Management of facial nerve palsy and a visit to the Facial Nerve Center at Massachusetts Eye and Ear Infirmary

Facial Nerve Center

I recently visited the Facial Nerve Center at Harvard’s Massachusetts Eye and Ear Infirmary to learn some state-of-the-art tips in the management of facial nerve palsy.  I had the pleasure of spending time with Dr. Tessa Hadlock and her fantastic team.  Some highlights for me included:

  • learning about the optimal medical management of Bell’s Palsy in the acute phase
  • reviewing the options for facial reanimation surgeries
  • adopting subtle clinical pearls using botulinum toxins to help balance the smile of patients with both paralysis and synkinetic facial movements
  • working with facial physical therapists who help patients learn physical therapy exercises to improve their facial movement

I definitely learned a lot from MEEI’s multi-disciplinary team and look forward to integrating some of their techniques when managing facial nerve palsy patients here in San Diego!


Meetings & Multi-specialty Collaboration to end 2013

The close of 2013 came fast and furiously with three fantastic meetings capping out the year in Los Angeles, New Orleans, and San Diego.

Multi-Specialty Plastic Surgery Symposium at Cedars-Sinai Hospital in Los Angeles (Nov 1-3), whose highlights for me included:

  • CT-based analysis of age-related bony changes in the facial skeleton and how to counteract these changes with soft tissue fillers
  • comparisons of different methods of face and neck lifting to address mid-face descent, jowls, and neck laxity
  • variations in injection technique and location to treat tear trough deformities with minimal bruising while addressing anatomical changes in deep medial fat pads of the mid-face

Annual American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS) Fall Meeting (Nov 14-15) & American Academy of Ophthalmology (AAO) Annual Meeting (Nov 16-19)

  • I delivered a podium presentation at the ASOPRS meeting on the use of fractional ablative lasers with laser-assisted delivery of 5-fluorouracil for burn-induced cicatricial ectropion, as well as the surprise honor of being invited as a co-instructor for the Jules Stein AAO Orbital Decompression Skills Transfer Course.
  • Session highlights included incisional vs. non-incisional techniques for Asian double-eyelid surgery (by Dr. Yoon Duck Kim) and state-of-the-art management of Facial Nerve Palsy (by Dr. Tessa Hadlock)
  • Meeting my oculoplastics “siblings” (also trained by Dr. Kikkawa) and my “cousins” (trained at the University of Wisconsin through Dortzbach, who trained Dr. Kikkawa) [below]



Comprehensive Aesthetic Restorative Effort (C.A.R.E.): Breakthrough Multidisciplinary Care for the Wounded Warrior and Traumatically Injured (Dec 5-8)

  • This meeting brought together an all-star cast from neurosurgery, plastic surgery, facial plastic surgery, dermatology, and many other aesthetic disciplines to speak on reconstructive efforts that apply to wounded warriors.
  • Highlights for me included presentations and personal dialogues with Dr. Rox Anderson on his latest work in skin micro-transplantation and epidermal blister skin transplantation, as well as Dr. Jill Waibel on her research on laser-assisted stem cell transplantation



Exciting News and Professional Development in 2014

With 2014 coming to a close, I figured I should share some exciting news and professional development highlights from the last few months.


  • In June, the UCSD medical students recognized my teaching efforts with the 2013-2014 Outstanding Teacher Award.
  • In November, I interviewed for an academic faculty position at University of Washington and gave a visiting lecturer Grand Rounds on The Promise of Stem Cells in Oculofacial Surgery.”   Seattle is an amazing city, and UW is notable for having a terrific and collegial department and division of oculoplastics!
  • In December, I officially became a Board Certified Ophthalmologist by the American Board of Ophthalmology after passing my written and oral board exams!

Teaching Award

MEETINGS–I had the opportunity to attend the following meetings and have already applied tips and learning from these meetings in the care of my patients with successful results.

Masters of Aesthetics, San Diego

  • Fantastic inaugural meeting featuring some of the stars of cosmetic dermatology and plastic surgery.  Great content on cosmetic injectables (toxins, fillers, liposuction/lipotransfer) and energy devices (lasers, radiofrequency, cryolipolysis)

American Society of Ophthalmic Plastic & Reconstructive Surgery and American Academy of Ophthalmology, Chicago

  • Presented on the use of Intralesional Bleomycin Injections for Orbital Lymphangiomas (ASOPRS)
  •  Posters on Managing Extensive Facial Cutaneous Malignancies in Xeroderma Pigmentosa, and Lateral Orbital Rim Decompression for Thyroid Eye Disease (ASOPRS)
  •  Displayed my first senior author poster on Poor Follow-up and Knowledge Retention Despite Glaucoma Counseling in South India (AAO)
  •  Co-taught the AAO skills transfer course on Oculoplastics Anatomy and Surgical Techniques
  •  Participated in the AAO skills transfer course on Face and Neck Lifting (which included performing a full face and neck lift on a cadaveric head)

