Rejuvenation: Look as Good as You Feel
 Upper Blepharoplasty (Upper Eyelid Surgery)
Upper blepharoplasty involves the removal of excess skin and when indicated, removal of bulging fat from the upper eyelids. Dr. Marshak always tailors this procedure to the individual in terms of how much skin and fat he will excise. His goal with both men and women is two-fold: create a natural, more youthful appearance while maintaining optimal function. In male patients, an additional goal is preventing feminization of the eyelids. Upper blepharoplasty may be covered by insurance if the excess skin is interfering with vision.
Though upper blepharoplasty is a safe and effective procedure, it is not always the right procedure to remedy drooping upper eyelids. In fact, in some cases, performing upper blepharoplasty may actually rob patients of the open, natural, youthful look they desire. In these cases, the forehead lift is actually the correct procedure to rejuvenate the upper eyelids (please see below). An experienced eye plastic surgeon like Dr. Marshak can best determine the optimal procedure for you.
Lower Blepharoplasty (Lower Eyelid Surgery)
Lower blepharoplasty involves the removal of the bags and wrinkles under the eye. There are two surgical approaches used to perform lower lid blepharoplasty.
The more traditional technique, still practiced by some doctors today, cuts the lower eyelid skin. The more advanced transconjunctival method, used by Dr. Marshak, requires no cutting of the skin. With the transconjunctival approach, Dr. Marshak removes eyelid fat by making a small incision on the back side of the eyelid. He then conservatively excises and/or carefully repositions the fat in order to produce a natural result, without creating a hollow appearance.
Immediately after performing the transconjunctival blepharoplasty, Dr. Marshak smoothes wrinkles and tightens the skin of the lower eyelid with rejuvenating/resurfacing methods using topical solutions (Designed Skin Peels®), lasers or Intense Pulse Light (IPL) therapy. These skin treatments can also address the common problem of dark circles under the eyes. (This method of contiguous transconjunctival blepharoplasty combined with skin rejuvenation in the same surgical session was first introduced in 1988, by David Morrow, MD, founded of The Morrow Institute. It has become one of the most commonly practiced methods of lower eyelid rejuvenation.) If necessary, Dr. Marshak may also tighten the lid by placing small sutures in the outer corner of the lid.
Both upper and lower blepharoplasty may be performed in approximately one hour under local anesthetic and or mild sedation. Recovery is virtually painless.
Forehead Lift -- Upper Facelift-Brow Lift
Though many people believe wrinkles and crępey, sagging skin of the upper eye is caused by too much skin, the problem is often caused by fallen brows which push normal eyelid skin down. In these cases, performing an upper lid blepharoplasty to excise extra skin is the wrong procedure. In fact, because blepharoplasty does not correctly address the anatomic problem, the procedure may actually pull the brows down even lower, causing the eye to look closed and the facial expression to appear concerned or angry.
When brows have fallen due to age, gravity or hereditary factors, better results are achieved by elevating the upper face, forehead and brows to their proper position. To this end, Dr. Marshak performs the forehead lift, which is also called the upper facelift and sometimes referred to as a brow lift. Unless the hairline needs to be modified for aesthetic reasons, Dr. Marshak performs the virtually scarless endoscopic forehead lift through small slits in the scalp. With the aid of the endoscopic camera and monitor, Dr. Marshak uses mini instruments to perform the surgery under the skin. Recovery is swift and virtually pain free. If, in the rare case following a forehead lift, Dr. Marshak and his patient decide a minor blepharoplasty will provide an even better result, Dr. Marshak will perform it, usually at no additional charge.
Mid Facelift-Triangle Lift®
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Wrinkle Removal: Botox®
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Facial Fillers
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Skin Rejuvenation: Designed Skin Peels®
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Lasers
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IPL
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LATISSE™
Long, thick, dark eyelashes have long been associated with glamour, mystery, and sex appeal. Those who have spent countless hours applying mascara (and removing it!) know it is at best a temporary fix to the problem of short, thin or inadequate eyelashes.
For a more permanent solution to the problem, which is clinically known as hypotrichosis, Dr. Marshak offers a safe, effective, prescription-only topical treatment called LATISSE™. Easy to apply, it is the first and only product approved by the FDA to treat hypotrichosis.
