Procedures

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All Procedures Available

Dr. Kang is proud to offer  the below procedures to her patients.

Upper Blepharoplasty

Over time, the skin, muscles and fat of the upper eyelid may sag and cause an unwanted, “tired” appearance. One of the most common procedures that Dr. Kang performs, an upper blepharoplasty removes the excess skin through an incision that is hidden in the natural eyelid crease. This surgery restores a youthful and rejuvenated look to the eyes and improves the “heavy” sensation on the eyelids. Knowing the right amount of skin to remove and designing the eyelid shape is an art, and Dr. Kang provides a bespoke, customized experience that considers and complements each individual’s natural beauty and unique features.

Starting From $75

Asian Blepharoplasty

The Asian upper eyelid has different anatomical differences that need to be taken into special consideration. Approximately 50% of Asians have a defined eyelid crease, or “double eyelid,” while the other half have little to no crease present. Furthermore, patients can have different eyelid crease shapes and sizes. Many Asian patients also have an epicanthal fold, which is a skin fold that covers the inner corner of the upper eyelid. Some patients desire a new or larger double eyelid crease at the time of their upper blepharoplasty (for both cosmetic and medical reasons), and some do not. There are several different reported techniques for double eyelid surgery, but the main two categories are a “non-incisional” suture technique vs. incisional. While the suture technique may have quicker recovery, the results are not as predictable and long-lasting as the incisional approach. A detailed pre-operative consultation to discuss post-operative goals and realistic expectations should be had with Dr. Kang to come up with a design, size and shape that complements the individual patient’s appearance.

Starting From $48

Ptosis

Ptosis is a condition that occurs when one or both upper eyelids droop and the edge of the upper eyelid falls toward or over the pupil. Ptosis is usually caused by stretching or thinning of the tendon between the muscle that raises the eyelid and the eyelid itself. With stretching or thinning, the muscle that normally raises the eyelid has to work harder to lift it. This leads to symptoms of eyelid and forehead muscle fatigue and eyelid heaviness. Other less common causes of ptosis are nerve or muscle damage from any cause, various types of eyelid surgery, infection, muscle weakness such as myasthenia gravis, and systemic diseases such as stroke and tumors behind the eye, hypertension, thyroid disorders and diabetes. Children can be born with congenital ptosis; the muscle is abnormally stiff or poorly developed and does not function well. This condition usually lasts until it is surgically corrected. Under certain circumstances, it can be combined with the operation known as blepharoplasty when fat and skin removal is an added goal of surgery. To correct ptosis, Dr. Kang will choose where to make the incision based upon what treatment the eyelid needs and whether the patient is an appropriate candidate. With the external or anterior approach, the Dr. Kang will make an incision in the skin in the upper eyelid crease in order to reach the muscle and tendon; if there is no eyelid fold, one can be created when the incision is made. The eyelid can also be surgically elevated through an internal or posterior approach by placing the incision on the inside part of the upper eyelid; with this approach, there is no cosmetic scarring. If the muscle is not strong enough to lift the eyelid the surgeon must create a “sling” by connecting the moving eyelid to the frontalis muscle in the forehead.

Starting From $40

Lower Blepharoplasty

Under eye “bags” and dark circles can make patients appear more tired than they really are, regardless of age or amount of rest obtained. The causes are often multi factorial, including excess skin, tissue and tendon laxity, fat pad herniation, fluid accumulation, skin hyper pigmentation, vascular dilation, etc. Other health conditions such as allergies, sinus disease and thyroid disorders can contribute to the appearance of under eye bags as well. All of these different issues need to be addressed and will require a treatment approach that may include non-surgical and/or surgical methods. Each patient will require an individualized plan that will be unique to them alone, as no two patients are alike. During surgery, incisions are often created on the inside of the lower eyelid and the herniated fat pads are released and repositioned to fill the tear trough, often accompanied by lateral canthal tightening. This technique minimizes the risk of post-operative lower lid retraction. If excess skin is present, a small incision will be made along the lower lashes for skin pinch removal, which is virtually imperceptible when fully healed. It is important to note that fine lines and wrinkles, especially when smiling,may still be present after surgery and can be further addressed with resurfacing and neuro modulators. Fluid accumulation, or “malar festoons,” are often caused by an issue with the underlying lymphatic drainage system and will not be corrected with a lower blepharoplasty alone and can sometimes be treated with direct surgical excision or other non-invasive modalities.

