DANIEL EZRA

SPECIALIST OPHTHALMIC AND OCULOPLASTIC CONSULTANT

Professor Daniel Ezra is an internationally recognised authority on oculoplastic surgery and is a consultant at the Adnexal Department at Moorfields Eye Hospital. At Moorfields he has held senior roles including those of training director, research lead and head of department for Oculoplastics. He is also the Medical Director of Neo Healthcare, a large interdisciplinary head and neck clinic in the Harley Street area of Central London. Daniel specialises in all aspects of cosmetic and reconstructive eyelid surgery and has a particular interest in primary and revision blepharoplasty surgery and the management of filler related complications. His NHS Practice is focused reconstruction of complex craniofacial deformity as well as facial movement disorders and lacrimal disease.

Daniel graduated from Cambridge and London Universities with degrees in Medicine and the History and Philosophy of Science, winning several prizes and awards. After initial experience in Neurology and Neurosurgery, he undertook higher surgical training at Moorfields Eye Hospital. Daniel’s subspecialist expertise in functional and aesthetic surgery was developed over several years through advanced subspecialty training at Moorfields Eye Hospital and as an Interface Fellow in Cosmetic and Reconstructive Surgery in Nottingham.

Daniel’s research into eyelid laxity led to a doctorate (M.D. degree) which was awarded the Sir Lionel Whitby Medal and Prize by the University of Cambridge for a thesis of ‘exceptional merit’. This research was also awarded the Syme Medal by the Royal College of Surgeons of Edinburgh. His subsequent research as an NIHR Clinical Lecturer was awarded further prizes including the ESOPRS award, BOPSS award, British Thyroid Association prizes. His has also been shortlisted for national awards on numerous occasions for best surgical result and has been Highly Commended.

PLASTIC SURGEON OR OCULOPLASTIC SURGEON?

This is the first question you need to approach. Eyelid surgery is a highly specialised area. It is anomalous that general plastic surgeons still carry out aesthetic eyelid surgery, given that all functional surgery of the eyelids is undertaken by oculoplastic surgeons in every hospital throughout the UK as there is a recognition that eyelid surgery is best undertaken by surgeons trained in eye surgery. Although many plastic surgeons are competent at executing aesthetic eyelid surgery, they have no training in ophthalmology and are unable to examine the eye, understand eye disease, anticipate eye problems that may affect the surgical plan, or identify complications.

Plastic surgeons have no training is the use of the basic equipment required to examine the eye. In contrast, Oculoplastic surgeons have training throughout several years in microsurgical ophthalmology followed by highly specialised training in the oculoplastics only. This means that the status of the eye itself is paramount in the eyelid surgery planning. The table opposite summarises some of these differences.

	Oculoplastic Surgeon	Plastic Surgeon
Well trained in executing eyelid surgery	✔	✔
Also performs facelift, Breast augmentation/reduction, tummy tucks	X	✔
Trained to deal with functional eyelid disease such as eyelid cancer, ptosis, entropion and lid malpositions	✔	X
Performs eyelid (and related) surgery only	✔	X
Trained to examine the eye	✔	X
Can identify pre-existing eye disease	✔	X
Can examine the eye postoperatively to ensure that there are no eye related complications	✔	X
Can manage any eye related postoperative complications if they arise	✔	X

PHILOSOPHY

The eyes are a central aesthetic feature of the face mediating much of our interpersonal interaction and communication. Ageing changes around the eyes are very common yet are amenable to many different approaches for both surgical and non-surgical rejuvenation.

All treatments offered by Prof Ezra are bespoke and are planned carefully with you, choosing from a range of options to deliver the aesthetic solution that is required. Everyone is different and any treatment, especially surgical, will be customised to your needs to work towards a desirable and natural looking result in harmony with your other features and avoiding an unnatural look.

Prof Ezra practices safe and responsible cosmetic surgery. This means that surgery will only be offered if it is right for you. The central priority for us is to achieve the best possible aesthetic result without risking your health and ensuring that the eyes are not compromised in any way by your surgery. Safety is particularly important around the eye, brow and midface areas, where the integrity of the eyes can be easily compromised as a result of poorly planned surgery.

