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JOSEPH Advanced Oculofacial Plastic SurgeryAbout JOSEPH Advanced Oculofacial Plastic SurgeryBlog & News Updates
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Cosmetic Procedures, Reconstructive Joseph Advanced Oculofacial Plastic Surgery Staff

Eyelid Surgery Troy Michigan

Many patients use search engines to look for "Eyelid Surgery Troy Michigan", but are otherwise unsure what procedures they may need or how to find a surgeon.  If you are looking for an eyelid surgeon in Troy, Michigan or the surrounding area of Metro Detroit such as Birmingham, Bloomfield Hills, West Bloomfield, Rochester, Rochester hills, you may find the information here helpful.

What are the most common types of eyelid surgery performed in Troy, Michigan?

The most common types of eyelid surgery are upper and lower eyelid blepharoplasty. These can be performed for cosmetic reasons, though insurance may sometimes cover upper blepharoplasty if there is visual limitation. Other types of eyelid surgery are more likely functional and is often covered by insurance; these include entropion and ectropion repair, eyelid retraction repair, floppy eyelid repair, and eyelid skin cancer repair.

What is Upper blepharoplasty?

The upper eyelids can develop aging changes including excessive and redundant skin, changes in upper eyelid fat pads, and skin hooding over the lashes.  These changes can make you look tired, angry and older than your years.

Upper blepharoplasty is a surgical procedure to address these aging changes to restore a more lively and refreshed appearance. This procedure tends to have little down time and very high satisfaction rates. The incisions are hidden away in the natural eyelid crease and heals very well with excellent results.

Learn more about upper blepharoplasty or visit American Academy of Ophthalmology EyeWiki's Blepharoplasty page (for which Dr. Shannon S. Joseph serves as the editor).

Upper Blepharoplasty (Eyelid Lift)

Upper Blepharoplasty (Eyelid Lift)

Upper blepharoplasty, also called upper eyelid lift surgery, is a surgical procedure that is used to improve the appearance of the eyes and in …

What is Lower blepharoplasty?

Lower blepharoplasty is one of the most frequently performed cosmetic surgeries to restore a more youthful and rested appearance to the lower eyelids. Lower eyelid bags and dark circles is a common problem that can make people look older and more tired than you are. This can be caused by a combination of redundant lower eyelid skin and excessive lower eyelid fat pads. Lower blepharoplasty is a surgical procedure that can address the redundant skin as well as reposition and sculpt the fat pads to smoothen the contour of the lower eyelid and restoring a more youthful appearance. Learn more about lower blepharoplasty.

Lower Blepharoplasty (Eyelid Lift)

Lower Blepharoplasty (Eyelid Lift)

Lower blepharoplasty is one of the most frequently performed cosmetic surgeries to restore a more youthful and rested appearance to the lower …

Where to get eyelid surgery in Troy Michigan?

When considering cosmetic or reconstructive plastic surgery on the face, it is very important to find a surgeon who specializes in performing procedures on the face. While many surgeons may advertise providing blepharoplasty and brow lift surgeries, not every surgeon performs them regularly.  This is important because, across medicine, it has been well demonstrated that surgeons who perform a given procedure frequently are more likely to have outstanding results and less likely to encounter complications.

Therefore, it is a good idea to understand how experienced your surgeon is in your procedures of interest. Specifically, it is important to verify your surgeon underwent the appropriate fellowship training, which is training beyond residency that allows surgeons become highly specialized in one area, such as plastic surgery around the eyes and face.

Meet Dr. Shannon S. Joseph - Oculofacial Plastic Surgeon

Meet Dr. Shannon S. Joseph - Oculofacial Plastic Surgeon

Dr. Shannon S. Joseph is a board-certified oculofacial plastic surgeon who specializes exclusively in cosmetic and reconstructive surgery of …

Schedule a Consultation

Dr. Shannon S. Joseph is a Johns Hopkins University and University of Michigan trained, board-certified, fellowship-trained oculofacial plastic surgeon. She specializes exclusively in plastic surgery of the eyes and face. Eyelid surgery such as blepharoplasty is the most common procedure Dr. Joseph performs, and she has successfully performed thousands of these surgeries. At your one-on-one consultation, Dr. Joseph will take her time to carefully listen to your expectations and goals, perform a comprehensive evaluation, and works together with you to design a plan that is fully tailored to your anatomy and aesthetic goals. Learn more about why patients choose us.

