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Eyelid reconstruction following Mohs surgery restores beauty, function.

Photo by Nerissa Johnson.

Pamela Gaerttner

For a good part of her adult life, work was something Pamela Gaerttner did “in between kids.” That’s why she wound up bouncing from one major corporation

to another, General Electric, IBM and Procter & Gamble among them. 

“I’d work for a while, have kids, then take what I referred to as community service time where I’d help out at the school or whatever,” Pamela explains. “Then after a while, I’d go back to work again to regain my sanity.

“I was usually hired as administrative help but mostly worked with computers. I did that for a couple of non-profits as well but eventually retired from Proctor

and Gamble in 2003, when my husband and I moved from Cincinnati to Florida, which I love.

“Florida is a great place,” Pamela adds. “After spending twenty years in Cincinnati and twenty years in Boston, I love how green it is here. And, of course, I love how warm it is here. I just love the sunshine.”

Pamela’s love of the sunshine remains despite the fact the sun was the likely cause of a serious skin problem that first began to develop a couple years ago on the outside of her lower right eyelid, right along the lash line.

“The problem started out with what I thought was a little skin tag,” Pamela explains. “It was hard to put makeup on around it, but other than that, it didn’t really bother me. Then, earlier this year, a second skin tag grew right next to it.”

Like the first skin tag, the second didn’t bother Pamela much, so at first, she simply ignored it. And she might have gone on ignoring it had another, non-related issue not cropped up shortly after that second skin tag appeared.

“I was driving home one night when I suddenly started to see flashes of light in my vision,” Pamela recalls. “My eye doctor is Dr. Katz at the Center for Advanced Eye Care, so I went to see him because I thought the flashes might be from a detached retina.

“Well, the flashes went away almost immediately, and I learned from Dr. Katz that I did not have a detached retina. But when I asked him about the skin tags, he suggested I have them looked at by another doctor at the Center for Advanced Eye Care.”

Reconstruction Project

Dr. Katz is Adam M. Katz, MD. His recommendation was for Pamela to see his associate Alexander D. Blandford, MD, a board-certified ophthalmologist who specializes in cosmetic and reconstructive surgery around the eyes and face.

In addition to performing upper eyelid (eyelid lift) and lower eyelid (lower bag removal) surgery, as well as brow lifts, Dr. Blandford also specializes in skin cancer removal/reconstruction, orbital surgery and tear drainage system surgery.

After examining Pamela, Dr. Blandford biopsied the eyelid growths to rule out skin cancer.  To Pamela’s surprise, the biopsy revealed that the “skin tags” were in fact basal cell carcinomas, or skin cancers.

Photo by Nerissa Johnson.

People can’t even tell Pamela had eyelid surgery.

Shortly after learning of the diagnosis, Pamela had the cancers removed via Mohs surgery, a procedure where microscopic layers of cancerous skin tissue are repeatedly removed and examined until the tissue removed no longer contains cancerous cells.

The next day, Pamela returned to the Center for Advanced Eye Care, where Dr. Blandford began the process of reconstructing her right lower eyelid.

“To ensure all the skin cancer was removed, Pamela lost about a third of the lower right eyelid, including the area where the lashes and the lid margin were, during the Mohs surgery,” Dr. Blandford describes.

“She also lost some skin in the cheek/lid area – about the size of a quarter – all of which needed to be repaired. She came back to me for her reconstruction, which required repair of both the eyelid margin and the skin/muscle defect in the eyelid/cheek.

“The lid margin was first repaired by tightening the lid and creating a continuous row of lashes. The skin/muscle defect was repaired by creating a carefully placed incision below the eyelashes all the way across the eyelid and creating an advancement flap.”

“The advancement flap required dissecting from the incision below the lashes down to the cheek to fill the space where she had lost tissue in the cheek/lid area. The key was to recruit enough tissue to cover the defect without pulling the eyelid down.

“In both cases, we were fortunate to be able to keep the incisions in what we call the relaxed tension lines of the face. That helps the incision to heal as nicely as possible and helps to avoid visible scarring.”

A good aesthetic outcome is only one of the goals Dr. Blandford seeks to achieve when performing reconstructive surgery on the face following skin cancer removal. The first objective is to maintain all sense of function in the eyelid to ensure the eye is protected.

“In terms of function, it is imperative to maintain the eyelid’s ability to blink, fully close, and protect the eye itself,” Dr. Blandford emphasizes. “Even though we are talking about skin cancer, as these cancers often present on the face, we are very cognizant of the patient’s desire to have everything look as good as it possibly can after reconstructive surgery.

“We always work to get the best aesthetic outcome, but function is paramount. Fortunately in Pamela’s case, we were able to accomplish a great outcome in terms of both function and appearance.

“Her incisions are essentially imperceptible. The dissection was quite large, but we were able to keep the incision essentially below the lashes all the way across the eyelid, from the inner to the outer corner.

“And the outer corner incision falls within the smile lines, or what people call the crow’s feet areas in the outer corner. The eyelid maintained its normal, almond shape, and the function is completely normal.”

And Pamela couldn’t be happier. The swelling and bruising that come naturally from Mohs surgery and its subsequent reconstruction began to disappear after only a week. Within a month, few could tell she had undergone any procedures at all.

“Dr. Blandford did a fabulous, fabulous job,” Pamela exudes. “About two months after having the surgery, I went to Maine for a vacation, and my friends there could not even tell that I had had surgery of any kind.

“I now have lashes all the way across my bottom eyelid again, and if I didn’t know it myself, I wouldn’t be able to tell that I‘d had surgery. Like I said, Dr. Blandford did a great job, and he really has a wonderful manner and way with people.

“He’s very reassuring. I was a little nervous about what was going to happen, because I try to avoid anything that’s invasive like this, but he was so nice and calming, and just as he said it would, everything came out great.”

 

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    • Center For Advanced Eye Care

      The caring staff at Center for Advanced Eye Care welcome your questions regarding ophthalmology and ophthalmic plastic and reconstructive surgery. To schedule an appointment, please contact Center for Advanced Eye Care, located at 3500 US Hwy... Read More

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      Adam M. Katz, MD, is board certified by the prestigious American Board of Ophthalmology. After receiving his undergraduate degree from Union College in New York, graduating summa cum laude and Phi Beta Kappa, he was awarded his medical degr... Read More

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      Edward S. Branigan III, MD, is board certified by the prestigious American Board of Ophthalmology. He received his undergraduate degree from Syracuse University, and then graduated from Downstate Medical Center. Following an internal medi... Read More

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      Alexander D. Blandford, MD, is a board-certified ophthalmologist with a focus in oculofacial plastic and reconstructive surgery. Dr. Blandford completed a two-year fellowship approved by the American Society of Ophthalmic Plastic and Reconstru... Read More

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