Eyelid Surgery

ELZA’s experience in Cosmetic and Reconstructive Eyelid Surgery

The quality of a treatment depends on the experience of the surgeon. ELZA’s eyelid surgeon is Dr. Dr. Dion Paridaens. He has more than 25 years of experience and has performed more than 20,000 eyelid surgeries. Dr. Paridaens is the co-founder of the Thyroid Center Rotterdam and, since 2021, ist he president elect of the ESOPRS (European Society of Ophthalmic Plastic and Reconstructive Surgery).

Dr. Paridaens heads the Department of Eyelid, Tear and Orbital Surgery at the Eye Clinic Rotterdam in Holland and has been operating complex cases in Switzerland since 2003. Since 2001, he has offered a fellowship in eyelid and tear surgery, and has already trained several generations of young surgeons in this sub-specialty.

Over the course of his career, Paridaens has published more than 160 scientific publications on eyelid, lacrimal and orbital surgery.

The main focuses of Dr. Paridaens are involved in cosmetic and reconstructive eyelid surgery, tear surgery, and ocular orbital surgery.

Need more info? The links on this page refer to ELZA pages (in English) with more detailed information on the topic.

Hooded eyelids (Dermatochalasis)

Hooded eyelids (dermatochalasis) are a result of excess skin on the upper eyelid, thanks to skin losing elasticity over the course of the aging process. In rare cases, inflammation can cause this to occur in children, a process called “blepharochalasis”. It is treated in the same way in both cases.

Dr. Paridaens also has extensive experience in treating Asian eyelids, which differ from European eyelids in terms of anatomy.
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After

Drooping Eyebrow (Eyebrow Ptosis)

A typical consequence of the ageing process, eyebrow ptosis is the descent of the eyebrow when the brow and the brow fat pad behind it drops over time.

This is easy to recognize: in a normal brow position, the edge of the bony eye socket can be felt under the eyebrow. In brow ptosis, the eyebrow is often 1 to 2 cm below it.
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After

Entropion Eyelid Surgery

Entropion is an inwardly turned lower eyelid, and the main cause of it is a progressive age-related relaxation of the lower eyelids.

Entropion cannot heal spontaneously and will worsen over time. The eye becomes irritated because the eyelashes of the lower eyelid are in constant contact with the cornea. Typical symptoms include pain, redness of the eyes, tears, and photophobia. In some cases, the constant rubbing of the eyelashes can cause severe infections in the cornea.

Entropion can be corrected by horizontally and vertically tightening the lower eyelid. The horizontal relaxation is corrected by straining the lower eyelid at the outer edge.
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Before
After

Ectropion Eyelid Surgery

An ectropion is an outward-facing (everted) lower eyelid: the insides of the lower eyelids are constantly exposed to the air and dry out.

Most commonly, ectropion appears as a symptom of aging, whereby eyelid tissue relaxes horizontally. In rare cases it can also be caused by skin diseases, infections or scarring of the skin of the lower eyelid. Irrespective of the cause, the outcome is the same: the eye becomes permanently irritated because the eyelids no longer close properly and dry out the surface of the eye. Often there is a compensatory excess production of tears, resulting in a watery eye – but the tears can not flow properly because of the malpositioning of the lower eyelid.

Long-term ectropion predisposes patients to developing corneal infections, which can lead to serious changes, in extreme cases to a corneal ulcer.

Ectropion eyelid surgery, much like entropion surgery, can be corrected by horizontally and vertically tightening the lower eyelid. The operation lasts about 45 minutes, is usually performed under local anaesthesia, and the success rate is 70–80%.
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After

Acquired Ptosis (Drooping Eyelid)

The word “ptosis” is the medical term for a drooping upper eyelid. Normally, the upper lid is opened by what’s called the levator muscle. The muscle runs from the upper edge of the eye socket into the upper eyelid. It fans out and enters the connective tissue, which gives the upper lid its strength.

