Adult Services

Dr. Gross understands you want to feel and look your best. He specializes in the diagnosis in treatment of complex disorders affecting eye movements, the eyelids, eye socket (orbit) and optic nerves and can apply the knowledge gained from studying these disorders to the treatment of many aging problems that also affect your appearance. He employs the very latest techniques that can be utilized to enhance your appearance and help restore a more youthful appearance to your upper and middle facial areas and your eyes.

Dr. Gross employs new technologies that allow you to gracefully defy the effects of aging so you can look as young as you feel. Discretion and professionalism are top priorities of Dr. Gross and his staff.

Medical Services & Evaluation

Surgical Services

Aging eyelid, brow and midface (back to top)

With the aging process, gravity can cause the fatty tissue that normally drapes over the cheekbones to sag, which affects the appearance of your eyes and midface. The result is less prominent cheekbones or a droopy fold of skin and fat between the nose and the cheek. A variety of brow lift, cheek lift or midface lift procedures may be performed alone or in combination with other procedures. These minimally invasive procedures reposition the skin and restores the youthful fullness your face. Dr. Gross will work with you to choose the best procedure for your situation.

Eyelid malposition (back to top)

The lower eyelid, though not showing the complex movements that the upper eyelid shows, nevertheless moves relative to the position of the eye itself and provides protection to the eyeball and cornea. In addition, it is involved with the proper flow of tears. Patients with lower eyelid malposition can experience ocular irritation, blurred vision, corneal scarring, tearing problems or an asymmetric appearance of the eyes.

Double vision (back to top)

If the two eyes are misaligned and aim at different targets, two non-matching images will be sent to the viewer's brain. When the brain accepts and uses two non-matching images at the same time, double vision results. Double vision is usually caused when the eyes are misaligned due to functional problems in the visual system. It may also be caused by a structural defect in the eye's optical system (for example, cataracts might cause such a defect). Double vision can be a symptom of many different visual conditions that affect children and adults, such as strabismus (eye turns: exotropia, esotropia, hypertropia), convergence insufficiencyor visual conditions related to head injuries.

Eyelid cancer (back to top)

Eyelid cancer is fairly common as individuals age. To a significant degree it is related to sunlight exposure and skin type. There are several different types of skin cancer of the eyelids. The most common type is Basal Cell Carcinoma (BCC). This type does not spread to other parts of the body but nevertheless grows uncontrolled and spreads locally. It can cause ocular irritation, unsightly lesions, disfigurement and if left unchecked, it can grow down beneath the surface of the skin and even grow into the boney socket (orbit) of the eye and, rarely, enter the brain at the back of the orbit. No chemotherapy is currently effective against BCC, and radiation therapy is only palliative, not curative. Therefore, the only known cure is full surgical excision.

Another common skin cancer is Squamous Cell Carcinoma. This type has the potential to invade and spread to other parts of the body. Treatment can be much more complex, but usually involves local complete (if possible) surgical excision.
(Click here for Eyelid Cancer Surgery)

Thyroid eye disease (Graves Disease) (back to top)

Effects of Graves Disease may include eyelid retraction, eyelid lag on downward gaze, corneal dryness, eye bulging, optic nerve inflammation and Strabismus. Many of these conditions are treatable.

Sudden vision loss (back to top)

Sudden loss of vision in one or both eyes is a frightening occurrence. If it occurs you should see Dr. Gross as soon as possible. Sudden loss of vision can be total (which is quite rare), partial, transient or permanent, involving either one or both eyes. If sudden vision loss occurs, rapid visual examination is imperative.

Headaches (back to top)

Eyestrain or diseases of the eye can often lead to headaches. Some eye diseases cause pain around the eye, forehead or temple region, often mimicking the symptoms of migraines. Should you have frequent or severe headaches, you should have your eyes evaluated by Dr. Gross to check for a medical condition or general vision impairment.

Nystagmus (back to top)

Nystagmus is an uncontrolled movement of the eyes, usually from side to side, but sometimes the eyes swing up and down or even in a circular movement. Nystagmus that develops later in may be the result of a stroke, multiple sclerosis or a blow to the head.

Surgery can be performed to alter the position of the muscles, which move the eye. These condions are complex. Speak to Dr. Gross about specific management.

Vision problems related to MS, brain tumors, stroke (back to top)

Vision, being controlled and facilitated by the brain may be affected by many brain related disorders. Dr. Gross is fully trained and board certified in both Neurology and Ophthalmology. His training and expertise in both fields provides him with an uncommonly found perspective from which to diagnose and treat many Neurological conditions that affect vision.

Surgical Services

Blepharoplasty (back to top)

As we age the skin around our eyes stretches and wrinkles. No matter how well we’ve taken care of ourselves, fat can collects and cause the upper lids to sag and the tissue under our eyes to bulge forward. Sometimes, in extreme cases, vision can become partially blocked by the eyelid. Usually these conditions are caused by the effects of aging but may also include hereditary factors, exposure to the sun, use of alcohol, smoking and poor diet.

Blepharoplasty (see Ptosis for true eye lift procedure LINK TO PTOSIS) is sometimes referred to as an eye lift. However, it is not truly a lifting operation. It can be performed on upper and/or lower eyelids. Fat may be sculpted as well. If a lower lid Blepharoplasty is combined with a ‘Cheek Lift’, it is sometimes called a ‘mini face lift’ because it can help restore a more youthful, healthy and vigorous look to your eyes, as well as mid face which have a tremendous impact on the look of your entire face. Depending on the amount of excess skin a small incision will be made either inside, behind or just below the base of the eyelashes. A fine scar will become barely visible as the incision heals. You may experience some bruising and swelling after the procedure – this should subside in one to four weeks. Most patients require little, if any, pain medication.