Cedars-Sinai Multi-Specialty Aesthetic Meeting, Beverly Hills-Los Angeles

  • The best talks for me were by Dr. Val Lambrose on the aging face and periorbital fillers for tear troughs and hollow upper lids/brow fat pads

Comprehensive Advanced Restorative Effort Conference, Navy Hospital San Diego

  • Picked up some new pearls on laser scar resurfacing from Dr. Jill Waibel
  •  Learned about future game-changing technologies for skin and tissue copying from Dr. Rox Anderson

AOCMF Principles of Operative Treatment of Craniomaxillofacial Trauma and Reconstruction, San Diego

  • Fantastic meeting covering didactics and hands-on plating of orbital, ZMC, mid-face, maxillary, and mandibular fractures

Skull 2Skull 1


That is the question of the hour!  I’m looking forward to entering the 4th quarter of my oculoplastics fellowship and the end of my 15th year of higher education/training.  Stay tuned for my post-fellowship plans, which are actively in the works…


A new publication and sentimental goodbye to glaucoma research

My most recent publication has been in the works for a long time but is one that makes me sentimental for a few reasons:

1.  This was my last research project during medical school and will most likely be my last one on glaucoma for a while.   Thanks to my co-authors, particularly my mentors Dr. Kuldev Singh and Dr. Shan Lin who believed in this project from the start and have been such supportive advisers over the years.

2.  This case study on the San Francisco General Hospital glaucoma clinic brings together various interests of mine: ophthalmology, health economics, health systems performance, and racial disparities in health care.  It also builds on my previous work at the Aravind Eye Care System in Tamil Nadu, India and drew on my background in health care consulting.

3.  Finally, this paper will hopefully make clinicians rethink the “blame” that is typically placed on patients for non-compliance and spur clinicians look internally to examine how they can improve the health care delivery system and the patient experience.

How often do we stop to ask patients why they were not able to take their medications or come for follow-up as instructed?  Did we really take the time to explain WHY they should spend hours out of their day to attend follow-up for a chronic disease that is often asymptomatic in its early stages?  Did language barriers—in spite of having a medical interpreter—influence the content of information communicated to the patient and thereby affect patients’ understanding of the disease and willingness to be compliant with treatment and follow-up?

Below is a free pdf version of the paper, which is hot off the press from the current issue of Investigative Ophthalmology & Visual Sciences.  

Patient-related and System-related Barriers to Follow-up in a County Hospital Population (IOVS paper)


A new job as Clinical Instructor and ASOPRS Fellow in Oculoplastics

And so it begins . . . an exciting 2-year ride as a Clinical Instructor & ASOPRS Fellow in Oculofacial Plastic & Reconstructive Surgery.  It’s hard to believe that it’s been only 3 weeks, given everything I have seen, learned, and done already!  It’s also so interesting to see how techniques vary significantly between Bascom Palmer and UCSD.

A few brief highlights so far:

*using a diamond burr drill to remove bone/bone marrow in a lateral wall orbital decompression

*decompressing the medial wall and floor in another orbital decompression

*learning how to do elegant trans-conj lower lid blepharoplasties

*doing my first endoscopic dacryocystorhinostomy

*performing a medial orbitotomy and globe-sparing exenteration for sinonasal-orbital mucormycosis (invasive fungal disease)

*implanting an orbital expander device with a scalp port in a microphthalmic child

*staffing surgical cases and a suturing workshop for UCSD Ophtho residents

*And most importantly, all the team lunches and dinners over sushi, dim sum, pho, boba, and all-you-can-eat Korean BBQ.   Miami made me forget how much I love Asian food!

Yes, I am on call 24/7 for oculoplastics . . . but am loving it here in San Diego and feel so blessed to do my training here at UCSD!


Photo: from the Shiley Eye Center welcome reception at La Jolla Shores

Shiley Welcome Reception


Dr. Lee speaks on ablative fractional laser treatment for facial burns at the JMH Burn Center

Dr. Lee will be speaking on novel non-surgical approaches using ablative fractional laser treatment for burn-induced facial scars that distort the eyelid, eyebrow, and facial cosmetic units.  The patient below presented with cicatricial ectropion from burn scars and underwent several sessions using ablative fractional laser treatment, which cured his lagophthalmos and cicatricial ectropion.

Cicatricial Ectropion

Cicatricial Ectropion 2

Cicatricial Ectropion 3

*Note: all patient photos on this website are posted with explicit permission by the patient

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