Friday, October 25, 2013

Cosmetic Eye Surgery

By Albert Smolyar, M.D.

As you may know, Koby Karp Doctors Eye Institute has long been among Louisville and Kentucky leaders in eye care. I became a part of Doctors Eye Institute in 2006 and have been performing cosmetic eyelid procedures and eye surgery for our patients since. In this article I would like to discuss and share with you some thoughts and information regarding cosmetic eyelid surgery.

Since ancient times it was believed that facial expression often reflects our internal emotional and spiritual state. Cicero, Roman philosopher and orator who lived more than 2000 years ago, said “Forehead in the gate of mind”. Proverbs state:  “Face is the index of mind”, “ Face reflects the brain”.   During human interaction, the face (and particularly the eyes) is the first area of visual attention by others.
Cosmetic products designed to enhance eye appearance and remedy effects of aging existed for at least 3000 years. But it was an emergence of oculoplastic and facial surgery which allowed to reverse many effects of aging to a significant extent. In addition, in recent years we witnessed an “explosion”of new nonsurgical techniques for facial  rejuvenation. These include injectable  Botulinum toxin products ( Botox, Dysport, Xeomin) and facial fillers (Juvedevm, Restylane) just to name the few.  Cosmetic eyelid surgery and injectables have gained an increasing acceptance in recent years. As we live longer, both women and men seek ways to look younger and to maintain their sense of self-confidence.

The earliest signs of aging face are wrinkles, redundancy and drooping of skin often involving eyelids. This creates an expression of fatigue, appearance of being “sleepy”. In addition, when severe, droop of upper eyelids (upper eyelid ptosis) or redundancy of upper eyelid skin (upper eyelid dermatochalasis) may lead to visual difficulties.

In this article I will concentrate on one of the most common surgical procedures performed for aging face – upper eyelid blepharoplasy.

What is Upper Eyelid Blepharoplasty?

Upper eyelid blepharoplasty is done to correct excessive wrinkles, skin redundancy of fat prollapse in the upper eyelids area.  Below is step-by-step description of upper blepharoplasty surgery:

  1. Eyelid skin to be removed is determined and marked. Excessive fat is also noted. 
  2. The patient is usually given some pharmacological sedation, often intravenous, to reduce anxiety.
  3. Local anesthetic is injected. Incision is made in the upper eyelid crease . This allows to conceal the scar ( which usually is very fine and is not easily visible postoperatively).
  4. Predetermined amount of skin and fat is removed. Hemorrhaging is controlled with thermal coagulation of “bleeders”.
  5. The incision is closed with several stitches.
  6. The patient is taken to recovery room and usually released with postoperative instructions 20-30 minutes after the surgery.
After the surgery patients use cold  compresses for the first 24 hours while awake. This helps to diminish swelling. However, a degree of bruising (although variable from person to person) is always present after the surgery and should be expected. Significant  decrease in bruising and swelling is expected by 1 week after the surgery. While heavy exertion is to be avoided for several days after surgery, most of  routine daily  activities can be resumed  within hours including  walking, reading, using computer, shopping etc.  Driving is allowed 24 hours after the surgery.

Who is a good candidate for upper eyelid blepharoplasty?

Best candidates are people who have excessive upper eyelid skin and puffiness and who are in generally good health. Medical problems, particularly cardiovascular conditions and high blood pressure, thyroid disease, blood disorders and treatment with blood thinners or aspirin should be discussed with your surgeon. Fortunately, upper eyelid blepharoplasty is a relatively minor aesthetic procedure and does not normally invlove a risk of systemic complications.

Often, age-related descent of eyebrow contributes to the wrinkles and “hooding” in upper eyelid area. In this case, obtaining the optimal cosmetic result without addressing eyebrow droop will not be possible. Therefore a discussion of all present variables, available alternatives and a thorough planning of the procedure is paramount in achieving patient’s satisfaction with upper eyelid blepharoplasty.

Often, results of the surgery can be further improved by using other modalities, for example injections of Botulinum  or hyaluronic acid products to reduce facial wrinkles.

Another factor making a patient a good candidate is maintaining a realistic level of expectations from your surgery. While patients undergoing upper blepharoplasty benefit  greatly from the surgery, bear in mind that it will not always improve your looks to match your ideals.

What are possible complications of upper eyelid blepharoplasty?
Complications of upper eyelid blepharoplasty, while rare, may include vision loss, excessive bruising, infection, asymmetric appearance of eyelids and others. Discuss them with your surgeon prior to making up your mind regarding the surgery.

Where is upper eyelid blepharoplasty performed for Koby Karp Doctors Eye Institute  patients?

I perform upper eyelid blepharoplasty, as well as other eye procedures, at Dupont Surgery Center. It is the only facility in Louisville area specializing almost exclusively  in eye surgeries. The center’s  staff, from nurses to anesthesiologists, is very experienced and skilled in eye and eyelid procedures, making surgeries safer and keeping patients very comfortable throughout their experience. Dupont Surgery Center and Koby Karp Doctors Eye Institute share the same building, making it very convenient for our patients.


In summary, upper eyelid blepharoplasty is a procedure with a high rate of patients’satisfaction. It makes people look and feel younger and allows improve self-confidence. Frank discussion with your surgeon is very important in setting up realistic goals and making the surgery a success.

Should you chose Koby Karp Doctors Eye Institute for your consultation or surgery, our staff, my colleagues and I will make sure that you achieve the best possible visual and cosmetic outcomes. You can schedule an appointment by calling (502) 897-1604

Wednesday, October 16, 2013

Cataracts: How Long does it take?