Endoscopic brow lift (back to top)

The eye brows are sometimes called the ‘curtain rods’ of the eyelid. Disorders of eyebrow position can have an important effect on our eyelids themselves. An eyebrow that is drooping or too low can cause an increase in apparent skin in the eyelid or an increase in the eyelid fold. There can even be a lower position to the lid itself (ptosis). The browlift is the unsung hero of eyelid plastic surgery. Many patients who would benefit from a brow lift incorrectly believe that they need Blepharoplasty. Some patients would benefit from both procedures. In previous brow lifting techniques, a large incision was made across the upper hairline making over corrections frequent (with excess stare like expressions of the face) and recovery was prolonged. Direct Brow Lifts require a much smaller incision directly over the brow but can leave a scar. Newer techniques utilize the operative endoscope. This instrument and technique (Endo Brow) allows Dr. Gross to elevated the brow via three very small incisions behind the hairline. Most patients experience rapid recovery, and overcorrection with excessive stare is unusual.

Cheek lift (back to top)

This procedure requires elevation of the deep tissues of the mid face and is performed through a small incision at the lower eyelash line.

Dermal fillers (Restylane / Radiese) (back to top)

Loss of tIsue fullness with aging can lead to folds and grooves around the eye. Fillers can restore a natural, youthful look to your face. It can correct smile lines, folds and wrinkles. A natural gel is injected into the skin in a safe, minimally invasive procedure. The gel acts as a support below the skin’s surface and helps rebuild your skin’s foundation. Results can be seen immediately and last for a year or longer. (Results vary from individual to individual.) Dr. Gross uses only FDA-approved, safe, clinically tested fillers. Many patients are happy with the results of just one office visit, with follow-up touch-ups occurring periodically. Patients may have mild irritation, swelling, tenderness, itching or bruising at the injection site.

Botox (back to top)

Botox is a simple, nonsurgical, treatment administered by Dr. Gross that can temporarily smooth frown lines between the brows in people ages 18 to 65. It is the only treatment of its type approved by the FDA. It only takes about 10 minutes – a few small injections – and within days you should notice an improvement (results may vary from patient to patient).

Wrinkles may be caused when a muscle tightens. Botox™ is injected through the skin into the muscle and keeps the muscle from tightening. When the muscle can't tighten, the wrinkle doesn't show as much.

Botox™ works for about four months. As the muscle returns to normal, you will see the wrinkle again.

Eyelid cancer surgery and reconstruction (back to top)

Dr. Gross performs simple as well as complex eyelid repairs related to treatment for skin cancer.

Ptosis (back to top)

Ptosis occurs when the upper eyelid falls into a position that is lower than normal, or droops. The entire lid is too low, not just extra skin hanging down. If this condition occurs in one eye, it causes that eye to appear smaller than the other. Sometimes both eyelids can be affected. In severe cases, the drooping eyelid can cover part or all of the pupil and interfere with vision. This differs from a condition called Dermatochalasis in which excess skin is present without actual loss of lid height. However, both conditions can co-exist. Ptosis is corrected surgically. The levator muscle, the primary elevator muscle of the eyelid, is shortened through a lid-crease incision. The incision is hidden in the existing lid fold or in a new lid fold created to match that of the other eyelid. Most patient’s experience only minor discomfort and require little, if any, pain medication.

Ectropion and entropion (back to top)

In ectropion the lower lid suffers a loss of tone and flops away from the eye, turning outward. This exposes the inner lining of the lid causing irritation, burning, and risk of inflammation and infection. Aging patients are at an increase risk for ectropion. In entropion, the eyelid turns inward. When the eyelid turns inward, the lashes rub against the eye, causing irritation, scratchiness, tearing and redness. Aging and the subsequent weakening of the eyelid muscle is the usual cause of entropion. Surgery to tighten and shorten the lower eyelid is necessary to correct ectropion. A small incision is made to the eyelid, the internal structures of the eyelid at the outside corner of the lid are reattached to the deep internal aspect of the lid and eye socket. Then a few stitches are placed in the skin at the lateral corner of the eye. The stitches are generally removed 7 to 14 days later. Most patients have little or no discomfort with the procedure. There may be mild bruising and swelling following the procedure, which should fade in about two weeks. 

Lacrimal surgery (tearing) (back to top)

Tears are made from the lacrimal gland located under the upper outer part of the eylid and orbit. They drain down across the surface of the eye and are collected by the lower lid into a very small opening at the inner area of the lid near the nose. From there, the tears drain into a duct that penetrates though a canal in the bone of the nose where drainage occurs in the lower part of the nasal cavity. That is why we find ourselves reaching for a tissue when we cry…the extra tears drain into our nose and irritate it. Blockage of this normal flow can cause epiphora, the excess overflow of tears onto the face. Sometimes, this blockage can lead to infections in the sac beneath the skin at the nose that collects the tears causing redness, pain and discharge. In many cases, correction can be achieved with a simple ‘probing’ procedure. Sometimes more complex surgery is required.

Basic and complex strabismus (eye muscle) surgery (back to top)

Strabismus, more commonly known as cross-eyed, is a condition in which a person can not align both eyes simultaneously. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time, such as, under stressful conditions or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment. Treatment will depend on the condition and individual. Eyeglasses may be prescribed to eliminate the eye turn and/or eliminate any optical difference between the eyes.

Adjustable Suture Eye Muscle Surgery (back to top)

In some patients, the position of the eyes can be adjusted 1 to 2 days after surgery by the use of the an adjustable suture technique.