Dr. Jeffrey Popp shares his experience and thoughts about eyelid surgery and reconstruction.
I was trained initially in eye surgery, ophthalmology. When I finished that training, I went into oculofacial plastic surgery, which is basically specializing in plastic reconstructive and cosmetic surgery of the face, and in particular, the eyelids.
One of the major differences between the upper lid and the lower lid is, for the most part, the lower lid doesn’t move. When we open and close our eyes, 99% of that is the upper lid. You not only have the coverage issue, meaning, that the eyelid has to cover the eye to protect it, but you’ve also got a movement issue.
Since the purpose of the eyelids is to protect the eye, there are a lot of very gifted and outstanding surgeons who, just by lack of experience, don’t feel comfortable doing that.
The most frequent thing that I do in both areas, for the same reason, is cancer surgery. I do about 3 to 4 skin cancer reconstructions every week. It’s probably one of the more frequent reconstructive surgeries that I do. These would be people who maybe have a skin cancer in their lower lid or their upper lid. We send them to what’s called a Mohs surgery who takes cancer off, and then they come to me for reconstruction.
I’ve had people have just little nicks out of their lid, and I’ve had people have their entire eyelid missing. Then it’s my job to figure out how to make a new eyelid or put it back together.
If somebody has to have a cancer removed from their lid and it’s just a small spot in the lid, just on the surface, literally in some situation, we can just let that heal in on its own. You don’t even need to prepare it.
Then, if you get into a situation where it’s maybe not any wider but it’s all the way through the lid, that lid has to be reconstructed, and in some cases, you just have to saw it back up and make sure that everything aligns properly.