The acquired ptosis usually occurs on both sides in adults and may have various causes. The point of attachment of the levator muscle on the upper eyelid slips upwards over time: the muscle works well, but it can no longer lift the upper eyelid to the correct height. In severe cases, the upper lid may partially or completely cover the pupil.

Ptosis can narrow the field of vision and also damage the even damage the region of the spine between the shoulders and the base of the skull, as patients try to balance the limited field of vision by constantly raising their chin.

The success of the operation also depends on how good the remaining power of the eyelid muscle is. Different approaches can be used, from Fasanella-Servat surgery (see below) to levator muscle resections and reinsertions

Causes

  • An age-related relaxation of the connective tissue
  • Wearing hard contact lenses. These stretch the levator muscle. Approximately 10% of all wearers of hard contact lenses experience slowly progressive ptosis after approximately 10 years
  • Previous eye surgeries in which a lid speculum was used
  • Previous severe inflammation or accidents that resulted in massive swelling of the upper lid
  • In very rare cases, ptosis is triggered by an as yet undetected muscle disease or neurological condition (myotonic dystrophy, myasthenia gravis)

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Before
After

Congenital Ptosis

“Ptosis” is the medical term for a drooping upper eyelid. There are two reasons why an eyelid droops: there’s a either a problem with the “levator” muscles that lift the eyelids, or a problem with the nerve that controls them. There are a number of causes – trauma, infection, cancer, autoimmune or inflammatory disease, and sometimes ptosis can be hereditary.

It’s caused by a dysfunction in either the muscles that raise the eyelid, or the nerves that control those muscles. Ptosis can occur on its own, but it can also be associated with trauma, autoimmune or inflammatory disease, infection, cancer, and in some cases, hereditary disease.

Sometimes, the ptosis is mild, and the upper eyelid droops only slightly. But in moderate-to-severe cases, the upper lid may partially or completely cover the pupil. This is of particular concern in children, ptosis that covers the pupil can cause amblyopia: the part of the brain that deals with vision from that eye just doesn’t develop properly as it isn’t receiving as much information from this partially closed eye.

Instinctively, children try to compensate for this by the following behaviours:

  • Putting their head back and lifting their chin
  • Lifting the drooping eyelid with their fingers
  • Raising the eyebrow to help lift the upper eyelid more.

But if you have a child with an eyelid that covers the pupil and they don’t use these compensating mechanisms, then it’s important that they get seen by a professional quickly: the ptosis can cause visual suppression, and can leave your child with permanent, lifelong amblyopia.

Congenital ptosis is usually based on a malformation of the muscle (levator muscle), which should raise the upper eyelid. This change can affect either one or both upper eyelids. Other, rarer causes of congenital ptosis may include: certain muscle diseases, tumors of the eyelids or neurological disorders.
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Before
After

Eyelid in Facial Paralysis

The seventh cranial nerve (facial nerve) supplies the circular muscle around the eye and other important facial muscles. There are a number of different causes Paralysis can have a variety of causes, including diabetes, multiple sclerosis, tick bite disease (Lyme disease), accident, tumor or infection. Paralysis may also persist since birth or may be temporary following vaccination. However, in more than 50% of cases, no cause can be found. Medicine then speaks of “idiopathic facial paralysis”.

The typical symptom of the eye is the incomplete eyelid closure (lagophthalmos): the lower eyelid is deeper than normal and the circular muscle does not receive enough orders from the nerves to completely close the eye.

If a facial paralysis has occurred only recently, then only the dry eye should be treated and it should be awaited whether the paralysis returns by itself. However, if the paralysis has been around for some time, the prospects for spontaneous recovery are small. Then the eyelid closure function should be improved for medical reasons, as there is a permanent eye irritation, which in extreme cases can lead to a corneal ulcer and complete vision loss.

