Tel: 07961 443 918
Oculoplastic Surgery
What is oculoplastic surgery?
Dan is an internationally trained oculoplastic surgeon; this means that he has completed his eye surgery training but he has also learnt some plastic surgery as well, making him uniquely qualified to handle plastic surgery around the eye.
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This is important because if surgery around the eye is not done correctly, it can have unfortunate consequences for your eyes, including painful dry eyes and even blindness.
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This knowledge makes Dan a more cautious surgeon, and do not be offended if he tries to talk you out of a cosmetic procedure that you have set your heart on. This is because he is often called upon from across the world to correct complications caused by other surgeons and your safety is his first concern.
Blepharoplasty/Eyebags
This is an operation to reshape the eyelids, either to correct overhanging skin, swelling and bagginess in the upper or lower eyelids. This usually occurs simply due to age but can be due to an underlying disease or even a tumour; Dan will make sure that you get a full examination to exclude any other problems with or around your eyes.
The surgery can be performed for functional reasons, because your eyelids are heavy and you cannot see properly, or for cosmetic reasons; it is one of the best and safest ways to rejuvenate your face.
Dan normally performs blepharoplasty surgery under local anaesthetic but you can have sedation or a general anaesthetic if you wish. He would not normally operate on upper and lower lids at the same time as this puts the eye at significant risk of exposure.
After the surgery your eyelids will be swollen and bruised for up to 2 weeks but after that it will be very difficult to tell that you have had surgery. Cold compresses are useful to reduce the swelling in the first few days.
Dan will talk you through the risks and benefits of the surgery so that you are fully informed before signing the consent form. Complications quoted with blepharoplasty surgery include over or under-correction, infection, bleeding, dry eyes, numb eyelashes and very rarely visual loss.
Ptosis/Droopy eyelids
Sometimes not only the skin but also the lid itself is drooping over the eye making it difficult to see and often causing headaches as you try to lift your eyelids using your forehead muscles. This requires slightly different surgery to a blepharoplasty, although the ptosis repair is often combined with blepharoplasty for the best possible result.
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Dan will make a full assessment of your eyelids and eyes to exclude any more sinister underlying disease causing the droopy eyelids and then offer surgery as appropriate. The risks are similar to that of blepharoplasty surgery outlined above.
Lumps and Bumps
If you have a lump or bump around your eyes that is either growing, causing pain or just cosmetically unsightly, Dan would be happy to see you, identify it and remove it if you wish. This can be done under local anaesthetic as a one stop process, just let the team know when you are booking and make sure you bring someone to drive you home afterwards.
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Sometimes it is clearly a benign lesion, but occasionally it is necessary to send the specimen for pathological examination and Dan will advise you if this is the case.
Eyelid cancer
Cancer in, around and behind the eyes makes up a large proportion of Dan’s NHS practice he is well placed to offer the best possible treatment at what can be a very worrying time for patients.
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If you, your GP or optician suspects that you have a suspicious lesion around your eyes, Dan would be more than happy to see you on an urgent basis to offer a diagnosis, biopsy and talk you through the treatment that is required.
Ectropion/Entropion
Ectropion is when the eyelids are turning out, entropion is when the eyelids are turning in. Both conditions are usually related to age, but can be due to more sinister causes. Both conditions cause discomfort and entropion especially can be dangerous to the eye because the inturned eyelashes rub on the surface of the eye and can cause infections and ulcers; therefore, it should be treated promptly.
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The usual treatment is surgery under local anaesthetic, but sometimes ather are non-surgical options. Dan would be happy to see you, assess your eyes and advise on the best course of treatment.
Brow lifts
Sometimes the eyelids are heavy because the eyebrows have dropped, either due to age, trauma or sometimes paralysis of the facial nerve, like Bell’s palsy. There are various ways to correct this, including Botox and surgery.
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A direct surgical brow lift often gives the best eyebrow raise and Dan is happy to see you and advise on the best course of action.
Watery eyes
It is common to have watery eyes, especially later in life. There are many different causes, including blockage of the tear ducts, poor eyelid position, ocular surface disease and over-production of tears. Often there will be more than one cause and therefore different possible ways to improve the watering.
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Dan has many years of experience of treating people with watery eyes and would be delighted to discuss the problems you are having, assess you thoroughly and offer the best possible treatment, including tear duct surgery if necessary (known as dacryocystorhinostomy or DCR). Dan uses a minimally invasive technique to reduce scarring known as the non-endoscopic endonasal DCR which was pioneered un Canada and is used all over the world.
Dry eyes
Many people are plagued by painful dry eyes which can seriously reduce quality of life and cause damage to the eyes themselves. There are often many factors causing the vicious dry eye cycle, some of which need treated medically and Dan would be happy to see you and assess the best way to treat you, including the use of more powerful drops and blocking the tear ducts if necessary.
Botox & Fillers
Non-surgical treatments for wrinkles and browlifts are commonplace and Dan is happy to offer Botox treatments if desired. Dan stopped using fillers around the eyes some years ago due to safety concerns from the oculoplastic community.
Blepharospasm
Dan runs the regional dystonia clinic at the University Hospital of Wales to help people with blepharospasm, hemifacial spasm and aberrant regeneration of the facial nerve, including crocodile tears.
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Blepharospasm is a type of dystonia causing the eyelids to twitch uncontrollably and is usually treated with Botox but needs to be repeated every 3 months. Dan also helps run a Dystonia Patient Support Group via the Dystonia Society, with regular events for education and so that patients can meet and support each other.
Dan with the Dystonia Clinic Team at the University Hospital of Wales
Blepharitis
Blepharitis is crusting and inflammation of the eyelids and eyelashes. It can be very uncomfortable as well as causing dry gritty eyes and cysts. There are many different treatments on the market and Dan is happy to advise on the type of blepharitis that you have and how best to treat it, including newer treatments for Demodex blepharitis.
Orbital surgery
Orbital surgery involves either operating on the bony orbit or the soft tissues within the orbit, around and behind the eye. Typically, surgery is required due to trauma, tumours or thyroid eye disease. Dan has many years’ experience treating orbital diseases and is often asked to give a second opinion so is happy to see you if you have an orbital problem.
Orbital surgery often involves re-shaping the bone around the eye socket
Bell’s Palsy/Facial Nerve Palsy
Bell’s palsy is the most common type of facial nerve palsy, but the facial nerve can be paralysed for many reasons, including trauma and surgery. Management requires the involvement of many specialties working together in the patient’s best interest including ophthalmology to protect the eyes, ENT, plastic surgery and sometimes clinical psychology.
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There are many different treatments required, depending on how severe the palsy is and when it happened. Dan would be delighted to help you through what can be a very difficult time and help with the rehabilitation process with his colleagues.
Thyroid Eye Disease
Also known as Graves’ Orbitopathy and usually seen in people with thyroid problems, especially an over-active thyroid. Thyroid eye disease is usually mild, causing some redness and swelling but in a small proportion of people can be sight threatening due to the eyes bulging out of the sockets, which can lead to corneal ulcers and the optic nerve being compressed behind the eye.
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Dan runs a combined thyroid clinic in the University Hospital of Wales with his endocrine colleagues. This allows the patients’ eyes and thyroid to be treated simultaneously to allow faster resolution of their symptoms. Occasionally medical and surgical intervention is required both in the acute phase and in the later rehabilitative phase.
Trauma reconstruction
Dan is often asked to help treat complex polytrauma patients both in the immediate life/sight-threatening phase and later when reconstruction and perhaps artificial eyes or prostheses are required. Here experience and teamwork are vital to ensure the best possible outcome for the patient.