Cosmetics & Reconstruction



Eyelid Tuck

Blepharoplasty, or eyelid tuck, is surgery to improve the appearance and function of the eyeylids. Click for more.

Blepharoplasty (eyelid tuck) is surgery to improve the appearance and function of the eyelids. The blepharoplasty procedure involves the removal of excess skin and fat around the eyelids to give one’s face a more youthful and fresher appearance.

The procedure is performed under local anesthetic and light sedation and takes approximately 45 minutes. It may be performed for cosmetic reasons or to improve sight by removing excess skin out of the patient’s field of vision. The recovery time is about a week and during this time the patient must refrain from any heavy activity and heavy lifting. It is not uncommon for there to be bruising around the eyelids following surgery.

Dr. Anjema believes in a tissue sparing blepharoplasty technique where healthy muscle tissue is preserved, and primarily redundant skin is removed. If excessive fat is present then this is either careful reshaped or transferred, and every effort is made to preserve the fullness of the youthful eyelid. Unfortunately, in years gone by, too aggressive removal of the fat and excessive skin/muscle removal has lead to a hollowed appearance to the eyelid, and a less than satisfactory function of the eyelid.

The Anjema Eye Institute complies with North American safety and sanitization standards, and is accredited by the Canadian Association of Ambulatory Surgical Facilities (CAAASF). Our surgical suite meets the highest quality norms and is rigorously disinfected prior to each day of surgery. Our sterilization equipment (autoclave) is inspected regularly and we also use disposable operating material.

Dr. Anjema’s office offers a private, convenient and affordable option for having this procedure performed.


Thyroid Eye Disease

Patients thyroid or Graves' disease can develop eye problems. Click to learn more.

The thyroid gland is located in the neck, and it produces hormones which are responsible for regulating one’s metabolism. Patients that have over or under active thyroid disease or even euthyroid (normal) Graves’ disease can develop associated eye and eyelid problems.

The exact cause of Thyroid Eye Disease is unknown; however it is thought to be caused by thyroid hormones triggering an autoimmune response in the fat and muscles behind and around the eyes. One of the most common features of thyroid eye disease is a staring appearance to the eyes. Even when the systemic disease process is clinically stable, there can be edema (swelling), exophthalmos (protrusion of the eyes), upper or lower eyelid retraction, hypertrophied contracted eye muscles with secondary double vision, and in some instances excessive orbital fat which can bulge into the eyelids.

Common symptoms of thyroid eye disease include burning and excessive tearing of their eyes secondary to corneal irritation from protrusion of the eyes and retraction of the upper and lower eyelids, which makes the lids not cover the eyes as well.

Eye drops, steroids, and time may provide relief for many, but symptomatic treatment is ineffective for approximately one-third of patients with thyroid eye disease.

In some cases, a series of surgical procedures around the eyelids and orbit is required to correct the stigmata of Graves’ eye disease. The usual order for the surgical correction of these problems is as follows:

  1. Orbital Decompression
  2. Eye Muscle Surgery
  3. Eyelid Repositioning
  4. Blepharoplasty

Usually, the eyelids can be adjusted so that re-operations are rarely necessary when eyelid levels are periodically checked during surgery, and the incidence of double vision after orbital decompression has been reduced using a balance technique, and appropriate pre-operative imaging to identify high risk patients.

The treatment of thyroid eye disease is complex, and patients should understand that often more than one procedure, and time between procedures, is required to achieve the desired result. Fortunately, with patience and appropriate therapy excellent outcomes can be achieved, and one will ultimately be rewarded for one’s patience.


Eyelid Malposition - Ectropion

Patients thyroid or Graves' disease can develop eye problems. Click to learn more.

Ectropion refers to out-turning of the lower eyelid, and is a commonly seen eyelid malposition in the elderly. The most common cause of ectropion is loss of eyelid tone with aging, leading to laxity of the tissue, which allows the eyelid to hang away from the eye. Less common causes of ectropion include Bell’s Palsy, skin conditions (eczema or psoriasis), or congenital malformations.

Once the eyelid begins to lose contact with the eye, it is very common for people to experience irritation of the eye and tearing. The eyelid itself will often undergo secondary changes such as thickening of the lid margin, keratinization of conjunctiva (roughness of inner aspect of the eyelid), and redness with discharge (secondary inflammation and mucous production).

The correction of ectropion is surgical, and involves tightening the lower eyelid. In more complex cases, tightening of eyelid may be combined with a skin graft to the lower eyelid. Dr. Anjema, as an oculoplastic surgeon, is very familiar with the different surgical techniques available to correct ectropion.


Hemifacial Spasm

Uncontrolled contracture of muscles on one side of the face. Click to learn more.

Hemifacial spasm is characterized by the uncontrolled contracture of muscles on one side of the face. Usually, the left side of the face is more commonly involved, however it may also occur on the right side of the face.