When it comes to Cataracts, we understand that patients are anxious to get results quickly and painlessly so we'll answer their "how long" questions here.
How long does it take for cataracts to develop?
The rate of development can vary among individuals and may also be different between the two eyes. Most age-related cataracts can progress gradually over a period of years. It is not possible to predict exactly how fast cataracts will develop in any given person. Some cataracts, especially in younger people and people with diabetes, may progress rapidly over a short time. A comprehensive eye examination can reveal early signs of cataract development.
How long does cataract removal take? or How long does cataract surgery take?
Removing cataracts is regarded as outpatient surgery and generally takes between 15 and 30 minutes to perform depending on the severity of the cataracts. You should not feel any pain during the procedure as local anesthesia is given. Afterwards, little if any pain is experienced.
It is wise to plan to be at the surgery center for approximately 2-3 hours, however, to accommodate the pre-op preparation and post-op recovery period. You will need to arrange to have someone drive you home after the procedure.
How long does cataract surgery recovery take?
The good news is that smaller incisions for cataract surgery means shorter healing time and more rapid vision recovery for most patients. 2.2 mm micro-incisions with new ultrasound equipment for cataract surgery may also reduce the chance of rare but serious infections.
In some cases patients see well the day after cataract surgery. Other patients see well a few days after surgery, and still others may need a full month or several weeks before reaching maximum vision improvement.
The new Multi-focal lens implants, the most advanced intraocular lenses (IOL's), allow patients who are good candidates, the opportunity to enjoy good distance and reading vision with minimal or no need for glasses following the cataract procedure. For more info click here.

Wednesday, October 2, 2013

What is Lazy Eye?

At Koby Karp Doctors Eye Institute we conduct a large number of pediatric eye exams. Not infrequently, while performing kindergarten or school eye examination, we encounter a child with decreased vision due to “lazy eye”.   “Lazy eye”, or amblyopia, is a condition that occurs when a child does not fully develop vision in one or, sometimes, in both eyes.  Lazy Eye is affecting 1-3% of population and is the most common cause of visual loss during childhood (1).   
Dr. Albert Smolyar

Amblyopia develops whenever visual input to the brain from one or both eyes is imperfect due to blurry image from the eye(s). As a result, highly specialized visual areas in the developing brain of a child do not reach a full functional capacity. Since many of “lazy eye” cases are treatable if detected early, it is important to diagnose the affected children and start the appropriate therapy as soon as possible.
Cases of “lazy eye” ( Amblyopia):
There are several common causes of “lazy eye”.
1.      Due to opacity in the eye. This can be caused by cataract or a scar of the cornea, leading to loss of sharpness of visual image.
2.      Due to strabismus, or “crossed eyes”.
3.      Due to a significant optical imperfection of the eye, such as high degree of farsightedness
                     (hyperopia), nearsightedness (myopia) or astigmatism.
4.      Due to congenital droopy eyelid covering part of the eye(s) and obstructing visual axis.
Signs of “lazy eye” ( Amblyopia):
1.      Eye that turns in or out.
2.      Apparent lack of coordinated movement between the two eyes.
3.      Apparent lack of depth perception in a child.
4.      Apparent poor vision in one or both eyes.
5.      No obvious signs.
While some of cases of “lazy eye” may manifest with one of the above visual signs – may cases go undetected.  Unfortunately, when amblyopia is discovered late, particularly after age of 9 or 10 years of age – it is very difficult to reverse, since brain formation by that time is almost complete. However, it is possible to treat “lazy eye” in some cases up to teenage years, although the best results are achieved if the treatment instituted in the first years ( or even months) of child’s life.

Treatment of Lazy Eye:

A treatment of amblyopia depends on a cause of “lazy eye”.  If farsightedness, nearsightedness or astigmatism is the culprit – wearing corrective glasses could be the only treatment required. In some cases, patching of the visually better eye for several hours daily will facilitate improvement of the “weaker “eye (2). If a significant cataract or droopy eyelid is present surgery often may be required.  In some cases of strabismus (“crossed eyes”) surgery also may be necessary, although certain  cases resolve with simple glasses wear.

If recognized early, “lazy eye” can frequently be reversed. At the same time, if overlooked, amblyopia leads to permanent visual deficit in 1-3 % of population.  Even in the absence of warning signs, eye screening by age of one year (and certainly before children enter kindergarten) represents an essential tool for detection and treatment of amblyopia (3) .

As one of the eye care leaders in the Kentuckiana area, Doctors Eye Institute is dedicated to prevention of amblyopia by early detection and, when needed, treatment.

Our Koby Karp Kids Club will be happy to provide your child with a free T-shirt and sunglasses along with all optical services to fulfill your child’s optical needs.

Schedule a pediatric eye exam at Koby Karp Doctors Eye Institute  (including school and kindergarten eye exams) with one of our doctors by calling (502) 897-1604.

- Albert E. Smolyar, MD


1.      Identification and treatment of amblyopia. 
Bradfield YS.Am Fam Physician. 2013 Mar 1;87(5):348-52

2.      A Randomized Trial of Increasing Patching for Amblyopia.
Pediatric Eye Disease Investigator Group; Writing Committee, Wallace DK, Lazar EL, Holmes JM, Repka MX, Cotter SA, Chen AM, Kraker RT, Beck RW, Clarke MP, Lorenzana IJ, Petersen DB, Roberts JT, Suh DW.

Ophthalmology. 2013 Jun 4. pii: S0161-6420(13)00339-4. doi: 10.1016/j.ophtha.2013.04.008. [Epub ahead of print]

3.      Effectiveness of screening for amblyopia and other eye disorders in a prospective birth cohort study. de Koning HJ, Groenewoud JH, Lantau VK, Tjiam AM, Hoogeveen WC, de Faber JT, Juttmann RE, Simonsz HJ.
 J Med Screen. 2013 Jul 19.