Our office is located in Troy, Michigan, serving patients from Troy as well as Birmingham, Bloomfield Hills, West Bloomfield, Rochester, Rochester Hills, and surrounding areas of Southeastern Michigan. If you are interested in a personal consultation with Dr. Joseph, contact us to schedule an appointment. We look forward to helping you look and feel your best.

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Bell's Palsty
Miscellaneous, Reconstructive Shannon Joseph

What you should know about Bell’s Palsy?

Bell's palsy is the most common cause of facial palsy, which occurs due to dysfunction of the facial nerve, leading to weakness or loss of facial movement. The abnormal facial movement can impact patients' everyday activities, including eating, speaking, smiling, and blinking or closing the eyes. Therefore, facial palsy can have profound social, emotional, and functional consequences for patients.

Even though Bell's palsy is the most common cause of facial palsy, it should only be diagnosed after other potential causes have been ruled out. Other potential causes of facial palsy include stroke, Lyme disease, Ramsay Hunt syndrome, brain tumor, head and neck tumor, trauma, surgery, and congenital abnormalities.

What are the symptoms of facial palsy?

Symptoms of facial palsy include:

  • Facial asymmetry
  • Facial muscle weakness
  • Difficulty closing eyes
  • Abnormal blinking
  • Difficulty making facial expressions
  • Changes in saliva and tear production
  • Changes in taste on the affected side of mouth
  • Sound sensitivity

How is facial palsy treated?

Patients with facial palsy should receive integrated care from a team of experts which usually includes facial plastic surgeons, oculofacial plastic surgeons, ophthalmologists, occupational therapists, but may also include optometrists, neurologists, otologists, and skull base surgeons.

Some patients with chronic facial palsy may be treated with procedures to restore facial movements and symmetry. These procedures may include free tissue transfer, nerve transfer, muscle transfer, and nerve grafting.  Static surgical procedures are also available to improve symmetry and function of the eyelid, brow, lip, and face.

How can I protect my eyes if I have facial palsy?

Facial palsy can weaken eyelid closure and blink. This often results in corneal dryness, but can also cause corneal scratches, or, in severe cases, even vision loss.

Every patient with facial palsy involving their eyelids should seek care from an ophthalmologist to receive a baseline eye exam. This helps determine the impact of facial palsy on the health of the eye. An oculofacial plastic surgeon is also often involved to assess the impact of facial palsy on the eyelids and develop an individualized treatment plan for patients to improve the function and position of the eyelids.

While waiting for a clinic visit, patients should use preservative-free artificial tears at least 4-6 times a day, and preservative-free artificial tear ointment while sleeping.

In this review article and this study, co-authored by Dr. Shannon S. Joseph, you can find a comprehensive summary of the impact of facial palsy on the health of the eye, and the management options available for patients with facial palsy affecting the eye.

Schedule a consultation

If you are have been diagnosed with Bell's palsy or facial palsy, please contact us to schedule a personal consultation with Dr. Shannon S. Joseph. She founded and was co-director of the Michigan Medicine Multidisciplinary Facial Nerve Clinic while on faculty at the University of Michigan and has extensive experience taking care of patients with facial palsy. She will perform a comprehensive evaluation and work with you to develop an individualized management plan that is tailored to you.

Figure Showing Molecular Mechanism of Teprotumumab
Research, Thyroid Eye Disease Shannon Joseph

Breakthrough Treatment for Thyroid Eye Disease

How does thyroid eye disease (TED) work?

Thyroid eye disease has many other names, including Graves’ eye disease, thyroid associated orbitopathy, Graves’ ophthalmopathy.

This review article authored by Dr. Shannon S. Joseph provides a comprehensive review of what we know and understand about the pathophysiology of thyroid eye disease.

In short, thyroid eye disease develops as a result of complex interactions amongst various molecules in the body including cell receptors, autoantibodies, immune cells, and other inflammatory molecules. These abnormal changes lead to the enlargement of the muscles and fat within the eye socket.

What are some symptoms of thyroid eye disease?

The eye socket is confined by rigid bony walls. When the muscles and fat within the eye socket are enlarged, the patients can develop prominent appearing eyes, abnormal positioning of the eyelids, inability to close the eyes, and double vision. Patients may also have redness and swelling of the eye and eyelids, as well as dryness, irritation, and tearing of the eyes. Severe TED can result in change and loss of vision.