Excessive and inappropriate surgery can lead to poor aesthetic results as well as significant eye problems. Prof Ezra’s work also concerns the correction of surgery performed by those who are not specialised in eyelid and brow surgery. Redo or revision blepharoplasty continues to become more and more common.

Prof Ezra will also give you an honest opinion about the potential benefits of surgery, to ensure that this is right for you. This means that it is not uncommon for some patients to be advised that surgery is not the right choice for them.

We also recognise the sensitive nature of many of our treatments and the need for complete confidentiality and discretion. For patients who require additional privacy, more discreet clinic visits can be arranged in advance.

3D FACIAL IMAGERY

It is often very difficult for patients to articulate the aesthetic issues which cause them most concern. This difficulty is also exacerbated by the difficulty in getting an objective view of the underlying anatomical changes that make the face appear to age and look tired. These anatomical features are often centred around the eyes, cheeks, midface, temples and brows, giving rise to a combination of hollowness, bulges and descent of tissue.

Prof Ezra often uses 3D facial analysis to describe in detail to patients how the underlying morphological features of the face come together to manifest the features which patient would like to have improved. This detailed analysis allows for a more informed discussion of the range of different treatment options that will be available to the patient. In addition, it is also possible to simulate to the patient how the results of aesthetic surgery might look. The 3D system uses the very latest cutting-edge technology imaging to form a high-resolution 3d Model of the face.

RESEARCH

Research is a central activity of Prof Ezra’s work. He has published numerous scholarly articles and lectures widely on his specialist areas. As the research lead for oculoplastics department at Moorfields, Prof Ezra leads and collaborates with teams of researchers investigating many aspects of eyelid and orbital disease. These include:

Investigating the underlying causes of thyroid eye disease on a cellular level. Research Funded by Fight for Sight has helped identify the mechanisms which cause fat enlargement and soft tissue swelling around the eyes. We are also developing new ways of testing novel treatments and drugs using laboratory models in order to accelerate the development of new drugs for use in patients.
Mechanisms of scarring in eyelid skin. The eyelid skin is a unique and highly specialised tissue. We are looking at understanding what drives the scarring process in these tissues and testing new treatments to prevent scarring using laboratory models.

In collaboration with City University, we are investigating the role of corrective surgery in improving the quality of life of patients with disfiguring eye diseases, particularly thyroid eye disease. The aims of these studies is to see if we can improve care for patients by offering targeted psychological support.
Identifying the drivers for blepharospasm. The cause of abnormal eye movement of the muscles around the eyes (blepharospasm) is complex. We are looking at ways that we can modify sensory input to improve outcomes for this condition.
Molecular pathology of eyelid cancer. Whilst many eyelid cancers behave in a more benign manner, several tumours are highly aggressive. we are investigating the genetic control of these tumours to better understand what makes some tumours behave more aggressively.

We are always looking for patients who are eager to be involved, not only in participating in research, but also in designing and running some of our studies. If you are interested in getting involved, please contact us by email.

For a full list of up-to-date publications, please see click here

TEACHING AND TRAINING

Daniel Ezra is committed to teaching and training. He has published research on several areas of medical education and is the Training Director for Adnexal Surgery at Moorfields, making him responsible for the training programme of the Oculoplastics Fellows. This programme not only trains the majority of UK based oculoplastic surgeons, but also many who travel from all over the world to train at Moorfields for extended periods of up to two years.

He is also regularly invited to lecture at conferences and makes special efforts to accommodate invitations to international organisations. He has been invited to teach and engage in training with local ophthalmologists around the world, from Africa, and the far-East to South America. Daniel Ezra is particularly dedicated to developing training in the developing world. In the past, western doctors would travel to developing countries to operate. However, the impact of this was limited. The emphasis is now on building and improving the training of local ophthalmologists which has a more powerful impact on local practice.