Cancer-caused reconstructive eyelid surgery is on the increase, Dr. Jeff Popp said. But he’s not shouting, “Epidemic!”
“First of all, we’re better at diagnosing cancers than we used to be,” he said. “Patients pay more attention when something looks funny. So they’re more likely to report it to their doctor, and that means it’s easier to catch a problem early,”
He also said the population base is increasing so there are simply more people in the world, which means more cancer.
Reconstructive versus cosmetic
The eyelid procedures Dr. Popp does are about half reconstructive and half cosmetic.
“We probably do three cancer eyelid reconstructions a week,” he said. ”But we also take care of baggy lids about three times a week.”
He deals with upper and lower eyelids, both inside and outside, as well as the eyebrow or adjacent area.
Usually, the cancerous part of a patient’s eyelid is removed by their doctor. Then the patient goes to Dr. Popp to have the missing portion reconstructed.
Dr. Popp said eyelid reconstruction is precision work because the area is so small.
“We utilize what’s usable of the eyelid after the cancer removal. Most of the reconstruction involves rearranging the eyelid that’s left behind,” he said.
There are different types of flaps and different sizes and shapes of skin grafts, but only so many techniques you can use for this procedure. He said there are three ways to reconstruct this part of the body:
- Borrow from another part of the body like in a skin graft.
- Close the area you worked on. If the skin has enough elasticity and it’s a small enough area, Dr. Popp said you can pull it together.
- Use flaps. If the lower lid is missing, Dr. Popp might borrow tissue from the forehead or the upper lid and swing it down where it’s still attached to its blood supply. He said they fill the defect with that tissue.
Most people only need local anesthesia for eyelid procedures. The patient is usually awake with the area numbed.
Dr. Popp said when a lot of tissue needs to be replaced under local anesthesia, he can do the procedure in a hospital.
“Lots of people do ocular-facial plastic surgery (eyelid surgery), but only me and a guy at the university are fellowship-trained in that part of the body,” he said.
Contributing one’s skills
Dr. Popp does eyelid reconstruction monthly at the VA Medical Center for Nebraska and Western Iowa.
He said there’s not much a difference with the people he sees at the VA and the people in the office. Many of them are the same age and demographic.
“I like to work at the VA because it’s fun to teach the residents. I like being involved in that side of things.”