies when photographs and visual fields document a medical need for the surgery. Dr. Burroughs’ office can act as your advocate to help get your insurance company to pay for medically necessary procedures. Many of the procedures he performs are done only to improve appearances, and these cosmetic procedures are not paid for by your insurance company. During you consultation, Dr. Burroughs will determine what procedures will offer the most functional (medical) and cosmetic benefit and discuss the range of options.

In nearly all cases of upper eyelid blepharoplasty surgery, there is excess skin in the upper eyelids, so removal of extra skin is only possible with an incision. Fortunately, the skin of the upper eyelid is some of the thinnest skin in the body and typically heals with little to nearly invisible scarring. Further, the incision site can be hidden in the fold of the upper eyelid allowing the incision to be hidden while healing. The incisions usually have to extend to the lateral crows feet area to avoid unwanted excess skin at the outside corners of the eyes.

Dr. Burroughs has used lasers, scalpel blades, bovie (electric needles), and radio frequency needles. His preference is to make the incision with a scalpel blade or with an electric (bovie) needle set at a low setting to optimize the wound shape and architecture while minimizing collateral heat damage that other modalities can cause. Once the initial skin incisions are made, then depending on the circumstance and patient needs, the other modalities can be used. One problem with lasers is they can easily become uncalibrated, causing the incision to be inaccurately placed, and they also can cause heat damage that leads to slower wound healing and, rarely, more scarring.

Dr. Burroughs finds eyelid wounds heal cosmetically better and faster with non-dissolving sutures that are removed between 7-14 days after surgery. Dissolvable sutures “dissolve” by causing local inflammation and can sometimes leave the incisions looking more red and “bumpy” in the initial phases of healing. Dr. Burroughs also finds that performing a “running” suture to be easier for removal than a series of interrupted sutures that have to be individually removed.

Aesthetically, the tendency is to leave as much fullness in the upper eyelids as possible. Removal of too much fat from the upper eyelids can give one a hollow appearance that is not desirable. Often the fat pad in the upper eyelid adjacent to the nose is bulging forward and is reduced in size at the time of upper eyelid blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow appearance. Some patients benefit with removal of the superficial skin while leaving the underlying muscle, which can be helpful in older patients or those with pre-existent muscle weakness before surgery that can worsen eyelid closure after surgery. Others, most in fact, benefit with some eyelid muscle removal, which can help reduce the crows feet appearance and provide a subtle and pleasing brow lift.

Yes. There are several options to include Wrinkle Blocker, filler, and surgery to improve these areas. Dr. Burroughs has published an article in the Archives of Facial Plastic Surgery journal, detailing an optimal technique to address these concerns at the same time as upper blepharoplasty surgery.

Yes. It is very common for patients to have surgery done to improve function at the same time that cosmetic surgery is done. The portion(s) of the surgery that is done to improve eyelid function and eye comfort may be covered by your insurance company.

Many other procedures can be done just before, during, or after your upper eyelid surgery. This can include Wrinkle Blocker, chemical peels, and fillers. Additionally through an upper eyelid incision, Dr. Burroughs can gently raise the eyebrows, reduce the wrinkle lines between the eyebrow, improve frontal area headaches, raise the lower eyelids, and improve the crows feet areas.

Yes. It is optimal when medically appropriate (you can see well enough to function) to have eyelid surgery first. Very rarely, eyelid surgery can change one’s vision and cause the need for glasses or an adjustment to one’s glasses prescription. Usually by 6-8 weeks, the eyes are stable and no further refractive (eyeglass) changes occur. It is quite rare for major shifts to occur, but because both laser and cataract surgery depend upon very accurate and stable preoperative measurements, it is best if one is thinking of doing eye surgery and eyelid surgery to do the eyelid surgery first. If you have already had laser (e.g., Lasik) or cataract surgery performed, then generally no substantial visual changes will occur, but is a slight risk. Patients that have had prior laser surgery are at a higher risk for dry eyes, which can be exacerbated following eyelid surgery and needs to be carefully monitored during healing.

This varies from patient to patient, but it may be made either in the upper eyelid, the lower eyelid, or at the temporal hair line. You should discuss this with Dr. Burroughs during your consultation.

This varies from patient to patient and their desired goals. Generally, if the eyebrows are resting at or below the orbital rim, then some form of brow or forehead lifting will be required for the best result. Dr. Burroughs can discuss this during your consultation.

Asian patients have different anatomy than occidental patients. Some Asian patients are born with a fold in the upper eyelid and others are not. When the fold is present, it is called a double eyelid. The fold in the upper eyelid of Asian patients is much nearer to the eyelashes than it is in the occidental eyelid. It is often said that Asian patients wish to have their eyelids “westernized.” In our experience, Asian patients seeking double lid surgery want their eyelids to look like those Asian patients that are born with a fold in the eyelid and do not wish to have their eyelids look like occidental or “western” eyelids. This form of cosmetic eyelid surgery is performed by Dr. Burroughs. If you are considering this type of surgery, it is helpful to bring a photograph of a model with the appearance you hope to achieve, so that this can be discussed and decided if it may be safely and reasonably achieved. Dr. Burroughs’ stepmother is Korean, and while he was still in the Air Force, he performed many Asian blepharoplasties on Filipino and Korean patients. He has also surgically treated patients from Japanese, Chinese, Taiwanese, Cambodian, and Vietnamese descent.

Yes, but this is usually a temporary issue that improves greatly upon suture removal in most cases. The upper eyelids are central to form and to visual function. Removal of too much skin from the upper eyelids does not look natural and causes problems with lid closure. Dr. Burroughs is an expert in both ophthalmology and plastic surgery which is why he is acutely aware of the need for the lids to both look and function normally after cosmetic eyelid surgery. The most serious complications of facial cosmetic surgery occur with eyelid surgery. Some patients with medical issues such as weak facial muscles require an even greater concern for properly performed eyelid surgery to enable the best and safest result. In the early stages of healing, sometimes the eyelids will not completely close, but after the sutures are removed, generally the skin loosens up and muscle strength returns allowing full closure of the eyelids. During this time, utilization of artificial tears, gels, and ointments can improve eye comfort and vision.

Recovery varies by the exact procedure(s) performed and the individual patient. Generally, eyelid surgery is minimally painful but results in bruising and swelling. Patients should plan on being home on the day of surgery and for two additional days. During these first few days, cool compresses are applied to the eyelids to reduce bruising and swelling. After the third day, most patients can drive a car and get about fairly easily. Postop patients should avoid heavy lifting and strenuous exercise for 10-14 days after their procedure. Most patients will wear sunglasses for 2-3 weeks to hide bruising and swelling. Dr. Burroughs will provide you with detailed written instructions prior to your procedure.

Yes. All medical and surgical procedures carry some risk. You should discuss the risk of complications with your doctor prior to surgery so you can make an informed decision on how to proceed. Many patients select Dr. Burroughs for their surgery because of his ophthalmic background, and they believe the risk of complications with cosmetic eyelid surgery may be lessened when performed by a surgeon with special plastic surgery training of the eyelids and who is vastly experienced in performing these procedures. A careful ophthalmic history and exam is critical before any eyelid surgery. Each year, Dr. Burroughs has been the first to diagnose eye problems prior to surgery that could cause suboptimal results following surgery or even vision loss whether surgery is performed or not. Dr. Burroughs will appropriately refer you to the correct eye specialist if he detects a problem that needs to be addressed prior to eyelid surgery.