Orbital decompression

Treatment with
orbital decompression

Proptophthalmia that is not due to Graves’ disease

Orbital decompression can also be performed for congenital proptosis that is not caused by Graves’ disease. People who are born with proptophthalmia, which makes their eyes appear as if they are protruding, do not have protruding eyes, but simply because the bones around their eyes have not developed properly. Very likely.

If tests for Graves' disease show no abnormalities, the patient will be diagnosed with congenital exophthalmia.

At our hospital, we perform a surgery called orbital decompression, which removes the fat and bone behind the eyes, for people with bulging eyes due to Graves' disease.We can apply this technique to treat people with bulging eyes who were born with bulging eyes. We also perform surgery.

However, health insurance cannot cover congenital bulging eyes, so you will have to pay for the entire cost out of pocket. However, if your eyes are too big, there is a good chance that you can make your eyes look more charming by making them smaller and modest. is.

About surgery for Graves’ disease
and thyroid eye disease

Orbital fat decompression
is less invasive to patients

1. Same-day surgery
2. both eyes at the same time
3. Remove only the increased fat
4. surgery without cutting the skin

In Graves’ disease and thyroid eye disease, the fat behind the eyeballs increases and the muscles that move the eyeballs swell, causing the eyeballs to move forward and causing a significant change in facial appearance.

The orbital fat decompression surgery that we perform at our hospital is based on the cutting-edge medical care that I gained while studying abroad in the United States, and by gaining knowledge from famous overseas doctors and using a microscope to perform it in a more detailed manner in a Japanese style. This is a surgery that is the culmination of world knowledge that reduces tissue damage.
There is no medical institution in the world that performs this surgery.

Same-day surgery is possible

This surgery avoids nerves and blood vessels related to visual function and only removes the increased fat, and requires extremely delicate and special techniques. Decompression surgery, which removes bones, was devised because there was no technology to remove fat while avoiding nerves and blood vessels, but it is physically taxing because it removes bones, and it may be difficult to do so due to post-operative pain and bleeding. Requires hospitalization for 2 weeks.

With orbital fat decompression at our clinic, both eyes are treated at the same time under general anesthesia, and you can go home the same day, minimizing the impact on your work and home life. Unfortunately, as it is a cutting-edge surgery, it is not covered by health insurance, but if you are suffering from an illness, we hope that you will choose orbital fat decompression at our hospital.

Graves’ disease and thyroid ophthalmopathy will be explained using case photos.

The face will look very different before and after treatment

See photos comparing before and after treatment

This woman had undergone the following treatments since the onset of Graves’ eye disease.
・Steroid pulse
・Orbital (cancer) decompression
・Additional fat removal
・Strabismus surgery (at another hospital)
If you compare before and after treatment, you will notice that your face is much prettier and your face looks completely different.

Next is a photo from the side

After surgery, the difference between before and after treatment was immediately obvious, and I was able to return to the beautiful facial features I had before the onset of the disease.
It seems that Graves’ eye disease was once called a beauty disease, but looking at this case, it becomes clear that the idea that “one who develops the condition becomes a beautiful woman” is misguided.

Surgery example of
orbital decompression

Explaining orbital decompression using case photos

Compare photos
before and after treatment

Please take a look at the pre-surgery photos. She has beautiful eyes with double eyelids, but the whites of her eyes are exposed a lot, and her upper eyelids look a little swollen, so she came to our clinic hoping to have these things corrected.

Next, please take a look at the photos taken 1 month after surgery.

There are still traces of bleeding on the lower eyelids and whites of the eyes. It usually takes 3-4 weeks for the bleeding to subside. You can see that the sunken eyes give a gentler impression.

Easy to understand and enlarge

Next is a photo taken from an angle.

Please pay attention
to your left eye

Compare photos before and after treatment

Comparing the left upper eyelid in an oblique photo, you can see that the puffiness has disappeared and the upper eyelid, which used to protrude more than the eyebrows, has become more depressed than the eyebrows after surgery.

In this way, you are born with large eyes (protruding eyes), and our clinic also performs corrections for this. If you have a similar problem, please feel free to contact us.