Starting From $64
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Brow lift

Brow ptosis is a condition that occurs when one or both of the brows droop, subsequently causing the upper lid skin to droop downward and potentially cover the eye. This can lead an appearance of being tired, sad or angry and cause symptoms forehead fatigue and eyelid heaviness. Sometimes, the superior or peripheral vision can be obstructed, which is relieved when lifting the brow. Possible medical causes of brow ptosis are facial nerve or muscle damage from trauma, prior surgery, infection, masses, muscle weakness and systemic diseases. For very mild cases, neuro modulators and other skin tightening procedures may help the appearance of droopy brows. The more definitive correction is through surgery, which will elevate and stabilize the position of the brow. The location of the incision can be made either direct above the brow or along/behind the hairline in order to reach the muscles and tendons. Sometimes, an endoscope can be used to lift the brow through small incisions behind the hairline.

Lid Retraction

In the case of upper eyelid retraction, where one can see the “white” of the eye above the iris, the most common cause is thyroid eye disease. For lower lid retraction, the causes may include thyroid eye disease, lower lid laxity or scarring from prior surgeries (such as excess skin removal from lower blepharoplasties), skin cancers – all which can pull the lid downward. Some people also may have naturally lower lids. Eyelid retraction can often lead to incomplete closure of the eye, causing dryness, redness and irritation. In severe cases, this can lead to corneal exposure causing abrasions, ulcers, scarring and vision loss. During surgery, the eyelid tendon is tightened horizontally. Sometimes a spacer graft (autologous, allogenic or alloplastic) or full thickness skin graft is required to provide structural support.

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Entropion Repair

An Entropion is a condition where the eyelid is lax or “loose” and has rotated inward. The lid turns towards the globe or eye causing the eyelashes to rub against the eye. This results in the eye become red and irritated. In severe cases, the eyelash rubbing can cause corneal abrasion, ulcers, scarring and permanent vision loss. Surgical correction will allow for the eyelid to return back to its proper position, usually accompanied by a horizontal tightening procedure.

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Ectropion Repair

An Ectropion is a condition where the eyelid is lax or “loose” and has rotated outward. The lid turns away from the globe, causing irritation by not holding the tears against the eye. The lid can become red and keratinized. The eye can become red and irritated as well. Sometimes the eyelid is pulled away from the eye due a shortage of skin (cicatricial ectropion) from prior sun damage, skin cancer removals, trauma or surgery. For these cases, a full thickness skin graft (usually taken from the upper eyelid, in front of or behind the ear, or supraclavicular region) may be used for extra support, as horizontal tightening may not be adequate for full correction

Thyroid Eye Disease / Teprotumumab

Thyroid Eye Disease (TED) is the ocular manifestation of having a thyroid disorder, most commonly associated with an autoimmune disease called Graves/ Disease (hyperthyroidism). TED can also occur in hypothyroidism, Hashimoto’s thyroiditis and even euthyroid patients. In this disease, there can be swelling and inflammation of the patient’s eyelids, extraocular muscles and expansion of the orbital fat and connective tissue. Symptoms may include pain or pressure behind the eye, eyelid swelling and redness, bulging of the eyes, double vision, redness, tearing, photophobia or light sensitivity, irritation/gritty sensation and decreased vision. While TED cannot be cured, there are several surgical and non-surgical treatments to help with managing the symptoms and help restore the patient’s function and appearance. Teprotumumab (brand name: Tepezza) is the first and only FDA approved treatment for thyroid eye disease and was released in January 2020. As an oculoplastic surgeon and thyroid eye disease expert, Dr. Kang has been published in several peer-reviewed articles regarding Teprotumumab and travels around the country as a speaker to help educate other providers about thyroid eye disease.

