Functional eyelid surgery

Eyelid problems

The most common eyelid problems referred to the Casey Oculofacial Plastic surgery group are eyelid malpositions such as ptosis, dermatochalasis (excess eyelid skin), ectropion, entropion, skin cancer, trauma, and blepharospasm. Each of these conditions can impact the patient's vision, as well as impact facial appearances. Treatment of each patient is specialized, but the goals remain the same; restore vision and appearances to the same or better than what existed prior to developing eyelid disease.

Ptosis & blepharoplasty

Ptosis surgery and upper eyelid blepharoplasty surgery are among the most common reconstructive surgeries performed by our doctors.

Some patients have enough extra skin and fat in the upper eyelids or enough drooping of the upper eyelids that it blocks a portion of the peripheral vision. This can cause problems keeping the eyelids open when driving a car or when reading. In these cases, upper eyelid blepharoplasty surgery to remove the excess skin and fat or ptosis surgery to tighten the droopy eyelid muscle may improve the peripheral vision. If your eyelids are blocking your peripheral vision, our staff will work on your behalf to get the surgery authorized by your insurance company.

It is also common for patients to have cosmetic lower eyelid surgery and cosmetic eyebrow or forehead lift surgery performed simultaneously with cosmetic or reconstructive upper eyelid surgery. At Casey, we find that patients who choose procedures that improve both form and function are the happiest with their post-operative result.

For patients with cosmetic eyelid concerns, appointments can be made with Casey Aesthetic Facial Surgery Center, located in Portland, Oregon by calling 503 494-3004.

Other eyelid malpositions

The eyelids are crucial for the protection of the eyes and abnormalities of contour, strength, or position can dramatically affect ocular comfort and vision. Drs. Dailey, Ng, and Steele are experts in correcting eyelid malpositions and have numerous papers on the subject, teaching others about the techniques they have mastered or pioneered.

For instance, ptosis is a condition where the upper eyelids droop due to abnormalities of the inner structures and dermatochalasis is a condition where the eyelids droop due to excess skin and fat in the upper eyelids. Both of these conditions can block the peripheral vision and make it more difficult to read or drive a car.

Entropion and trichiasis are conditions where the eyelashes rotate against the eyeball and ectropion is a condition where the eyelid sags away from the eyeball. Entropion, ectropion, and trichiasis can cause a red, watery, irritormsated eye.

These common forms of eyelid malposition and hundreds of other less common forms can be corrected by our experts in the field, doctors Dailey, Ng, and Steele, with an outpatient surgical procedure.


Dr. DaileyEssential blepharospasm is an idiopathic disorder characterized by involuntary spasm of the eyelids and sometimes other facial muscles. Most patients also have dry, irritated eyes and in most patients, symptoms are worse when exposed to sunlight or bright lights indoors.

Blepharospasm is an uncommon problem. However, doctors Dailey, Ng, and Steele all care for patients with this condition. They have experience using Botox injections for this disabling disease as far back as 1985, making Casey well prepared to handle such problems.

Some patients' symptoms cannot be controlled with Botox alone and for this group of patients Myectomy surgery was developed. Many patients with blepharospasm also develop eyelid malposition and come to Casey for treatment.

Skin cancer

The face and eyelids are very common locations for skin cancer. Many times skin cancers may appear as benign growths. Other times they can develop cancerous characteristics over a relatively short time. Potential warning signs are new growths with elevated, irregular boarders, coloration, indentation, or ulceration. If skin cancer forms along the edge of the eyelid it often causes the eyelashes to fall out.

Casey uses state-of the-art technology. The area of concern is first biopsied to determine if it is in fact a cancer. If the biopsy is not cancerous, no further treatment is generally required. If the biopsy is cancerous, most are then removed using the MOHS technique because this method has the highest cure rate and preserves the most normal tissue around the eyelids and face.