Depending on the extent of facial nerve paralysis, one or two operations are needed:

  • Lateral block: to tighten the lower eyelid. The operation is identical to the operation of ectropium.
  • Gold weight in the upper eyelid: If there is a pronounced weakness of the eyelid, a small gold plate can be sewn into the upper eyelid. This comes under the skin to lie and is barely recognizable. The idea of ​​this plate is to help the upper lid by an additional weight (about 1 gram) to close correctly. How high the weight of the plate must be, we can determine before the operation.

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Before
After

Malignant Eyelid Tumors

The word “tumor” can be a frightening word for people to hear – many patients view “tumour” as being synonymous with “malignant cancer”. It’s important not to confuse the two terms.

The first distinction to be made is the difference between an inflammatory swelling in the eyelid area and “more tissue”. Eyelid tissue is delicate and a slight inflammation can lead to a massive swelling, and there can be many causes of this inflammation, including an inflamed lacrimal gland or an infection caused by a small injury.

If there is a real “extra tissue” (such as from a tumor), then it is often benign changes such as an encapsulated barley grain, a wart, or a so-called “molluscum contagiosum”, caused by a harmless, but contagious virus.

However, various malignant tumors (carcinomas) do occur on the eyelids. The most common malignant eyelid tumor is basal cell carcinoma (90%), followed by squamous cell carcinoma (~5%) and sebaceous carcinomas (~5%). In all cases, suspected malignant tumors should be treated quickly. If necessary, we will consult specialists of other disciplines such as internists, dermatologists or oncologists (cancer specialists).

Basal cell carcinoma (BCC): 90% of all malignant eyelid tumours. BCCs are the result of intensive, long-term sun exposure of the skin, preferably in fair-skinned people. BCCs grow locally and only rarely form new tumours (metastases) in other parts of the body.

Squamous cell carcinomas (SCC): make up about 5% of malignant lid tumours. Here, too, excessive sunlight plays a role. The lower eyelid, like in BCC, is more frequently affected because it receives more sunlight. Squamous cell carcinoma metastasizes in about 20% of cases, initially to the lymph nodes of the ear and jaw.

Sebaceous Carcinomas: Make up about 5% of malignant eyelid tumours. Arises on degeneration of a sebaceous gland. This tumour is aggressive and metastasizes early.

The operation

Biopsy

For small tumors, we first take a biopsy in a short outpatient procedure. The material is sent to a laboratory and examined under the microscope to confirm the diagnosis. In a second operation, the tumor is removed.

For large tumors, the tumor is excised, plus an additional region of what appears to be non-tumour tissue to ensure all of the tumor has been removed, and this often requires the patient to be under general anaesthesia. This is followed by what’s called “rapid-cut diagnosis” – the pathologist examines the material immediately under the microscope and informs us 1–2 hours after removal whether the cut edges are free of tumour. Subsequently, the reconstruction of the lid takes place on the same day in a second operation.

Eyelid reconstruction

The next step is lid reconstruction. There are a variety of surgical options available to do this, and in general, eyelid reconstruction has made tremendous progress over the past two decades. 

In the past, large skin transplants from the middle of the face were used to replace one or even both eyelids – and sometimes eyes were removed altogether. Fortunately, thanks to improved techniques, this “radical” surgery is no longer used in most cases today.

These days, defects of all sizes, including the complete lid can be covered by material derived from near the eyelids. Which method is used depends on how much of the eyelid needed to be removed (or in other words, how big the defect needing to be covered is). Modern surgical techniques range from a direct closure, to skin grafts, muscle or connective tissue slices, which are taken from the upper / lower lid of the same side or the lids of the other, healthy eye.

In rare cases where more skin is necessary, this is taken from behind the ear.

In addition, some of the modern procedures require two rounds of surgery, where the lid is reconstructed and the eye can not be opened for about 10 days. This is followed by another (short) intervention to complete the reconstruction.
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Dermatochalasis (Hooded Eyelids)

The ELZA Institute

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Augeninstitut ELZA
4.8
Based on 110 reviews
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Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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