Eyelid Surgery London, UK

The diagnosis of Blepharospasm is always delayed and the patient has access to treatment 5 years on average after onset. Injections are the most efficient treatment of the Blepharospasm and can control the spasm for about 3 months. Not all the Blepharospasm are the same; each patient requires a personalised scheme of injections, tailored to their own type of Blepharospasm; a lot of poor response to the treatment are due to inappropriate targeting of the muscles around the eyes. In particular spasms of the eyelids (so called, apraxia of eyelid opening or eyelids dystonia) require injections along the eyelashes, called pretarsal injections for a good response to treatment. Dr Marion is a Blepharospasm London specialist for pretarsal injections, into the eyelids itselves, for treating this type of Blepharospasm, called Apraxia of eyelid opening. It’s one of the main reasons of failure of treatment of Blepharospasm. If the dystonia has spread to the lower part of the face, the patient in addition to the eye closure has involuntary spasms of the mouth, tongue, jaw. ( called Meige Syndrome). The treatment needs to address all the facial muscles affected by the dystonia as the treatment of only the eyes spasms will not be sufficient.

BoNT-A is a neurotoxin secreted by Clostridium Botuli and purified to be used in therapeutics. There is seven serotypes ( A,B,C,D,E,F,G) but only BoNT-A and BoNT-B are licensed for focal dystonia treatment. BoNT-A is a polypeptide with 2 chains linked by a disulfuric bridge. The heavy chain is responsible of the specific binding of the BoNT-A to the cholinergic fibers. The limited action on cholinergic fibers due to this specific bindings is one factor of safety of the BoNT-A . The light chain is responsible of the enzymatic action of the BoNT-A, which cuts a membrane vesicle protein ( called SNAP-25), making the release of the acetylcholine in the synaptic cleft impossible. When the release of the acetylcholine is blocked, there is no more signal from the nerve to the muscle , therefore the muscle is less able to contract. Also there is no more signal between the nerve and the glands ( sweat or salivary glands for example), and the gland stops secreting. This blockage of the release of the acetylcholine is transient, as there is sprouting of the nerve terminals and also synthesis of new membrane vesicle proteins.

Age takes away much of the fullness in our upper eyelids, causing the looser skin to fall toward the eyelashes and / or fold backward to create prominent creases. Other conditions created by advancing maturity include fine lines, wrinkles, and under-eye shadows or puffiness. Cosmetic eyelid surgery, also known as blepharoplasty, corrects this appearance of drooping skin and removes any excess fat on the upper eyelid. It does not, however, erase the fine lines at the outer aspects of your eyes: this condition may be treated by placing fat beneath the skin to plump up any creases. The surgery can take different approaches depending on the patient’s situation: sometimes the eyelid skin is augmented using fat from a different area of your body, or a small amount of skin is removed to improve both the eyelid fold and the contours. Some patients elect to have both the upper and lower eyelids improved simultaneously, while others choose to correct one or the other, especially if problems are more apparent in a single area.

Age takes away much of the fullness in our upper eyelids, causing the looser skin to fall toward the eyelashes and / or fold backward to create prominent creases. Other conditions created by advancing maturity include fine lines, wrinkles, and under-eye shadows or puffiness. Cosmetic eyelid surgery, also known as blepharoplasty, corrects this appearance of drooping skin and removes any excess fat on the upper eyelid. It does not, however, erase the fine lines at the outer aspects of your eyes: this condition may be treated by placing fat beneath the skin to plump up any creases. The surgery can take different approaches depending on the patient’s situation: sometimes the eyelid skin is augmented using fat from a different area of your body, or a small amount of skin is removed to improve both the eyelid fold and the contours. Some patients elect to have both the upper and lower eyelids improved simultaneously, while others choose to correct one or the other, especially if problems are more apparent in a single area.