From Heavy Lids to Clear Vision: Understanding Eyelid Surgery

Loose or sagging skin creating folds on the upper eyelid, excess skin and wrinkles around the lower eyelid, drooping lower eyelids -- all these and others can at some point impair your vision. Or perhaps you feel that the skin around your eyes could use a refresh. Coby Ray, M.D., an oculoplastic surgeon at Texas Tech Physicians, is our expert for this episode. Dr. Ray explains that sometimes blepharplasty is sometimes medically necessary to prevent vision impairment caused by droopy eyelids. He goes over what's involved with the surgery and recovery and his recommendations to help prevent droopy eyelids. 

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield,. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. We here at Texas Tech Health Check do our best to bring not only correct and possibly new information to our listeners, but interviews full of useful information. This episode is a good example of that. Before talking to Dr Coby Ray, I thought eyelid surgery was mostly cosmetic, but Dr Ray explained how blepharoplasty can be medically necessary, because drooping eyelids can obstruct our vision, not that there's anything wrong with cosmetic surgery, because who am I to judge? Dr Ray, oculoplastic surgeon at Texas Tech Physicians also tells us what's involved during surgery and recovery and some of the causes of droopy eyelids and hopefully a way to prevent it.

Melissa Whitfield  1:14 
Dr Ray, welcome to our podcast.

Dr. Coby Ray  1:16 
Thank you. Thanks for having me. Yeah, that's great.

Melissa Whitfield  1:18 
How are you doing today?

Dr. Coby Ray  1:19 
I'm doing really well. How are you?

Melissa Whitfield  1:19 
I'm doing well. Thank you.

Dr. Coby Ray  1:20 
Good.

Melissa Whitfield  1:21 
Well, it's your first tune here on our podcast. So I'd love for you to tell our audiences a little bit about yourself, your expertise and what you do here at the Health Sciences Center.

Dr. Coby Ray  1:30 
Sure, absolutely. I am a long time Texas Tech guy. I was born and raised in Dallas, but came out here for medical school. I trained in the ophthalmology department for my residency, and now I am practicing as an oculoplastic surgeon. So it's a facial plastic surgery kind of limited between the hairline and the jawline, I like to say. And I take care of all manners of diseases of the eyelids, the orbit, both cosmetic and functional issues that people may struggle with.

Melissa Whitfield  1:56 
Well, again, welcome to our podcast.

Dr. Coby Ray  1:58 
Thank you.

Melissa Whitfield  1:58 
So can you explain to us or talk to us about what is an eyelid lift or eyelid surgery? And I know you mentioned from the hair line to the jaw, but is that just the upper part, or does it include under the eyes? Can you talk a little bit about that?

Dr. Coby Ray  2:15 
No, that's a great question, because this is by far the most common complaint that patients come in and ask me about or asked me to help them with and and that's as we age, we oftentimes get extra skin on our eyelid that we essentially don't need, and that's a blepharoplasty that a lot of people have probably seen on various apps online or videos online that people use looking at these surgery videos. And for us, that's our most common surgery, but it's also the simplest way to really help people. And so a blepharoplasty really refers to the upper eyelid and the excess skin that you have there. And I always tell my patients, it's kind of like taking up the hem on a pair of pants. We take the extra fabric that you don't need or is blocking your vision and weighing your lid down, but leave you with enough that you can close comfortably and feel good about things. And then there is an option too, and when we get older, a lot of times the fat that we all have that surrounds our eyeball starts to push forward in our lower eyelid, then it can, you know, cause both a functional issue or a cosmetic issue, where we just don't like the way it looks. And that is something else that we offer, where we can actually go in through the inside of the eyelid, so you don't usually end up with a skin incision, and we're able to take out that extra puffiness underneath the eyelids, and it usually makes patients both more comfortable and also feel better about the way they look and kind of the way their eyelids look for them.

Melissa Whitfield  3:29 
What causes this excess skin and who is the candidate for this procedure? Is it something that would be considered elective, or could someone have a medical reason for it?

Dr. Coby Ray  3:40 
Sure. So it's something that most often is caused by too many birthdays. As we age, we end up with a little bit of redundant skin, extra skin that we don't really need to open and close our eyelids. That's the most common reason. Out here in West Texas, we get a lot of wind, a lot of dry air, a lot of dust and dirt in the air. We're all eye rubbers. We all rub our eyes all the time, so that constant tugging on our eyelids can make both our upper lids and our lower lids a lot more loose and lax, and we end up with these issues that both affect the vision, because our eyelids are blocking our eyes, but also the comfort of our eyes, because our lids aren't where they're supposed to be. The eyes don't stay moist and comfortable like we would all like them to be. By and large, these issues are covered by the health insurance. For the most part, insurance is very good at recognizing that these issues cause vision problems. They cause eye problems that really affect their patients in a medical way. So it's really surprising that a lot of the time, these are covered by insurance and something that is a medically necessary surgery to have.