The vast majority of TED patients also have Graves’ disease of the thyroid. However some patients can have normal or low thyroid levels. If your doctor suspects you may have TED, they may order blood work testing for certain antibodies, thyroid hormone levels, and imaging of your eye sockets if needed.

What are the risk factors associated with the development or worsening of TED?

The three main modifiable risk factors associated with the development or worsening of TED are smoking, diabetes mellitus, and abnormal thyroid function.

Smoking is the single most important risk factor for TED. Patients with Graves’ disease who smoke are 1. more likely to develop TED, 2. tend to have more severe disease and 3. are less responsive to treatment. Therefore, patients diagnosed with TED who are active smokers should quit as soon as possible.

Diabetes has been shown to be a risk factor associated with the development of TED-related optic nerve damage leading to vision loss. Therefore, diabetic patients diagnosed with TED should work with their PCPs/endocrinologists to ensure adequate blood sugar control.

Abnormal thyroid hormone levels is a risk factor for more severe TED. Patients who have abnormal thyroid hormone levels should work with their endocrinologists to restore and maintain normal thyroid function as soon as possible.

What are the treatment options for thyroid eye disease?

The treatment options for TED depends on multiple factors. One of the main factors for consideration is disease severity. Most patients have mild TED, and these patients can often improve spontaneously. The mainstay of treatment for mild TED is conservative, and can include artificial tears for eye lubrication, low salt diet and sleeping with head elevated to reduce swelling, and cold compress for comfort. Some patients who are selenium or Vitamin D deficient may benefit from supplementation. Smokers should stop smoking as this can lead to worsening disease. Patients should work with endocrinologists to normalize their thyroid hormone levels.

Patients with more severe disease may need any or a combination of medical and surgical treatments. Medical treatment options mainly include teprotumumab (Tepezza) and steroids. Surgical treatment options include orbital surgery, eye muscle surgery, and eyelid surgery. Other treatment options include orbital radiation. To achieve the best outcome, it is important to take a customized approach in developing treatment plans for each patient tailored to their needs.

What is Tepezza and how does it work?

Teprotumumab (Tepezza) is a human monoclonal antibody targeting against one of the key players in the development of TED: the IGF-1R. Extensive research has shown that blocking the IGF-1R pathway reduces the downstream effects of the two central players in TED: IGF-1R and TSHR. Therefore, teprotumumab (Tepezza) actually targets the underlying molecular mechanism (the root of the problem) in thyroid eye disease. This is what sets teprotumumab apart from other currently available treatment modalities for thyroid eye disease (steroid/radiation/surgery). The development of Tepezza is widely considered a major breakthrough in the treatment of TED.

Which patients could benefit from Tepezza?

Tepezza was approved by the FDA in January 2020. As a newer drug, we are still continuing to learn about its efficacy and safety. This review article co-authored by Dr.  Shannon S. Joseph provides a comprehensive review of what we know so far about the efficacy and safety of Tepezza. Here is a brief summary: 

What we learned from the two clinical trials
– The trials studied only a specific type of TED patients: those with active, moderate to severe disease who developed TED within 9 months prior, and have had no history of most other medical and surgical treatments.
– The trials showed that ~70-80% of patients responded to the treatment. These patients often had rapid improvement in eye prominence, inflammatory signs, and double vision.

What we learned since then:
– Recent case reports, including this article co-authored by Dr. Shannon S. Joseph, suggest patients with chronic TED or compressive optic neuropathy may also see improvement with teprotumumab.
– Further studies are needed to better understand the effect of teprotumumab in these patients.

What are the potential side effects & adverse reactions of Tepezza?

This review article co-authored by Dr. Shannon S. Joseph provides a comprehensive review of what we know so far about the efficacy and safety of Tepezza. Here is a brief summary: 

– Pregnancy and active pre-existing inflammatory bowel disease are contraindications for teprotumumab.
– The most common adverse events include muscle spasms, nausea, hair loss, diarrhea, fatigue, hearing impairment, and elevated blood sugar.
– Patients with pre-existing diabetes and pre-diabetes should have close monitoring of blood sugar.
– ~10% or more of patients reported hearing-related issues in the clinical trials. Subsequent case series show this percentage may be higher. Future studies are needed to better understand these observations. Patients at risk for hearing loss should get baseline and periodic audiograms should they choose to undergo treatment with Tepezza. 