The cause of hemifacial spasm is usually related to irritation of the facial nerve as it exists the brain stem. In many cases, a blood vessel can be seen on magnetic resonance imaging (MRI) touching the facial nerve, which gives rise to uncontrolled contracture of the facial muscles. In a small percentage of patients (<1%), a tumor may be responsible for the irritation of the facial nerve, so imaging is mandatory in all patients with hemi-facial spasm.

The main form of treatment for hemifacial spasm is BOTOX® injections to the periocular and upper cheek muscles. In some case, there is a surgical option to treat the disease, by neurosurgical microvascular decompression of the nerve; however this is a complex surgical procedure, and should only be considered in carefully selected cases, at a center specializing in this surgical technique.


Ptosis Repair

Ptosis is the medical term for drooping of the upper eyelid. Click to learn more.

This condition can affect one or both upper eyelids, and can occur as a result of aging, trauma, muscular or neurological conditions or may be congenital.

Correction of ptosis in adults may be done at the same time as blepharoplasty and is accomplished by repositioning the levator muscle tendon (anterior approach) or resection of the Muller’s muscle and conjunctiva (posterior approach).

In Dr. Anjema’s experience, both an anterior and posterior ptosis surgery can achieve excellent surgical outcomes. However, in many cases a posterior approach, involving the resection of Muller’s muscle and conjunctiva gives the most consistent result, especially in cases where a pre-operative test (phenylephrine test) has given a favorable result.

Ptosis surgery is usually performed under local anaesthesia with light sedation. The procedure takes approximately 30 minutes, and can be combined with other functional or cosmetic eyelid procedures. For example, it is not uncommon to tighten the lower eyelid at the time of ptosis surgery to reduce tearing, or to perform a cosmetic browlift to improve the overall aesthetic result of the ptosis surgery.

Following ptosis surgery, it is advisable to avoid any strenuous activity or heavy lifting for one week. Immediately following the surgery you will be instructed to apply an ice pack to the eyelids, which is recommended you use off and on for the next 48 hours.

Excellent symmetry is achieved in many cases. However as with any surgery, exact symmetry cannot be guaranteed, and in a minority of cases minor surgical revision may be required to achieve satisfactory symmetry.



Ptosis is the medical term for drooping of the upper eyelid. Click to learn more.

Benign essential blepharospasm is the name given to uncontrolled contraction of the muscles that surround the eyelids. The condition is always bilateral (affecting both sides of the face) and in some cases may involve the lower muscles of the face and neck (Meige’s Syndrome).

The cause of blepharospasm is not completely understood, but it is thought to be related to abnormal neural pathways within an area of the brain, referred to as the basal ganglia.

Over the years a number of therapies have been used to treat blepharospasm, including anti-depressive and anticonvulsive medications, however BOTOX® injections have been the first line to treatment for at least the last 10 years. Dr. Anjema has been treating patients with blepharospasm for over 15 years, and is familiar with both the diagnosis and treatment of this disease.

Unfortunately, at the present time there is no cure for blepharospasm, however many patient experience excellent relief from their spasms with periodic BOTOX® injections.


Eyelid Malposition - Entropion

Ptosis is the medical term for drooping of the upper eyelid. Click to learn more.

Entropion refers to in-turning of the lower eyelid. This condition is most commonly related to aging of the eyelid structures, but often there is a co-existent spastic component, which increases the intensity of the eyelid malposition. Entropion often develops insidiously with the patient first experiencing intermittent irritation of the involved eyelid and eye, but eventually it becomes constant, and quite uncomfortable.

The correction of entropion is surgical, and requires correction of the underlying anatomic defects which lead to the condition. In most cases the surgical correction involves correcting a component of eyelid laxity, combined with reattachment of a muscle complex, located deep within the eyelid, called the lower eyelid retractors. In complex cases, scarring of the inner lining of the eyelid (palpebral conjunctiva) needs to be addressed with some form of a mucous membrane graft.

Dr. Anjema has found many patients experience fairly immediate relief (within 3 days) of the spastic component of entropion by the use of Botulinum toxin A injection to the pre-tarsal muscle. Patients appreciate the pain relief, and the temporary paralysis induced by the BOTOX® facilitates the surgical repair.


Eyelid Skin Cancer

Skin cancers around the eyelid are common. Click to learn more.

Skin cancers around the eyelid are common. In many cases the skin cancer begins as an innocuous lesion that does not resolve over time, and ultimately draws attention to its self. The most common type of skin cancer that occurs around the eyelid is basal cell carcinoma. Fortunately, this type of skin cancer is treatable, and the outcome excellent if intervention occurs reasonably early in the disease process.

The recommended treatment of skin cancers around the eyelids is surgical excision, however many different modalities have been used in the past. The surgical management of eyelid skin cancer requires an in depth knowledge of the eyelid anatomy and the periocular structures, including the nasolacrimal duct system.

Dr. Anjema can help develop the most appropriate treatment plan. A variety of reconstructive techniques are used to repair the surgical defect once the eyelid skin cancer has been removed.  And in the later stages CO2 laser has been helpful correcting minor eyelid and eyelid margin irregularities.

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