Ptosis Repair

There is a lot of confusion between eyelid lift (upper blepharoplasty) and ptosis repair. Because both procedures deal with the delicate tissue of the upper eyelids. Ptosis is a condition where the upper eyelid droops due to weakened eyelid muscles, while excess eyelid skin (dermatochalasis) involves loose and redundant skin of the upper lids or folds. These two are distinct conditions. Ptosis may involve only one eye or both and most often creates asymmetry between eyes. Loose skin often involves both sides.

Ptosis repair corrects the drooping of the eyelid by tightening or shortening the eyelid muscles, whereas a traditional eyelid lift (blepharoplasty) removes excess skin and sometimes fat for a more youthful appearance without addressing muscle weakness.

Drooping of the upper eyelid is often caused by aging, congenital, familial, extended use of contact lenses, certain neuro-muscular conditions or trauma that weakens the eyelid-opening muscles; ptosis is diagnosed when the eyelid margin falls below its normal level and may obstruct vision. Your surgeon will make the determination as to what the cause and appropriate treatment is.

Ptosis can affect just one eye (unilateral), both eyes (bilateral), or one eye more than the other (asymmetric bilateral).

Good candidates for ptosis repair may experience asymmetric appearing eyes especially in photos, forehead muscle fatigue from unconsciously lifting eyebrow to keep eyes open or headaches, and heaviness in the upper lids.

A lid that appears “normal” may actually have mild hidden ptosis masked by compensation. Once the worse side is corrected, the other side can look droopier. For that reason, bilateral surgery is sometimes recommended when subtle ptosis exists in both lids.

Ptosis repair can be performed by either an internal or external approach. With the external approach, an incision is made along the natural eyelid crease of the upper eyelid. Through careful dissection, the surgeon identifies the muscle that elevates the eyelid, known as the levator muscle, and advances or tightens it before securing it back into position. With the internal approach, an incision is made on the inside surface of the eyelid ( no skin incision) to tighten a different muscle called Müller’s muscle. In both approaches the risk of a visible scar is minimal.

If there is both significant sagging skin and drooping of the eyelid, It is strongly recommended that ptosis repair be combined with blepharoplasty in one procedure to optimize cosmetic results.

Ptosis surgery is designed to improve the position of the upper eyelid and create a more open, symmetric appearance; however, it is important for patients to understand that ptosis surgery is not 100% predictable. The muscles that control eyelid opening function through a complex neurological feedback system known as Hering’s law, in which both eyelids often work together as a coordinated pair. Because of this dynamic relationship, the final eyelid height and contour may vary during the healing phase and can be influenced by swelling, and individual muscle response. In the hands of an experienced oculoplastic surgeon, patients should expect a favorable outcome, but minor asymmetry or contour irregularities can occasionally occur. If needed, revision adjustments may be performed to further optimize the final result. In some cases, during surgery the patient may be asked to open eyes so the surgeon can make fine adjustments to the suture placement that controls the height and contour of the upper eyelid.

Ptosis repair surgery is typically performed as an office-based procedure under local anesthesia. In most cases, there is no need for IV sedation or general anesthesia.

Ptosis repair surgery typically takes 30 minutes, depending on the severity and the surgical technique used.

After surgery, most people can return to work in 5-7 days, but should avoid strenuous activities for 10-14 days and wait 2-3 weeks before using contact lenses.

Most patients can enjoy permanent results from ptosis repair, although future muscle weakening is possible and may cause drooping to recur in rare cases.

Improvements in vision and appearance are usually noticeable within a week after surgery as swelling and bruising subside.

Long-term maintenance is generally minimal, but future evaluation may be needed if there is any recurrence of drooping or concerns about muscle weakening.