Schedule a Consultation

Dr. Shannon S. Joseph is a board certified oculofacial plastic surgeon with extensive experience in thyroid eye disease.  Our practice serves patients in Southeastern Michigan with many patients who are from Birmingham, Bloomfield, West Bloomfield, Troy, Rochester, and the Rochester Hills areas. Dr. Joseph also frequently takes care of patients who travel from other parts of the country to see her. Do you have or think you may suffer from thyroid eye disease and would like a comprehensive evaluation and develop an customized treatment plan tailored specifically to you and your eyes? Contact us to schedule a consultation.

Learn About the Best Ways to Look Less Sleepy
Cosmetic Procedures, Miscellaneous Joseph Advanced Oculofacial Plastic Surgery Staff

Best Ways to Look Less Tired

People frequently tell us that they want to look less tired – that the appearance of their eyes makes others think that they are tired or sad or even angry. There is actually scientific evidence that the eyes are one of the first things that people look at, and also spend the most amount of time looking at, when meeting and/or talking with you. Unfortunately aging can negativity impact how our eyes look, which can in turn affect our social interactions. There are a number of changes we see around the eyes with aging:

  1. Upper eyelid skin drooping
  2. Eyebrow drooping
  3. Lower eyelid bag
  4. Darkening from a sunken area under the eyes or lower eyelid dark circles
  5. Wrinkles near the corners of the eyes
  6. Wrinkles between the eyebrows

What are the best ways to make your eyes look less tired?

Fortunately, there are many options to help reverse these changes and get you feeling and looking your best. Both surgical and nonsurgical options can be highly effective depending on your anatomy and goals.

Early crow’s feet and H-wrinkles between the eyebrows respond well to Botox injections, which are simple treatments that can be done without any downtime. There is some suggestion that these medications may even prevent formation or worsening of wrinkles. In appropriate patients, additional office-based skin treatments may also be considered, such as chemical or laser peels. These have a little more down time, but most patients are back to their usual social activities after a week.

Early lower eyelid bags may often be improved without surgery through use of dermal fillers, which lessen the tear trough deformity and give a more youthful and refreshed appearance. Within this area, fillers may last for one year or even longer. Instead of dermal fillers, some patients may wish to use their own fat from elsewhere on their body to treat the tear trough through fat grafting. More pronounced lower eyelid bags do often require surgery to achieve the best results, but this can be done with with an outpatient procedure called a lower eyelid blepharoplasty. For patients with droopy eyebrows, a brow lift helps to open the eye and gives a more youthful appearance. Finally, upper eyelid blepharoplasty is perhaps one of the most rejuvenating procedures around the eyes, and can restore a natural youthful appearance to the eyes with a minimally invasive surgery.

Schedule a Consultation

The anatomy of the eyelids and surrounding areas is complex. It is important for your eye surgery to be performed by a surgeon who specializes in plastic surgeries of the eyes and face.  Dr. Shannon S. Joseph is a fellowship-trained oculofacial plastic surgeon with extensive experience in eyelid surgery.  She is also a board-certified ophthalmologist with keen understanding of the health of the eye and vision. Learn more about why patients choose us. Our practice serves patients in Southeastern Michigan with many patients who are from Troy, Birmingham, Bloomfield Hills, West Bloomfield, Rochester, and the Rochester Hills areas.  To learn more about whether this procedure would be appropriate for you, contact us to schedule a consultation.

Photo of Johns Hopkins Hospital with dome visible
Cosmetic Procedures Joseph Advanced Oculofacial Plastic Surgery Staff

Finding the Best Blepharoplasty Surgeon in Michigan

Our faces contain the most personal of all of our traits, and in many ways define us to the outside world.  The face is also one of the most medically complex anatomical areas of the body, with many nerves, blood vessels, and other critical anatomic structures.  When considering cosmetic or reconstructive plastic surgery on the face, it is very important to find a surgeon who specializes in performing procedures on the face.  This guide was formulated to help patients who are considering upper eyelid blepharoplasty (eye lift), lower eyelid blepharoplasty, and brow lift surgery, and are searching for the right surgeon.  Much of the advice within the article also applies to other types of facial cosmetic and reconstructive surgery.

