Oculoplastic Surgery

Oculoplastic Surgery is a highly specialised field with combined skills in ophthalmology and plastic surgery. It is practiced by some specialist ophthalmologists who are interested in eyelid, tear duct and orbit function. Usually further training is undertaken overseas and skills are unique. It is important to choose someone with oculoplastics training to ensure stability of the eye and vision.

The field of Oculoplastics is expanding and currently requires specialised surgical skills to enable eyelid function after surgery. If eyelid function is not retained then there may be a threat to vision.



Patient’s with chalazia often suffer from ocular irritation. A chalazion is due to a pressure build up within one of the tear glands in the eyelids. There are usually some 20 to 30 glands on each lid and the area forms a small boil. This can be treated either with massage and ointment or with minor surgery. The procedure is performed as day surgery and is successful in the majority of cases but occasionally these areas recur.

Cosmetic Eyelid Surgery – Upper

A/Prof Ghabrial specialises in cosmetic eyelid surgery. Blepharoplasty surgery and brow lift procedures can be performed as day surgery. Upper lid blepharoplasty is usually very satisfactory and creates a more rested appearance with a platform which allows for simple make-up application.

A/Prof Ghabrial performs cosmetic surgery of the upper face, primarily of the upper and lower eyelids. Brow surgery can also be performed.

Upper eyelid surgery is primarily performed under sedation as day surgery. The skin is excised while the patient is under anesthesia and the area assessed for excess fat. If there is excess fat or muscle, these are removed and the lid is closed with sutures which are removed one week after the initial procedure.

Lower lid blepharoplasty surgery can be performed from the outside (transcutaneous) or the inside (transconjunctival) route. These procedures are to remove excess tissue from the lower lids. In general the approach from the skin is performed where there is excess skin and internal approach preferred where there is more excessive fat (swelling) than skin.

A/Prof Ghabrial specialises in cosmetic eyelid surgery. Blepharoplasty surgery and brow lift procedures can be performed as day surgery. Upper lid blepharoplasty is usually very satisfactory and creates a more rested appearance with a platform which allows for simple make-up application. See images above.

Cosmetic Eyelid Surgery – Lower

Lower lid transcutaneous blepharoplasty post op

Lower blepharoplasty surgery can address swelling or hollows beneath the eye as well as excessive skin. All surgical options will be thoroughly discussed and patient’s will be able to view pre and post-operative photographs during consultation.

The images above show a lady who had transcutaneous (skin incisions) to approach her lower lid swelling. The younger lady below had no skin incisions and a hidden approach from behind the eyelid to address mild swelling.

Cosmetic Eyelid Surgery – Lower

The above images indicate substantial early bruising which may occur after this surgery. We will speak to you about options to reduce bruising and improve recovery.



Ectropion is a turning of the eyelid away from the eye. This frequently results in watering of the eye as well as irritation and occasional infection.

Ectropion occurs primarily in older patient’s and is mainly due to looseness of the tissues around the eye. If sun exposure has been extensive then the skin may shrink and pull the eye lid away from the eye.

If the patient is concerned about the symptoms of the appearance of the eye then surgery may be considered. Day surgery usually involves tightening of the lid with or without placement of skin. Skin can be used as a skin graft. A/Prof Ghabrial’s preferred technique is to use a skin flap which is rotated from the upper lid.

Surgery is performed under a twilight sedation as day surgery as Sydney Oculoplastic Surgery. Our expert anesthetists enable you to have a light anesthesia so that there is no difficulty with pain or discomfort. This means you will require someone to take you home as you may be slightly light-headed after the anesthesia wears off.


Note eye lashes on patient’s left lower eyelid turned inwards to irritate the eye

Entropion is the term given to an in-turned eyelid. This occurs where the entire margin of the lid turns towards the eyeball and or the lashes can cause scratches and abrasions on the sensitive front part of the eye (cornea).

Entropion repair can be undertaken by stabilising the lid. This requires identifying and repairing a muscle surgically by a hairline incision beneath the lash line. Once the procedure has been performed the lid remains in position and is very unlikely to turn inwards. The success rate of this procedure is above 95% and patient’s are usually very grateful and comfortable.

Eye Socket

19 year old young man with sunken socket of the left side after removal of eye in his youth. Pre- volume augmentation operation.
19 year old young man with sunken socket of the left side after removal of eye in his youth. Pre- volume augmentation operation.

