Customized Approach


Customized Approach to Thyroid Eye Disease Surgery

As a Thyroid Eye Disease (TED) specialist, Dr. Raymond Douglas believes that every patient deserves a treatment that is customized to their exact needs, as no two patients are exactly the same. An aesthetic customized approach to TED is important because not only does it correct the functional issues associated with the disease, but it also allows the patient to look and feel their best.

Many patients often feel guilty thinking about undergoing the surgery, but no one would ever think twice about fixing a facial fracture after a car accident. In this same vein, at the International Orbital Institute, we want patients with Graves’ eye disease or TED to know they should not feel guilty about wanting to restore their appearance to their pre-disease look. We all deserve to feel confident with our appearance!

At the International Orbital Institute, our goal is to provide you with personalized care so you can be you again!

What is aesthetic and functional reconstruction?

The purpose of customized orbital decompression is to return, or even improve upon, the pre-disease appearance and function of the eye and orbit. Both aesthetics and function are critically important for social interactions and overall quality of life.

Furthermore, Dr. Douglas applies the philosophy of “form follows function” when he performs surgery for his patients. Meaning, the aesthetic improvements he is making to the appearance of the eye will result in improved function of the eye and eyelids. This holistic approach provides his patients with the best results possible.

What are the key factors to customized surgical planning?

While TED patients typically have similar concerns and goals for surgery, it is very important to evaluate each patient on an individual basis and determine what aspects of the surgical outcome are the most important to them. Once Dr. Douglas has a thorough understanding of a patient’s goals and has evaluated the extent of their disease, he can determine the best course of treatment.

Below are the key factors that Dr. Douglas considers when customizing the surgical plan.

Patient’s Goals

There is a wide spectrum of how affected a patient’s eye appearance and function may be from the disease. Whether the patient is affected very mildly or severely, Dr. Douglas spends just as much time with each patient getting to know them and having a conversation about the goals of treatment during an initial consultation. The result of the consultation may be that surgical intervention is not desired or needed at this time, or it may be that surgical and non-surgical options can be further explored to whatever to the degree the patient desires, in considering the risk and benefits.

Type of Disease& Disease Severity

The second factor in considering the best course of treatment is determining the type of disease. This means we need to determine if the disease is fat or muscle predominant. This is important because it dramatically influences the risk profile for the patient. The next thing to consider is the disease severity. The disease may be mild, moderate or severe, and the patient and surgeon must be realistic in thinking about the potential for recovery.

Risk of Double Vision

The presence or risk of double vision is always a consideration. This is the most common likely risk but is highly dependent upon whether the disease is muscle or fat predominant. As a result of performing a countless number of decompression surgeries, Dr. Douglas takes many steps to minimize the chance of double vision. His rate of double vision or problems associated with the surgery is far less than that of most other surgeons.

Bony Structure

Finally, the bony structure or the bone available for decompression and the bony structure that supports the eye will often dictate what we can accomplish with surgery. Photos, especially old photos of facial structure appearance, are incredibly important to return a patient’s appearance back to normal and how things were before the disease.

How to Achieve the Best Aesthetic Functional Reconstruction Results

Our goal is to make aesthetic and functional improvements. When choosing to undergo a customized decompression, patients very rarely need to perform lower eyelid surgery. In fact, less than 5 percent of our patients need lower eyelid surgery after they had a highly customized minimally invasive orbital decompression. We avoid the need for lower eyelid surgery because we focus not only on moving the globe back but also on moving the globe up or down to create a normal eyelid position.

Customized Approach B/A
Customized Approach Beverly Hills, CA

In the examples above, you can see Dr. Douglas was able to create a very natural looking lower eyelid appearance by doing a customized decompression.

Adjunct Procedures

Improving Appearance with Adjunct Procedures

As part of Dr. Douglas’ customized plan, he also considers how to improve the cheek junction and upper eyelids and brow with surgery.

Improving the cheek junction can be a very important part of surgery for patients, as it creates a smooth transition from the lower eyelids to the mid-face and a very nice overall facial appearance. Some of the procedures that can be performed in conjunction with orbital decompression to improve the cheek junction include:

  • Eyelid retractor release to elevate the lower eyelids
  • Orbitomalar ligament release to address the bags under the eyes
  • Midface lift or support
  • Cheek lift and implants (in the most complex patients)

The upper eyebrow and upper eyelid are very important components of the aesthetic appearance and overall function for the patient. Improvements can be achieved in these areas through a variety of approaches. As an expert in the field, Dr. Douglas is able to improve the upper brow and lid utilizing a variety of approaches, depending on the needs of the patient, including:

  • Reduce the brow fullness
  • Camouflage the fullness
  • Augment the area to achieve a better function and appearance (rare)
  • Selective decompression can be done to further improve the appearance by hiding the lacrimal gland if it is prolapsed to achieve a very smooth upper eyelid and eyebrow

During a consultation with Dr. Douglas, he will evaluate the patient and determine which of the above adjunct procedures will help him achieve the surgical goals of the patient.

Photo Gallery

Thyroid Eye Disease Before & After Gallery

As we have indicated several times before, every patient is different and requires an individualized approach to surgery so that they get the best results possible. You can see more examples of all the different patients we have helped before & after surgery in our photo gallery. Browsing through the gallery will allow you to see all of the different types of patients Dr. Douglas has improved both aesthetically and functionally.

Customized orbital decompression



Schedule Your Customized Orbital Decompression Consultation Today!

If you or a loved one is suffering from TED, Dr. Douglas and his team are here to provide you with the personalized care you deserve. Please contact us at (310) 657-4302 to schedule a consultation with Dr. Douglas to learn how he can help you.

For patients who live out of town or out of the country, we offer initial Skype consults so you can meet Dr. Douglas from the comfort of your own home.

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(310) 657-4302

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