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Cover Focus | July/Aug '17

Oculoplastic Surgery in the Comprehensive Practice

Is it time to revisit?

Over the past decade, the desire to specialize has become increasingly important to ophthalmologists. Whether it is to be a LASIK surgeon, retina surgeon, glaucoma surgeon, corneal surgeon, or oculoplastic surgeon, the field of comprehensive ophthalmology seems to continue to decline. However, the need for truly comprehensive ophthalmologists continues to grow: My patients live 1 hour of interstate driving to the nearest specialist. To those living in metropolitan areas, this seems like no problem; to folks living in rural towns, this is an arduous process.

In these days of ever-decreasing reimbursements, the need to complement one’s practice with different avenues of revenue streams has become paramount. Many surgeons have already garnered the ideas of learning MIGS, adopting premium IOL surgeries, and implementing newer aberrometry devices. However, in my impression, few seem interested in oculoplastics any longer. Why is this?

My presumption is that, in the past decade, we have been inundated by messaging from the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), and many people feel like, because they are not ASOPRS-trained, they cannot perform oculoplastic procedures. This thinking is probably true for deep orbitotomies and tumor surgery; however, the typical blepharoplasty, ptosis, entropion, or ectropion procedures can certainly be in the surgical armamentarium of a comprehensive ophthalmologist.

Let’s explore three reasons that oculoplastic surgery should be added to your practice.


Patients typically want to stay with their regular eye doctor for services that can be rendered at that location. Patients frequently come to our practice because we do cataract surgery and eye exams all in the same location. Often, when our technicians ask a patient, “Are your eyelids bothering you by covering up your vision?” the patient says, “Yes, but I figured no one could do anything about it.”

To me, this is the easiest way to get a referral. Your staff can be trained to be on the lookout for these patients. If a patient comes in the door with ectropion, our staff members will typically inform the patient that we treat that right in our facility and can offer him or her relief from this condition onsite. Generally, these patients are extremely satisfied: They feel good about their new appearance, and they are happy that they can see the world better. Often, my oculoplastic surgery patients are happier than many of my cataract patients who see 20/20 on day 1 postoperatively.


In my rural area, many optometrists would have to send patients 1 to 2 hours away to find an oculoplastic doctor who would see them in a timely manner. Since we started performing blepharoplasty, ptosis repair, and entropion and ectropion repair, our surgical volume has gone up nearly 25%. This is impressive considering we were already performing a fair amount of procedures. The reason for this is simple: If you do one good oculoplastic procedure, the physicians in your surrounding communities immediately start sending more referrals to you.

Additionally, the visible results of oculoplastic surgeries are a native marketing tool. My patients go to church, Walmart, the mall, or the county fair, and people notice their improved cosmesis. Suddenly, everyone wants to have the doctor “fix their eyelids.” This has certainly been the case for me. Referrals continue to grow in our practice due to oculoplastic services being offered.


The profitability of performing one blepharoplasty per hour versus three to four cataract procedures per hour is likely not attractive. However, with practice and experience, it is fairly simple to increase that volume to two blepharoplasties per hour, including the time to mark and block. In my facility, I mark and block the second patient while the first patient is rolled into the OR. Using a Bovie device and minimal supplies, I can perform the procedure bilaterally in 25 minutes, easily.

Immediately after the procedure is finished, my surgical staff removes the drapes and cleans the patient while I go to preoperative holding area and mark and block the third patient; simultaneously, the second patient is rolled into the OR. This design allows for minimal disruption to the operating schedule and allows for the procedure to become rather profitable to the practice. Lateral tarsal strips, which pay quite well, can easily be performed in 10 to 15 minutes and are good sources of revenue for the practice and surgery center.


With the three simple principles discussed above, an ophthalmology practice can only grow from adding oculoplastic procedures. I recommend ophthalmologists reconsider their approach and take a course or two at the AAO meeting to get acclimated to cosmetic practices. You won’t be sorry you did.

Michael Patterson, DO
Michael Patterson, DO