A/Prof Ghabrial specialises in repairing patient’s eye sockets once an eye has been removed. He also specialises in removal of the eye to gain the most lifelike, realistic appearance after such a devastating procedure.

The options given to patient’s are usually that of enucleation or evisceration. The risks and benefits of each will be discussed as well as the relevant merits.

If you have lost an eye in the past, often an improvement in the appearance can be achieved by surgical means. A/Prof Ghabrial has specialised and researched these options extensively.

Eyelid Skin Cancers

Patients who have skin lesions of the eyelid may be suffering from simple benign lumps or not infrequently suffer from skin cancers of the eyelid. These sun spots are often known as BCC’s or SCC’s. Removal can be undertaken by A/Prof Ghabrial as day surgery. Reconstruction is undertaken on the day. To read more please click on the PDF file provided below.


Facial Palsy

Facial (seventh nerve) palsy can occur in patient’s from a congenital or acquired reason. Most commonly Bells palsy causes difficulty with the muscles of the face. The upper facial upper muscles affect the eye through the actions of the eyelids.

The main problems for patient’s are;

  • difficulty of closing the upper lid,
  • drooping of the lower lid and,
  • dryness of the eye.

Depending on your particular difficulty the issues can be addressed surgically as day surgery or with non-surgical options.

Orbital Surgery

Orbital Tumour

A/Prof Ghabrial specialises in orbital disease. This includes fractures of the orbit where the patient may suffer double vision. Repair can be undertaken by delicate surgery, usually performed under general anesthesia.

Orbital tumors are another area of interest of A/Prof Ghabrial’s. Extensive research has been performed and the best way to remove these tumors is usually approached through hidden crease incisions. Once the area has been addressed the lesion is usually sent for pathology and determined to be benign or malignant. The options are discussed with the patient at that stage.


Ptosis is the medical term for drooping of the eyelid. It may affect one eye or both eyes. Ptosis can be due to a multitude of causes but is most likely simply due to laxity of the muscle complex of the upper eyelid; this occurs primarily with age. Some patient’s are born with ptosis and these patient’s are a different subset as they require different surgery usually while they are children.

Ptosis surgery is quite straightforward but can be a little unpredictable. The procedure is performed under sedation as day surgery. There is a skin crease incision to allow minimal scaring. The muscle is then identified through this incision and the lid is raised with stitches to the muscle. This procedure is very effective but occasionally follow-up procedures may be required to balance the eyes if the height is not as predicted during the operation.

Stitches are removed one week after the operation and the patient is usually able to return to work at this stage. There may be some mild, residual bruising or swelling after this time but usually patient’s are very happy. An alternative to this skin crease incision is a procedure that can be performed internally. A/Prof Ghabrial has performed many of these operations and these are also very effective. A/Prof Ghabrial will discuss with you whether you are a candidate to have the internal (scarless) procedure.

Children with Ptosis are often managed with brow suspension slings made of silicone.
This surgery is best done under general anaesthetic. An example of such is above.

Tear Duct Surgery for Watery Eyes

Patients can suffer from watering of the eye if they have a blockage or partial blockage of the tear duct. This watering eye condition can cause social embarrassment as well as recurrent infections and ocular irritation. To read more please click on the PDF file provided below.

Tear Duct Disease

Thyroid Eye Disease

Thyroid eye disease is caused by an accumulation of tissue behind the eyes. It usually occurs in the presence of thyroid disorder and can cause multiple problems. Reconstruction and rehabilitation is undertaken by a combination of medicine and surgery. A/Prof Ghabrial has vast experience in this disease and has written numerous articles. To read one of these articles written for eye care health workers, please click on the PDF file provided below.

We present an image of a patient who had thyroid eye disease affecting the left eye only
After surgery you can see the position of the eyes is greatly improved and symmetry is achieved.

For more information please refer to the PDF below.

Thyroid Eye Disease


Xanthelasma is often due to excessive cholesterol in the blood. When there is not found to be any high cholesterol, xanthelasma may simply deposit in the eyelids for unknown reasons. Surgical removal can be performed as day surgery and is considered in each case and complex plastic surgery is used to repair the defect. The procedure is usually satisfactory but up to 10% or 20% of cases can recur.