General Before and After Gallery

This patient underwent reconstructive surgery following Mohs micrographic surgery for basal cell carcinoma.

This 35 year old female presented with a progressive orbital mass, worsening over the previous 2 years. She had no significant past medical history. On examination, there were no signs of an optic neuropathy or ocular motility abnormality. CT scan showed an extensive sinonasal orbital mass. Biopsy demonstrated invasive fungal sinusitis from aspergillus. The patient underwent anterior orbitotomy with aspergilloma debulking by Dr. Mettu and endoscopic sinus surgery by ENT in a combined case. The patient was treated postoperatively with IV antifungals.

Lower eyelid retraction is a condition in which the lower eyelid is too low. This can lead to symptoms of tearing and discomfort. Common causes of lower eyelid retraction include thyroid eye disease and previous eyelid surgery such as transcutaneous (through the skin) lower blepharoplasty. This patient had lower eyelid retraction that was corrected by releasing the lower eyelid retractors, a midface lift, placement of a posterior spacer graft, canthoplasty, and a Frost suture tarsorrhaphy. After surgery, the lower eyelid is returned to a normal position.

This patient underwent reconstructive surgery following Mohs micrographic surgery for basal cell carcinoma.

This patient underwent reconstructive surgery following Mohs micrographic surgery for basal cell carcinoma.

This patient underwent reconstructive surgery following Mohs micrographic surgery for skin cancer.

This patient was attacked by a dog and suffered severe facial injuries including the mid face, the brow, and the upper and lower eyelids (arrow denotes complex full thickness left upper eyelid laceration). Dr. Mettu was consulted by the facial trauma team due to the eyelid injuries. In a collaboration with the facial trauma service, this patient underwent successful repair of her injuries (she is 6.5 months post op in the ‘after’ photo).

Lower eyelid retraction refers to when the lower eyelid rests too low but is still against the eyeball. Causes of lower eyelid retraction include age-related changes, thyroid eye disease, and previous transcutaneous lower blepharoplasty. This patient presented with age-related lower eyelid retraction. Due to the eyelid position, her eyes were more exposed. This resulted in burning, stinging, and tearing (common symptoms when the eye is dry). To help with these symptoms, this patient underwent bilateral lower eyelid retraction repair in which the lower eyelids were elevated and tightened. Surgery improved her symptoms and restored a more natural appearance.

A large object fell and struck this patient in the face. Fortunately, the eye was not injured. The brow laceration was repaired in the emergency room by another provider, and the patient was then referred for management of the right upper and lower eyelid injury. He underwent successful repair 2 days after the injury.

This patient presented with age-related entropion of the right lower lid. Due to loosening of tissues, the eyelid became destabilized, rotating towards the eye. Irritation from the eyelashes caused symptoms of a gritty sensation, tearing, and blurry vision. The symptoms resolved after the eyelid was returned to a normal position by tightening and repositioning the loose tissues surgically.

Orbital decompression is a surgery to help with prominent eyes (proptosis). Frequently, bone of the orbit (eye socket) is removed to allow more room for tissues within the orbit to expand and thus for the eye to recess some into the orbit. There are various approaches to orbital decompression depending which bones of the orbit are to be addressed. Most commonly, this procedure is performed for patients suffering from thyroid eye disease.

In this specific case, this patient underwent a bilateral medial orbital wall decompression. In this before and after coronal (oriented like the patient is looking at us) CT scan, the medial walls of both of the orbits (bone shows up as bright white on CT) has been removed. In the 'before' scan, we can appreciate that the optic nerve (indicated by the yellow arrow) is within a tight space due to extraocular muscle enlargement associated with thyroid eye disease. This patient had vision loss on both sides due to optic nerve compression. Note the purple arrow that indicates the medial rectus muscle (the muscle that moves the eye inward toward the nose). After the medial orbital wall has been removed and the periorbita (layer of tissue around the orbit) has been opened, the medial rectus muscle is now able to occupy space in the ethmoid sinus and there is more space around the optic nerve.

The bottom image depicts an endoscopic view of the right orbit during a bilateral medial orbital wall decompression for compressive optic neuropathy due to thyroid eye disease. This was a combined case with ENT. The image was taken after the medial wall was removed and the periorbita had been opened. The star indicates medial rectus muscle.

The top image shows a coronal CT scan that was performed post operatively. The effects of surgery (and the position of the medial rectus muscle) can be appreciated radiographically. The orientation of the CT is similar to the orientation of the endoscopic image.