Melissa Whitfield  4:44 
What is the procedure like and what is the recovery time?

Dr. Coby Ray  4:48 
Sure, great question. So the upper eyelid surgery, it's one of the simplest procedures a patient can have. As I kind of alluded earlier, I always describe it as taking the hem on a pair of pants, but that's essentially exactly what we do. We look at the upper eyelid, and we identify the extra skin that the patient doesn't need to open and close their eye comfortably, and we remove that skin. We do it all in office. There's no anesthesia required. It's a simple numbing procedure, and the patient is completely awake during the entire surgery. It takes about 15, 20, minutes, not a very long or cumbersome surgery, and for the most part, patients are back at their normal activity later that day or the next day for sure. They go back to work, they can bathe, shower, wash their hair, do all of that the very next day. And so it's a very minimally invasive surgery. It's something that patients tolerate very well, and really not a lot of downtime at all.

Melissa Whitfield  5:39 
What are the risks?

Dr. Coby Ray  5:40 
Sure. So anytime we operate around the eyeball, there's always, always theoretical risks, anytime we're in that small of an area or close area. But probably the biggest risk is an issue of maybe the wound opening again. As I mentioned earlier, we're all eye rubbers, and, you know, a good tug on even a nice place suture can open up. And you know, so some small risks like that. Anytime we do surgery, there's a risk for infections and other sort of kind of the generic problems. But again, very easy surgery, very easy recovery, and patients do really, really well for it.

Melissa Whitfield  6:12 
So what does it not do? And are there other eye procedures that you you do?

Dr. Coby Ray  6:19 
Yeah, sure, no. So blepharoplasty is not going to change the way the eyeball sees, and I think that's always important. I think an eyelid surgery is going to allow the eye to see the very best that that eye can see. But we're not we're not doing a cataract surgery. We're not removing anything in the eyeball itself or changing the way that other parts of the eye work. And so what we're trying to do is allow that eye to see the very best with the potential that that eye already has from the other medical conditions that patients often have. There's another number of eyelid surgeries besides the upper lid skin tightening or the lower lid blepharoplasty that we talked about, very common in West Texas, from that eye rubbing is is what we call an ectropion, and that's a lacks lower eyelid, where the eyelid, if you tug down on it, it almost falls down on your cheek a little bit. It rolls out more than it's supposed to, and again, it causes issues with comfort. A lot of patients that are struggling with dry eyes and that constant irritation and redness in their eyes. It's really from eyelids that are not properly positioned. And so it's something you want to ask your eye provider to look at or ask your primary care doctor to have you come see me and let me take a look at it, or a surgeon like me. And you know, I think that's one of the more common things that people struggle with, but it's another very, very simple, very easy in office fix that can really change somebody's life and really that daily comfort, not to mention maximizing that vision potential of an eye.

Melissa Whitfield  7:42 
Do patients need a referral for the procedure?

Dr. Coby Ray  7:44 
Not usually, sometimes there's insurance specific referral needs that of course, you know, the office staff is happy to help the patients with and kind of explain to the patients and help them understand the process. But by and large, having an eye exam is something that everyone should do once a year, at least, if they don't have another disease that requires more frequent follow up. And, you know, so getting in to see me for an eyelid exam is something we're always happy to do, and surgery is not always the option, and it's not the perfect fit for everyone, but that's, you know, one of the important things that we do in clinic is trying to identify the the right fix for the right people. And I think we're able to do that pretty well for most of our patients.

Melissa Whitfield  8:20 
Is there anything else you'd like to add?

Dr. Coby Ray  8:23 
Sure, I mean, I think it's important to realize, again, I think a lot of people see the Hollywood pictures and think that you're going to come out maybe looking scared or surprised all the time, or have an over treatment or something that you don't really need, or it's only for vain people. I hear, I hear that a lot, and I think it's a mistake to discount the benefits that these surgeries can help someone with, again, their vision, but also with their comfort and just their everyday life. And so I think if it's something that people are struggling with, they should reach out and ask for an evaluation. There's no harm to being looked at in clinic and talking through everything. And that's something I would love to do, and I love meeting new patients here in West Texas, we have just the best patient population, I think, anywhere. And so getting to meet new folks is always the highlight of my day.

Melissa Whitfield  9:07 
Well, thank you so much for coming on our podcast and talking to us about this.

Dr. Coby Ray  9:11 
No, I appreciate it. Thanks so much for having me.

Melissa Whitfield  9:09 
Can't wait to have you back.

Dr. Coby Ray  9:14 
Thank you.

Melissa Whitfield  9:14 
Thank you.

Melissa Whitfield  9:17 
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts, this information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna, Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.