Your Eyes Are In Good Hands

Oculoplastic surgeons provide an array of treatments to enhance your facial appearance.

First impressions are made at eye level. The look of the eyes and face says a lot about a person, which is why it’s essential that people take special care of these areas.

Dr. Applebaum discusses his evaluation with one of his patients.

When age, genetics or sun exposure affects the eyes and face, fellowship-trained oculoplastic surgeons Craig E. Munger, MD, PhD, and Robert J. Applebaum, MD, MBA, of Florida Eye Specialists & Cataract Institute go to work.

“Puffy or drooping eyelids can make people look old, tired or even mean,” Dr. Munger alerts. “While puffy eyelids are often hereditary, they become more pronounced with age.”

To treat sagging eyelids, Dr. Munger and Dr. Applebaum often recommend blepharoplasty, a safe, effective and cosmetically appealing eyelid surgery. Blepharoplasty involves removing excess eyelid tissue. It can be done on the upper and lower eyelids, and can make a dramatic difference in the appearance of the face.

“With upper blepharoplasty, excess skin is removed from the upper eyelids, which can drop due to age, sun exposure and genetics,” Dr. Applebaum explains. “The repairs we perform help functionally as well because the excess tissue can get in the way of vision and endanger  the patient.”

Excess skin on the upper eyelids can obstruct a patient’s field of view, interfering with peripheral vision, Dr. Munger expounds.

“If you look in the mirror and see the skin on the upper eyelids approaching your eyelashes, that may well represent a loss of the visual field,” Dr. Munger elaborates. “Unfortunately, because the condition develops slowly, people may lose as much as 30, 40, even 50 percent of their visual field before they realize they need help.”

Medicare and other medical insurance programs may cover the cost of eyelid surgery if the visual field is impaired due to excess skin. Whether motivated by cosmetic or functional issues, upper eyelid blepharoplasty is a relatively easy procedure, Dr. Applebaum reports.

“It is performed in our clinic. We give our patients a derivative of Valium to relax, and with their eyes gently closed, we remove the excess tissue along the course of the upper lid and stitch the incision closed.

“The scar is placed into the lid crease, so when the eyes are open, the scar is tucked away into the normal anatomical fold of the crease. The eyelid skin is the thinnest skin on the body; consequently, scarring is extremely minimal.”

Bags and Puffiness

Lower eyelid surgery, called lower blepharoplasty, can also make a big difference in the appearance of the face, Dr. Munger contends.

“Most people are born with five ‘bags’ of fat around the eye to protect it and hold it in the socket,” he states. “But with aging, that fat can come forward and manifest itself as puffiness under the eye. Lower blepharoplasty can diminish the look of tiredness and aging by decreasing excess fat and skin beneath the eyes.”

There are two approaches to lower blepharoplasty.

“If there is excess skin as well as puffiness, we use an anterior approach. An incision is made under the lower eyelid lashes, and the excess fat and skin are removed,” Dr. Applebaum explains. “If excess skin is not an issue, then the procedure can be performed through a tiny incision on the inside of the eyelid, and no external incision is required.”

UV Rays and Cancer

Exposure to the sun’s ultraviolet rays can lead to skin cancer, including cancer of the face and eyelids. The eyelid skin is especially sensitive because it’s so thin, and UV rays don’t have to penetrate very deep to reach the lower levels where many cancers begin.

A technique called Mohs surgery, which removes cancerous tissue one layer at a time, is generally effective at removing skin cancer. But it can leave large, open wounds on the surface of the skin. When these wounds are near the delicate eyelid area, the oculoplastic surgeon must perform reconstructive surgery.

“Using a product such as JUVÈDERM, people not only get the benefit of a more youthful appearance, but the results are also very natural looking.” – Dr. Applebaum

“We perform reconstructions after we remove skin cancer ourselves, as well as when patents are referred to us by our dermatologic colleagues,” Dr. Munger notes. “In those cases, the dermatologists remove the skin cancer, but we perform the reconstructions because the operative areas are so close to the eyes.”

Three factors are very important when performing eyelid reconstructions.

“The first, of course, is to ensure complete removal of the eyelid skin cancer,” Dr. Applebaum relates. “Second, our reconstructive goal is to maintain the function of the eyelid so it can properly open and close. And third is to make the reconstruction as aesthetically pleasing as possible.”

Clarifying Cosmetics

Dr. Applebaum and Dr. Munger commonly use intense pulsed light, or IPL, to rejuvenate the skin of the face and around the eyes.

“Skin problems typically begin when people are in their 30s,” Dr. Munger observes. “That is when production of collagen and elastin, the building blocks of skin, starts to decrease and skin cell turnover begins to decline. These conditions make it more difficult for the skin to recover from the effects of aging and from injury caused by exposure to the sun and elements.”

These conditions result in the formation of brown age spots, discoloration of the skin, visible blood vessels on the surface, uneven skin tone, and fine lines and wrinkles. They also make small scars, such as those from acne, more visible. IPL can improve these concerns.

“IPL is not a laser resurfacing technique,” Dr. Applebaum stresses. “Instead of a laser, IPL uses high-intensity light at multiple wavelengths. The wavelengths and frequency of the light can be adjusted to address various skin conditions. IPL does not damage the surface of the skin, which can occur with laser techniques.”

While not a laser, IPL works on the same principles. Light is absorbed into specific skin cells, where it is converted into heat energy. The heat damages the walls of the targeted blood vessels and breaks up the skin’s pigment cells. The affected blood vessels and pigment cells then either rise to the surface, where they fade, or are carried away by the lymphatic system.

“One of the biggest advantages of IPL over lasers, which generally produce more noticeable results, is its minimal downtime,” Dr. Munger points out. “Because IPL does not affect the surface of the skin, there is little redness following treatment. Patients can have IPL over their lunch break and return to work immediately afterward.”

Fitting Fillers

In addition to surgical procedures, Dr. Applebaum and Dr. Munger offer nonsurgical facial cosmetic services. These include BOTOX® Cosmetic injections and a variety of facial fillers. These options can help reverse changes associated with aging.

Dr. Applebaum

“BOTOX Cosmetic is a synthetic toxin that is altered so it is nontoxic to the body of a healthy person,” Dr. Applebaum informs. “It blocks the release of neurotransmitters that trigger muscle contractions, which leads to wrinkles.”

Among the fillers used by the physicians are JUVÈDERM® VOLUMA and Restylane®. Many fillers contain hyaluronic acid, a substance found naturally in the body that helps restore volume and hydration to the skin.

“Over time, materials in the skin, including the collagen and base membranes, break down, so the face begins to sag. We use fillers in the cheeks to add volume and give the face a nonsurgical lift,” Dr. Munger describes. “We also use fillers in areas slightly lower on the face to decrease the appearance of fine lines and wrinkles around the nose and lips. Often, we use them in the lips to give the lips more fullness.”

Another filler, KYBELLA®, is used specifically to decrease the appearance of a double chin. It is injected into the fatty tissue of the chin, where it breaks down fat cells.

“Using a product such as JUVÈDERM, people not only get the benefit of a more youthful appearance, but the results are also very natural looking,” Dr. Applebaum assures. “Patients don’t look like they’ve had anything done.”

People with any face or eye condition can rely on Dr. Applebaum and Dr. Munger for their care. Plus, both physicians are supported by the skilled staff at Florida Eye Specialists & Cataract Institute.

Dr. Munger operates out of the Brandon and Sun City locations. Dr. Applebaum provides services at the Brandon, South Tampa and Riverview locations.

© FHCN article by Patti DiPanfilo. FHCN file photos. mkb


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