The major added value of the Casey Oculofacial plastic surgery group begins after the cancer is removed. It is paramount that our patients not only obtain a cure of the cancer but also achieve the best possible post reconstruction function and facial appearance. Our doctors have extensive experience in performing  reconstructive surgery and understand how to protect the delicate structures of the face and maximize facial appearances.

Frequently asked questions about skin cancer

What is the most common type of skin cancer?

Basal cell carcinoma is the most common type of skin cancer followed by squamous cell carcinoma. Melanoma is less frequent but it is more likely to metastasize, so early detection is important.

What causes skin cancer?

Risk factors we are born with include: fair complexion, light colored eyes, blond or red hair, tendency to burn instead of tan, family history of skin cancer, and a weakened immune system. People who have had a prior skin cancer are much more likely to form another. The number one modifiable risk factor for skin cancer is sun exposure.

How does sun exposure contribute to skin cancer?

Ultraviolet light damages the skin cells and causes them to become cancerous.

Is all ultraviolet light bad?

Yes. Ultraviolet light can be divided into the A rays and the B rays. The B rays are more responsible for causing skin cancer but the A rays can also act as tumor promoters. The A rays actually penetrate deeper into the skin are more responsible for the loss of skin elasticity and premature aging of the skin seen in those with chronic sun exposure. It is important to choose sunscreen that blocks out both A and B rays.

Is it true that one, really, bad sunburn can cause skin cancers later in life?


When do most people get sun damage to the skin?

Most sun damage occurs prior to the age of 18. It is very important that children be protected from the sun and that sunburns not be acceptable in children.

Is skin cancer becoming more common?

Yes. More than one million skin cancers are diagnosed each year. All types of skin cancer are becoming more frequent possibly in part due to depletion of the ozone layer of the atmosphere.

How is skin cancer diagnosed?

The important first step is that the patient or the doctor recognize a lesion that might be a skin cancer. The lesion is then biopsied and sent to be examined with a microscope. If the lesion is a skin cancer it will require further treatment to remove it completely.

What changes on my skin should I suspect are skin cancer?

Skin cancer does not hurt. Sometimes it will be elevated above the surface of the skin but often is flat. A scab that falls off to reform in the same place is very often a skin cancer. Any skin abrasion that does not heal is very suspicious for a skin cancer. Pigmented lesions or moles that are asymmetrical, have an irregular border, have different shades of brown black or tan color, have a diameter of >6mm, or evolve (change) over time are suspect of being melanoma.

What is MOHS surgery?

MOHS surgery is a procedure where a dermatologist with special training removes a skin cancer. MOHS surgery has the highest cure rate for most skin cancers and it is the procedure that preserves the most normal skin adjacent to the skin cancer. Preserving normal skin is very important when dealing with cancers on or near the eyelids.

What can I do to prevent skin cancer

Avoid sunburns or excess sun exposure, avoid tanning booths, and protect your children from the sun. Use broad spectrum SPF 30 or greater sunscreen and apply it liberally and frequently. Wear sunglasses and a broad brimmed hat when in the sun.

I have a history of sun exposure; what can I do to prevent this from being a problem.

As with most things you cannot take back what you did when you were young. However, you can assist by bringing any suspicious lesion to the attention of your primary care doctor, a dermatologist, or one of the doctors at Casey. Often a skin cancer is noted by the way it changes with time. It is very useful to bring to the attention of a doctor that a skin change is getting bigger, sometimes bleeds, or sometimes forms a scab. Skin cancers are much easier to treat and less likely to leave a scar if they are small when diagnosed.

What role do the doctors at the Casey play in diagnosing and treating skin cancers?

Our doctors can biopsy any suspicious lesion. Most typically, we recommend skin cancers be removed using the MOHS technique and the center will coordinate this appointment for you. Our doctors are experts in reconstructing the defects left after skin cancer has been removed from the eyelids, face, or trunk. Our goal is to cure you of the cancer and restore normal appearances.