Eyelid lesion biopsy / Cancer (Mohs) Reconstructions

There are many benign bumps on the eyelids that can occur, such as skin tags, nevi (moles) or freckles, seborrheic keratosis, cysts, etc. However, it is important to note that up to 5-10% of skin cancers may occur on the eyelid. Bumps or lesions on the eyelid should be evaluated by an eyelid expert like Dr. Kang and a biopsy may be performed if the lesion appears suspicious for possible malignancy. If a malignancy is diagnosed, Dr. Kang may perform an excisional biopsy with reconstructive surgery. Sometimes, this removal is coordinated with a dermatologist specialized in Mohs surgery, in which could occur on a different day. Several techniques are involved in the repair depending on the resulting size and location of the defect and it can be impossible to predict what is needed until time of the surgery. Reconstructive surgery may also require multiple stages.

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Chalazion / Hordeolum

When a nodule appears on the eyelid, this can often be due to an obstruction of the sebaceous (oil) gland on the eyelid (also known as a chalazion). When there is infection or inflammation of the eyelash follicle or oil gland, this is called a hordeolum. Medical conditions such as blepharitis or rosacea, wearing eye make-up and false lashes, frequent touching of the eyelids (exacerbated by allergies and other environmental irritants) all can increase your risk of developing chalazions or hordeolums. Conservative treatment measures include frequent warm compresses, oral or topical antibiotics, and intralesional injections of steroid and/or 5-fluorouracil. Surgical incision and drainage may be indicated if the chalaziondoes not respond to medical therapy.

Bell’s palsy / 7th Nerve Palsy

Bell’s palsy, or 7th nerve palsy, is a temporary or permanent paralysis/weakness of the facial nerve. The facial nerve is responsible for the motor function or movement of facial expression, eyelid, forehead and neck. Paralysis often involves one side of the face, but can also affect both. Causes for paralysis include idiopathic reasons, viral or other types of infection and inflammation, ischemia, toxic exposures, prior surgeries, trauma or other intracranial pathology. Bell’s palsy can cause facial asymmetry, inability to close the eye (lagophthalmos) causing dry eye and ocular surface disease, decreased tear production, lower eyelid drooping (paralytic ectropion), oral incompetence and drooling, asymmetric smile, as well as lower lip deficit. Due to an inability to blink, the patient is at high risk for significant corneal disease, including dry eye, possible cornea infection/ulceration, thinning and rupture. Surgery can be performed to correct to the position of the lower lid, and a gold weight can sometimes be placed on the upper eyelid to help close the eye. Botox may also be injected to the upper lid to temporarily induce ptosis/drooping to cover and protect the eye. Sometimes, the eyelids need to be sutured closed together in a temporary or permanent tarsorrhaphy. Even after recovering from Bell’s palsy, the patient can later develop synkinesis or hemifacial spasm, which can significantly interfere with their functioning and quality of life. This can be addressed with neuromodulators (see rest in hemifacial spasm/blepharospasm section).

Hemifacial spasm / Blepharospasm / Eyelid Myokymia

Hemifacial spasm is characterized by involuntary contractions on one side of the face, involving the muscles specifically innervated by the 7th cranial (facial) nerve. These muscles are responsible for facial expression and can cause unilateral spasms around the forehead/brow, eyelids (causing excessive blinking), twitching of the side of the mouth and cheek, and even down to the neck. Hemifacial spasm can occur due to primary compression of the facial nerve at the brain stem due to either a mass or dilated vessel, or secondary causes such as Bell’s palsy and other ischemic/compressive/demyelinating etiologies, trauma, surgeries, etc.

Blepharospasm is characterized by excessive contraction or involuntary closure of the eyelids which occur on both sides. This condition is often benign but can exist as a part of a systemic disease or syndrome. Patients may also complain of ocular surface irritation, blepharitis and photophobia. Eyelid myokymia is temporary eyelid twitching that can be triggered by lifestyle factors such as stress, dehydration, caffeine consumption, and lack of sleep. Usually, the condition is self – limited and spontaneously resolves with time, often with lifestyle modification. Injecting small amounts of botulinum toxin can temporarily relax the muscles and help restore the patient’s functioning and confidence. It is important to note that neuromodulators typically last for 3 – 4 months and repeat injections will be necessary to maintain the effect.

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