Risk

Cases of congenital bulging eyes

Explaining a case of congenital exophthalmia

Deepening of orbital sulcus cause completely different appearance which may bring impression of aged person.

Compare photos before and after treatment

Pre

The eyes are large and give the impression that they stand out too much. The area of the whites of the eyes is large, making them look like Sanpaku eyes. It also looks like the eyes are a little far apart.

Post

This is a photo taken the day after surgery. You can see that the eyes are sunken and the area of the whites of the eyes has decreased. The distance between my eyes has become closer and my balance has improved. The black lower eyelid is due to internal bleeding.

Easy to understand and enlarge

Pre

I have enlarged the photo for clarity. The area of the white of the eye is large, and there is also the white of the eye between the cornea and lower eyelid.

Post

This is a photo taken the day after surgery. You can see that the upper eyelids are sunken and the area of the whites of the eyes is reduced. The white of the eye between the lower eyelid and cornea is gone, and the tripaku has resolved. The black lower eyelid is due to internal bleeding.

Next, let’s take a look at the photo from an angle.

Pre

It is noticeable that the eyes are very large. I think people with small eyes would be envious of them, but having them too big can also be a problem.

Post

In the photo taken the day after surgery, the area of the whites of the eyes has decreased and the impression that the eyes are large no longer appears. It has changed to a calmer impression.

Enlarge the photo of the right eye

Again, we may remove fat as much as possible if patient demands, but it may result worsening of impression.

Pre

The position of the eyebrows and the position of the eyeballs are approximately the same height.

Post

It’s the day after surgery. As the eyeballs become sunken, the upper eyelids become sunken, and as a result, the area of the whites of the eyes becomes smaller.

Other cases of orbital decompression surgery

Case1 Approximately 20 years old female

Case2 30 years old Male

Orbital fat decompression can treat congenitally proptotic patient.

However, from the side, you can understand the change.
Comparing the top of eyelid and eyebrow, it is remarkable eyeball position changed Different from thyroid eye disease, congenital proptosis do not have increasing volume of fat.
So there is limitation to remove the fat.

Case3 Approximately 40 years old male

Case 4 Approximately 50-year-old male
(after multiple surgeries for right facial nerve paralysis at another hospital)

Case5 30 years old Female

Case6 40 years old Female

This is the result after fat decompression. We performed both upper and lower fat decompression for this case.

Case7 30 years old Female

Risks associated with this treatment and their incidence

• Internal bleeding may occur at the wound site due to surgery. At first, internal bleeding looks like a red bruise, but it turns yellow and moves downward under the skin due to gravity, disappearing in about 3 weeks. The swelling will mostly subside within the first two weeks. It takes about six months for complete disappearance. If a hematoma forms in the wound, surgery is required to remove it.
• If there is no diplopia before surgery, eye movement disorders will appear after surgery, resulting in double vision. It often disappears by the next day, but it may remain.
• If diplopia remains, it will gradually improve over 3 to 6 months, but diplopia remains in 0-3% of cases with lipectomy alone, 3-6% with lateral walls, and 10-65% with medial walls. It is said that then. In that case, strabismus surgery may be necessary. Even if double vision does not appear in frontal vision, there is a 10% chance that double vision will remain in peripheral vision (up, down, left, and right).
• After the surgery, your pupils may dilate or it may become difficult to see up close, but this will gradually improve over about six months.
• If damage occurs to the important nerves related to the eye or the blood vessels that feed them, vision and visual field problems may occur, leading to blindness. The incidence is approximately 1%, including mild cases.
• Since the surgery is performed close to the brain, infection can lead to serious conditions.
• The scar will gradually become less noticeable after surgery, but it may become noticeable or become a keloid. If the wound disintegrates after surgery, suturing will be required again. Orbital cellulitis may occur due to infection.

Author information

Tomoyuki
Kashima

/ MD, PhD

Over the past 10 years, we have performed more than 10,000 eye plastic surgeries in Japan and the United States.
I aim to provide the cutting-edge medical knowledge and experience I have gained to patients in need in Japan.