Thyroid Eye Disease Surgery

TED Surgery has undergone many advancements over the last several years. In the past, surgery required often large incisions, multiple staged procedures and rarely restored a patient back to their previous appearance. Fortunately, considering surgery one eye at a time and in a staged manner is not needed anymore in the vast majority of cases.

Customized TED surgery which is aesthetic functional and accomplished in one surgery is now commonplace and expected. The surgery should achieve maximal functional improvement. Customized TED surgery should have the ability to improve both function AND form. This is known as aesthetic-functional surgery.  The surgery should achieve maximal functional improvement such as reducing eye pain and symptoms of exposure and dryness while also maximizing aesthetic outcomes.

The central pillar of customized TED transformation surgery often involves orbital decompression surgery. Orbital decompression surgery typically moves the eye back to a more normal position, also reducing eye bulging. Depending on the specific areas of bone that are removed, it can also lead to subtle changes in vertical eye position, thus improving lower eyelid retraction. The decision of bone and/or fat to remove, and where to remove it from is customized for each patient depending on the degree of eye bulging, presence of lower eyelid retraction (pulled down lower eyelids), imaging findings, functional aesthetic goals, potential risks and more.  Often, decompression of both sides can be done at one time if indicating, minimizing patient’s down time and recovery.

Not all decompressions are created equal– seek an expert.

Advances in surgical techniques have led to minimally invasive techniques often with small or hidden incisions. However, these approaches can have a higher risk when performed by an inexperienced surgeon, so it is critical that patients seek care by a qualified surgeon who performs them routinely and creates a customized plan specific to you.

Upper and lower eyelid surgery must also be considered in customized TED aesthetic functional surgery. The upper eyelid is typically full and bulging and reducing this appearance is important to restoring patients back to their pre-TED appearance. Likewise, the lower eyelid can have fat herniation (also known as eyelid bags) and improving this is aesthetically important.

Facial contouring is often overlooked but of critical importance in TED surgery. Facial fat expands in certain areas of the face in TED patients, changing the shape of the face and in many cases dramatically affecting patients’ appearance. Facial contouring can help recreate the natural lines and angles of the face, restore facial balance and shape, and also rejuvenate the face. Key considerations here are augmenting the fat in areas such as cheeks and temples. This will reduce the appearance of eye bulging and give pleasing contours. Also removing buccal (cheek) fat which has accumulated due to TED can also restore the facial symmetry. Conservative buccal fat removal is one of the most consequential procedures in facial recontouring of TED patients, often with a high patient satisfaction rate.

• Decompression
• Fat Injections (brow & cheeks)
• Lower Eyelid Blepharoplasty
• Upper Blepharoplasty
• Buccal Fat Removal

• Decompression
• Upper Eyelid Retraction Blepharoplasty
• Fat Injections (cheeks)
• Buccal Fat Removal

• Decompression
• Upper Blepharoplasty
• Fat Injections (brow & cheeks)
• Lower Eyelid Blepharoplasty
• Buccal Fat Removal

• Asymmetric Decompression
• Upper Blepharoplasty
• Fat Injections (brow & cheeks)
• Lower Eyelid Retraction Repair and Blepharoplasty