Read our new publication in Plastic and Reconstructive Surgery (PRS) Journal

Little is known about surgical adhesives and their antimicrobial role.  We assembled a team of plastic surgeons and microbiologists to investigate the role of Mastisol and compound tincture of benzoin, both very commonly used adhesives in surgery, in fighting infections. In summary, we show that compound tincture of benzoin and Mastisol manifest antibacterial activity against surgical-site infection-related pathogens, including methicillin-resistant S. aureus. (MRSA). 

Antibacterial Analysis of Surgical Adhesives.

Joseph JM, Voldman A, Zoumalan CI, Lisman RD, Iovine NM.

Plast Reconstr Surg. 2012 Feb;129(2):402e-404e. 

 

 

Case presentation: Ptosis Surgery (Droopy Eyelid Surgery)

This patient was unhappy about her droopy left upper lid. She was a long-time contact lens user, which has been associated with ptosis in younger patients.  She was unhappy about not only her appearance but also was having difficulty seeing well with her peripheral vision.  She underwent ptosis repair to help improve her appearance and also see better.  The surgery takes no more than 20-40 minutes and can be performed using mild intravenous sedation.  There is minimal downtime with this particular type of ptosis surgery as well.  

Figure above shows a ptotic, droopy left upper lid. 

This photo was taken 6 weeks after undergoing posterior-approach ptosis repair surgery. Note the improvement in symmetry and lid height.

Read more about ptosis surgery at Dr. Zoumalan's website:

Ptosis surgery--Dr. Zoumalan

Upper lid blepharoplasty

Upper lid blepharoplasty surgery is a very gratifying surgery for patients.  Dr. Zoumalan is one of a handful of surgeons that exclusively specializes in upper and lower eyelid blepharoplasty surgery. Blepharoplasty is an eyelid surgery which involves the removal of excess skin and fat pockets in the upper and lower eyelids. In the upper eyelids, excess skin can result in a tired appearance to some, while in others, it can actually result in difficulty seeing in the top gaze of your vision (also referred to as limitations in super visual field). 

This particular patient had excess skin blocking her visual fields and resulting in a tired appearance (termed dermatochalasia). She has mild droopy lids (ptosis) as well in addition to a mild left brow ptosis. She underwent bilateral upper lid blepharoplasty, mild ptosis repair, and a left-sided brow lift. 

Preoperative photo of left upper lid dermatochalasia (extra skin), mild lid ptosis, and left brow ptosis. Note the slight asymmetry of the left upper brow resulting in mild asymmetry.

 

Post op photo taken 4 months after surgery showing an improved upper lid and brow contour, appearance, and symmetry.  

Read more about upper lid blepharoplasty surgery on Dr. Zoumalan's website at:

Upper lid blepharoplasty surgery---Dr. Zoumalan

Case presentation: Lower lid ectropion

Lower lid ectropions can result in a droopy lower lid, resulting in an outward positioned eyelid. This not only changes the appearance of the lid but also results in ocular irritation, red eyes, and often tearing.  The eyelids need to be in a normal position to allow for good tear production and drainage and to allow the eyelids to close properly during each blink. When the lids are malpositioned, they can be very irritating to the eye and result in tearing, pain, and even infections. The lower lid positions can change with age, trauma, sun damage, or prior surgery. They can either be turned out (referred to as an ectropion), turned in (referred to as an entropion) or can be retracted or notched.

This patient below had bilateral lower lid ectropions resulting in tearing.

She underwent lower lid ectropion repair and is now doing well and has an improved appearance to her lower lids and also able to blink well with resolution of her tearing symptoms.

New publication about the latest techniques in orbital decompression surgery

My colleagues and I discuss our latest orbital decompression techniques in this recent article that was published in the Operative Techniques in Otolaryngology Head and Neck Surgery Journal. Orbital decompression is type of orbital (eye socket) surgery that restores the normal volume in the eye socket so that the eyeball can rest in a more appropriate position.  One of the most common reasons we perform orbital decompression is in patients who have thyroid-related eye problems.  This article discusses the various ways we go about in performing orbital decompression. 

Rare injury but lucky patient: Man's eye saved after impalement

Although rare, these are cases that involve many doctors of various fields to help in the care of the patient that suffer severe orbital injury: from neurosurgeons, maxillofacial surgeons, otolaryngologists, plastic surgeons to oculoplastic surgeons.   I saw similar cases, although not inolving shears, during my residency and fellowship training.  I had the opportunity to work at two very busy county hospitals: Santa Clara Valley Hospital during my training at Stanford University and at Bellevue County Hospital during my fellowship training at NYU.  We had cases of gun shots, pencils, forks, and even knives piercing the orbit and luckily leaving the eyeball free from injury.  However, there were also those cases where the eye was severely injured and had to be removed and replaced with an orbital implant and a prosthetic.  Read this CNN article below for more about this latest case from Arizona.

Man's eye saved after impalement

Revisional eyelid surgery: A case of upper lid ptosis and lower lid retraction

A common reason patients see me is for abnormal eyelid positions. The term revisional eyelid surgery refers to the correction of the eyelid position (either upper or lower lid) after having undergone prior eyelid surgery. A few of the more common reasons for eyelid malpositions are from prior blepharoplasty or eyelid reconstruction from trauma or removal of an eyelid skin cancer.

The eyelid is a series of aesthetic units that all together makes it an extremely challenging area to operate on. It is difficult to tell which patient is at risk for having an eyelid malposition prior to any surgery but in many cases, we as surgeons do our best in preventing such circumstances.

My goal in revisional eyelid surgery is to customize the management to each patient. Conservative therapy can often help in some symptoms, but ultimately, most patients will end up requiring some form of revisional eyelid surgery. There are various components to performing revisional eyelid surgery and it depends on each patient's clinical findings.

 I recently saw a patient that had undergone prior upper and lower blepharoplasty in the past (see below photograph). He complained of a droopy appearance to his upper lids (termed ptosis) and irritation in both eyes due to the retraction in his lower lids. Retraction of the lower lids is a result of a downward displacement of the lower lids either from prior surgery (cosmetic or trauma), thyroid related problem, or just as a result of aging changes. The retraction can be a direct result of the laxity (or looseness) of the lower lids, or secondary to the scarring changes that may occur after surgery, or a combination of both factors.   He also had ptosis in his upper lids which may have worsened with time. He wished to have his eyelids appear more natural appearing, see better, and improve his irritation.

Preoperative Diagnosis: Bilateral upper lid ptosis and lower lid retraction

The goal of my surgery was to help him see better by lifting his eyelids and also to correct the laxity and retraction he had in his lower lids. The retraction in his lower lids prevents him from closing his eyes at well so he has problems with excessive exposure to the eyes. This results in his irritation and redness to the eyes. As a result, he underwent bilateral upper lid ptosis surgery with no additional removal of eyelid skin though. He also underwent retraction repair to help lift up his lower lids to a more normal position by a canthoplasty. A canthoplasty is a type of a lower lid resuspension technique.

Postoperative Photograph, four weeks after underging bilateral upper lid ptosis surgery and lower lid retraction repair through a canthoplasty lid resuspension technique.

Surgeon: Christopher Zoumalan, MD. Oculoplastic Surgeon.

Location: Beverly Hills, California