Dra. Fabiola Murta 

Oculoplastic Surgeon - Ophthalmologist

Oculoplastic Surgery

HPA Magazine 21 // 2024

Oculoplastic, this rather peculiar word refers to the subspecialty in Ophthalmology performed by an eye surgeon expert on the upper two-thirds of the face, correcting functional disorders as well as improving the aesthetical appearance and asymmetry which may affect this area. This highly specialized subspecialty offers surgical treatment for eyelids & eyebrows’ conditions; watering eyes; eye socket reconstruction (including prosthesis implant); eyelid & periocular tumors; orbital diseases and conditions affecting the entire area around the eyes - from the cheek to the forehead. 

Although the Oculoplastic subspecialty has its own representative professional bodies all over the world, there aren’t many expert professionals trained in this area, hence few patients have access to those professionals. Dr Murta is one of the few specialists on this field and is now practicing at HPA in the Algarve. 
On the functional spectrum of the subspecialty, Dr Murta addresses conditions such as eyelid asymmetry and malpositions. 
The drooping eyelid (Fig. 1, 2, 3 & 4), named ptosis, can happen with ageing, on long-term contact lenses wearers, on congenital disorders in children or in some other rare clinical conditions. 
Ptosis can be corrected by an oculoplastic surgeon choosing the best technique according to the case achieving excellent results, functionally and cosmetically. The specialist also treats other eyelid malpositions such as inwards and outwards turning of the lower eyelids, medically nominated as entropion and ectropion, respectively. 
Those conditions can happen with ageing and are very troublesome due to exposure of the eye ball which can lead to permanently vision impairment if not surgically addressed (Fig5).
Amongst other eyelid conditions Dr Murta also treats lumps, pumps and tumors on the eyelids and periocular area via surgical excision of the tumor combined with reconstruction of the eyelids (Fig. 6, 7 & 8), some of those cases can be very complex surgeries  that involves flaps and/or grafts from local tissue. 
She treats eyelid injuries in the acute or later phase restoring its anatomy(Fig. 9 & 10).She uses surgical and non-surgical techniques to minimise the eye complications and facial asymmetry in facial palsies (Fig. 11); she addresses watering eyes due to tear drainage impairment in adults and children(Fig. 12) via endonasally or external; 
She treats involuntary eyelid twitches (blepharospasm and hemifacial spams); she treats clinically and surgically styes, blepharitis and dry eyes; and treats diseases of the orbits such as Graves’ diseases also known as Thyroid Eye Disease, as well as orbital & lacrimal gland lesions: benign and malignant (Fig. 13 & 14).
On the spectrum of periocular aesthetic surgeries Dr Murta not only addresses the hooding and excessive skin of the upper eyelid (Fig. 15) and the lower eyelid sagging & eyelid bags (Fig. 16), but also offers eyebrow and cheek lifts. 
Procedures that are not only limited to improve the tired, sad and withdrawn facial appearance but also benefit on reducing symptoms such as vision tiredness, headache due to constant attempt of keeping the eyes open, eye irritation and reduction of visual field. Restriction on visual field is particular debilitant as it reduces patient’s independence on performing their routine cores and confidence on driving. 
Overall, those surgeries enhance patient’s quality of life, which mustn’t be underestimated.Hooded skin of the upper eyelid and lower eyelids sagging inevitably occur with time at variable degrees, but can be addressed by a surgery called blepharoplasty when needed/desired by patients, having excellent cosmetic and functional results. As an oculoplastic surgeon primary trained as an eye surgeon Dr Murta focus on offer those benefits while protecting the eye and preserving its function, which sometimes is overviewed by other specialists.
Moreover, having had practiced in Sao Paulo and in London she has a wide experience in blepharoplasty in Oriental or Asiatic eyelids also called “western eye blepharoplasty” or “double eyelid surgery”, so diffused and requested by the oriental female population. 
Dr Murta also has extensive experience on correcting asymmetries of the upper face via endoscopic eyebrow lift (Fig. 17), as well as less invasive techniques such as direct brow lift surgery and botulinum toxin injections when appropriated, aiming to improve appearance, visual field and overall self-esteem.  
Her enthusiasm and passion for her profession lead her to take a further degree in aesthetic medicine, by the Italian school of the pioneer Professor Bartoletti. 
This had gave her substantive experience in laser treatment on the periocular and facial area, allowing her to associate procedures to enhance the surgical results while reducing the surgical down time to one surgical event instead of two, as on the “blepharoplasty plus” procedure. 
The blefaroplasties performed by Dr Murta are tailored by gender, ethnicity, individual anatomic features and patient’s desire, always within a realistic and feasible results. 
Hence for each patient a personalised treatment plan is made, aiming to achieve patients’ expectations, maintaining a natural gaze and always protecting the eye to achieve an optimal and safe results. Indeed, Dr Murta’s moto is “helping patients to feel better with the way they see themselves while still recognising their image, but protecting the eye and its function in first place”. 
Beyond her clinical experience, her approaches and practices are based on scientific evidences that the way patient’s see themselves have an enormous psychological impact on their quality of life and the fact that the eyes play a particularly role on communication. Indeed the eyes is one of the canons of beauty and in perceived attractiveness. In fact, ever since the Ancient Egyptians, the literature has been full of references to the eyes as a vital vessel for expression. 
Even nowadays, the “Nefertiti’s eyes” or also called “almond-shaped eyes” is a symbol of beauty, youth and female attractiveness. Meanwhile, when it comes to males the eyebrow shape and its position play a more important role, although the upper eyelid blepharoplasty on males has its own place on making a more nature and less tired gaze (Fig. 18). 
All those caveats added to the gender, ethnicity and personal/familiar features need to be taken into account when planning a treatment to the upper portion of the face in order to keep a natural appearance. 
This goes beyond the need of a vast surgical dexterity & experience by the surgeon, requiring a sharp perception of symmetry and sense of facial harmonization, in other words it requires “the state-of-the-art of medicine”.  
Oculoplastic is a complex specialty since it involves essential and delicate anatomic structures of the eyelids and upper face limited not only to protect the eye ball but also on the facial expression, as such it requires a highly skilled and multidisciplinary knowledgeable surgeon to offer top level treatment. 
Dr Fabiola Murta’s passion for the specialty lead her to dedicate a long period of training in Oculoplastic in Brazil and in the UK.
She has extensive experience as a consultant oculoplastic surgeon in both countries, including at Moorfields Eye Hospital in London. 
Dr Murta has also substantial experience in research in the UK and Brazil, with a particular interest on eyelid tumour, Graves' disease during its active phase as well as on rehabilitation surgery to correct the changes of the appearance that the Graves diseases can bring, and on blepharospasm. 
In fact, she took on a leading role in some research projects including the UK’s first blepharospasm patients and researchers meeting.
She is active in publishing articles in high impact scientific medical journals, revisor of medical journals and is frequently invited to address national and international conferences around the world. 
She is a member of UK, USA and Brazilian Oculoplastic societies, as well as the Sociedade Portuguesa de Medicina Estética. 
She joined the HPA, bringing her experts skills to the team of eye surgeons based at Gambelas Hospital.