LATISSE is believed to affect the growth phase of the eyelash. Its effects are gradual, but quick. In clinical trials, patients saw significant improvement within two months. Patients at The Morrow Institute have seen improvement in as little as two weeks.
Patients who are interested in LATISSE™ may schedule a complimentary consultation with Dr. Marshak by calling The Morrow Institute.
Plastic Reconstructive Surgery & Repair
 Canthoplasty
Canthoplasty is performed to horizontally tighten the lower eyelid and/or raise the lower lid if it has fallen. Dr. Marshak performs the procedure using a small incision on the outer corner of the eye. His goal is to bring the lower eyelid in close proximity to the eyeball and to maintain or restore the natural almond shape of the eye.
Ectropion Repair
An aging lower eyelid can become lax and rotate outward. This allows the inner side of the eyelid to be exposed to air. The eyelid becomes red and the eye becomes dry and irritated, which causes excessive tearing. Dr. Marshak repairs these problems by tightening the lower lid using a canthoplasty. Severe ectropion may also require Dr. Marshak to elevate the soft tissue of the cheek in order to support the lower eyelid.
Eyelid Retraction Repair
Eyelid retraction, which appears as a rounding of the eye, can occur when the lower lid no longer adequately hugs the eyeball. It can be caused by an age-related stretching of the tissues of the eyelid, which is then pulled down by the weight of the cheek. It can also occur if scar tissue has developed from prior surgery on the lower eyelid or if too much skin was excised from the front of the lower eyelid.
Eyelid retraction can lead to chronic eye conditions including dry eyes, excessive tearing, redness, burning and blurred vision. Dr. Marshak repairs the problem and restores the natural almond shape to the eye. He uses a small incision at the outer corner of the eye, to remove scar tissue and tightens the lower lid with a canthoplasty.
Lacrimal Surgery
Excessive tearing can be caused by an obstruction within the tear sac or tear duct. This can occur as the bony part of the tear duct within the nose shrinks with age. It can also occur due to infections in the tear sac between the inner corner of the eye and the nose. In mild cases, Dr Marshak treats the problem by opening the tear duct with a small incision.
In moderate cases, Dr. Marshak uses a mini balloon to open the tear duct. In more severe cases, he creates a new boney opening from the tear ducts into the nose with a procedure called dacryocystorhinostomy (DCR). He performs this correction using a small incision on the side of the nose or endoscopically from inside the nose.
Orbital Decompression
Grave's disease, also known as thyroid eye disease, can lead to proptosis, an unflattering bulging of the eyes which can sometimes lead to loss of vision. Orbital decompression surgery expands the eye socket to create more room for the eyeball and its surrounding tissues. In mild cases, Dr. Marshak excises some of the orbital fat around the eye. In more severe cases, Dr. Marshak performs a boney decompression in order to remove some of the bones of the eye socket to allow the orbital contents to expand into the sinuses.
Eyelid retraction can also occur in Grave's disease. In this situation, the upper eyelid retracts upward and the lower lid retracts downward, so that the eyelids cannot close. To remedy this problem, Dr. Marshak performs surgery to relax the upper eyelids; he may also place autologous (self donor) tissue grafts in the lower eyelids so they may close properly.
Ptosis (Drooping Upper Eyelid) Repair
Weak muscles can cause upper eyelids to droop, sometimes impairing vision. Dr. Marshak repairs ptosis by tightening one of the two muscles responsible for opening the eyelid. Most of the time, he performs this procedure through the inner side of the upper lid so that there is no scar. When the situation warrants it, Dr. Marshak makes a small incision in the lid crease of the upper eyelid, which hides any scarring.
Several types of skin cancer can affect the eyelids. The most common are basal cell carcinoma and squamous cell carcinoma. Eyelid cancers are usually slow growing, however because there is very little eyelid tissue to begin with, it is best to excise the lesion as soon as possible.
Dr. Marshak often works in conjunction with a Mohs dermatologic surgeon who ensures that the entire tumor has been excised at a microscopic level. The same day the tumor is removed (or the day after), Dr. Marshak performs the reconstruction.
Dr. Marshak has extensive experience in eyelid reconstruction, ranging from small closures to reconstruction of an entire eyelid, depending on the size of the defect created by the excision of the tumor.
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