Can’t Most Cosmetic Surgeons Perform these Procedures?

While many surgeons may advertise providing blepharoplasty and brow lift surgeries, not every surgeon performs them regularly.  This is important because, across medicine, it has been well demonstrated that surgeons who perform a given procedure frequently are more likely to have outstanding results and less likely to encounter complications.  Further, while no surgery is without risk, the likelihood of any individual complication lessens substantially with specialists who perform the procedure regularly. Therefore, it would be prudent to understand how experienced your surgeon is in your particular procedures of interest.

What Credentials Matter when Looking for a Blepharoplasty Surgeon Near You?

The short answer is that it is the entire sum of training that matters, including (but not limited to) the following:

  1. Medical School
    The reputation of a medical school can help give background on the type of student the surgeon was prior to entering residency.  Furthermore, students who graduate from top medical schools are often more likely to be accepted into a better and more competitive residency training program.  The US News & World Report ranks medical schools each year, and while the individual rankings may differ somewhat with any given year, medical schools that are frequently listed at the top include Harvard University, Johns Hopkins University, Columbia University, Yale University, University of Pennsylvania, University of Michigan, Stanford University, and others.
  2. Residency Training
    The type and location of a residency training program are important when considering the credentials of an eyelid plastic surgeon.  Generally, most surgeons performing blepharoplasty and brow lifts will have completed an ophthalmology residency, general plastic surgery residency, or otolaryngology – head and neck surgery residency.  Similar to the medical school, institutions with better reputations often expose young surgeons to a more complex patients to help form their experience.  Residency training program rankings are now also compiled by Doximity for ophthalmology, plastic surgery, and otolaryngology – head and neck surgery.  Across the residency types, Johns Hopkins University and University of Michigan and usually within the top five when ranked by reputation.
  3. Type of Fellowship Training
    Fellowship is a very important aspect of modern surgeon training.  Fellowships are training beyond residency that allow surgeons to focus on one particular aspect of what are otherwise very broad fields.  Many cosmetic surgeon may simply list that they underwent fellowship training in a given city where people assume many plastic surgeries are performed (e.g. Beverly Hills, New York, etc).  However, this does not ensure appropriate training.  In fact, certain fellowships in these locations are only “observerships”, where a fellow simply watches another surgeon without him/her performing any aspects of the procedures.   Medical societies have attempted to combat this by certifying individual fellowships.  It is therefore important that you verify your surgeon underwent proper fellowship training.  You can search for whether your surgeon completed and/or is a member of the American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), a plastic surgery craniofacial fellowship, and an American Association for Facial Plastic Surgery Fellowship.
  4. Board Certification
    Surgeons who practice within an individual specialty become board certified to ensure that they have the education and experience necessary to practice within a field.  For blepharoplasty and related procedures such as brow lift, you should ensure that your surgeon is board certified by one of the following certifying authorities: American Academy of Ophthalmology, the American Board of Facial Plastic and Reconstructive Surgery, and/or the American Board of Plastic Surgery.
  5. State Licensure
    You surgeon should be licensed to practice medicine in the state where you will be having the medical services provided.  Within the State of Michigan, you can ensure that a surgeon has up-to-date licensure by searching within the Michigan Department of Licensing and Regulatory Affairs.  Public enforcement actions against a physician may also be listed on this website.

Why do patients choose us?

  • Dr. Shannon S. Joseph is a Johns Hopkins University and University of Michigan trained, board-certified oculofacial plastic surgeon.
  • She specializes exclusively in plastic surgery of the eyes and face.
  • Blepharoplasty is the most common procedure Dr. Joseph performs, and she has successfully performed thousands of these surgeries.
  • Dr. Joseph firmly believes in treating each patient like her family and is committed to providing patients with the highest quality care as well as stellar experience.
  • At your one-on-one consultation, Dr. Joseph will take her time to carefully listen to your expectations and goals, perform a comprehensive evaluation, and works together with you to design a plan that is fully tailored to your anatomy and aesthetic goals.
  • Learn more about why patients choose us.

Dr. Joseph serves patients located in Troy, Birmingham, Bloomfield Hills, West Bloomfield, Rochester, Rochester Hills, and surrounding areas of Southeastern Michigan. If you are interested in a personal consultation with Dr. Joseph, contact us to schedule an appointment. We look forward to helping you look and feel your best.

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