Dr Skippen has trained extensively in reconstructive techniques in eyelid surgery. He undertook a rigorous Clinical Oculoplastic and Orbital Fellowship in Cardiff, United Kingdom and gained further reconstructive eyelid, facial and orbital surgical expertise in Genoa and Milan, Italy.

Reconstructive eyelid surgery restores eyelid function and appearance usually after tumour excision, eyelid trauma or due to age-related problems.

Eyelid tumour surgery

This may be a single day operation or involve more than one operation for reconstruction in larger cases.

Disorders of eyelid position

Eyelid ptosis – droopy upper eyelid

When the upper eyelid margin begins to droop down toward the pupil, this is termed upper eyelid ptosis. This is different from dermatochalasis, which is extra eyelid skin hanging down over the eyelashes. Both ptosis and dermatochalasis can actually block vision.

In adults, age-related levator aponeurosis dehiscence, is the most common cause. In children, the most common cause is poor development of the levator muscle. Adults infrequently have ptosis caused by nerve or muscle problems.

Ptosis surgery aims to correct the underlying problem and ideally match the heights of the two upper eyelids to achieve symmetry. This surgery is performed under a local anaesthetic.

Ectropion – eyelid rolled out

Ectropion results in exposing the inner eyelid, either in one section of the eye or across the entire eyelid. This may prevent tears from draining from the eye correctly, resulting in watery eyes and/or irritation.

Correction of ectropion requires a surgical procedure in which the lower eyelid is tightened or shortened. This is performed under a local anaesthetic and sometimes with light sedation as well. A skin graft may be required.

When the ectropion is caused by scars, sun damage or prior surgery, the procedure typically relies on a skin graft.

Entropion – eyelid rolled in

More common on the lower eyelid, the skin and eyelashes may rub painfully against the cornea. Corneal ulcers and scarring which can threaten vision are a potential risk from this condition. The lower eyelid may turn in constantly or only at times when the eyes are closed tightly.

Entropion usually arises as a result of aging. Other causes can include injury, skin infections and inflammatory conditions.

Ultimately, lower eyelid entropion needs to be corrected through a surgical procedure in which the eyelids are repositioned. This is performed under a local anaesthetic and sometimes light sedation as well.

For entropion due to muscle weakness, the surgery may involve tightening of the eyelid. A skin graft may be necessary for when the entropion is caused by scars or prior surgery.

Eyelid retraction – upper eyelid too high, lower eyelid too low

Upper eyelids that rise and reveal the white part above the eye are said to be retracted. This is usually a sign of thyroid eye disease, although other causes exist.

Lower eyelids that sit low to reveal the whites below the eye are said to be retracted. This is most commonly caused by age-related laxity of the lower eyelid. However, it can also be seen in thyroid eye disease or after trauma. It can be corrected surgically by various techniques under local anaesthesia.

Blepharoplasty (For loose, baggy upper eyelids)

• Upper eyelid skin reduction – this procedure may be cosmetic (see cosmetic section) or functional if impacting on vision (Medicare-eligible in these cases).
• Lower eyelid blepharoplasty (for lower eyelid bags) is cosmetic surgery.
• For the upper eyelids, usually only excess skin (dermatochalasis) is removed through an incision hidden in the natural upper eyelid crease. If the eyelid is also droopy, the muscle that raises the upper lid can be tightened (ptosis surgery). The incision is closed with fine sutures.

Removal of unwanted non-cancerous eyelid lumps and bumps:

These include:

• Benign eyelid lesions
• Eyelid cysts
• Chalazion
• Abnormal eyelashes (trichiasis)

Protection of the underlying eye in facial palsy:

These may include:

• Lower eyelid elevation and tightening
• Tarsorrhaphy (surgical or chemical eyelid closure)
• Gold weight insertion into the upper eyelid to assist eye closure

Revisional oculoplastic surgery:

Correcting outcomes of previous surgeries done by other surgeons

Paediatric eyelid surgery:

Eyelid ptosis (droopy upper eyelid) in children