Ptosis Repair

Individuals with eyelid ptosis (pronounced “toe-sis”) may feel like they have a sleepy eyelid that never fully opens. One or both eyes may be in a state where the upper eyelid droops over the eye. Eyebrows can be affected as well. A phenomenon known as “Hering’s effect” occurs when the eyebrow on the same side as the droopy eyelid involuntarily raises higher than the other. This occurs as the body’s natural attempt to compensate for the drooping eyelid by lifting the brow to improve vision, which leads to an uneven appearance of the brows.

It is crucial to get a correct diagnosis before undergoing ptosis repair. The condition is often misdiagnosed or not identified, even by the most discerning surgeons. Sometimes, it is extremely subtle. Other times, individuals and surgeons alike may think that cosmetic blepharoplasty (eyelid lift) alone is required to address the “drooping” effects.

Eyelid ptosis does not occur because of drooping eyelid skin or eyebrows but rather, most commonly, due to issues with a muscle called the levator palpebrae superioris. The levator muscle normally operates like a pulley, drawing your eyelid open. When this muscle weakens or partially detaches, it leads to a partially closed eyelid, impacting vision and appearance.

Horner’s syndrome is a relatively rare cause of eyelid ptosis, compared to the natural aging process. It is characterized by a combination of symptoms such as drooping eyelid, constricted pupil, and reduced sweating on one side of the face, typically caused by disruption in the sympathetic nerve pathway. Neurology evaluation is necessary with suspected Horner’s syndrome before any type of surgical repair.

It is imperative to undergo a thorough examination to determine the root cause of eyelid issues. You may seek more than one evaluation, ideally with an oculoplastic surgeon who has specialized training in eye plastic surgery, including this highly delicate procedure. However, some facial plastic surgeons and plastic surgeons may also be adept at performing ptosis repair. For pediatric ptosis, a super-specialist needs to be consulted. Discuss all your symptoms and medical history with your physician as you develop a treatment plan.

Once a decision is made to proceed with ptosis repair, your surgeon has several options depending on your anatomy and function.

In the “open” approach, your surgeon makes an incision in the eyelid’s natural crease. Through this incision, they access the levator muscle and either shorten or reattach it to lift the eyelid to the desired position. This approach is utilized for more severe cases.

In “closed” ptosis repair, also known as the “internal” or “posterior” approach, the surgeon corrects the eyelid position without making an external incision. Instead, they operate from the inside of the eyelid, making adjustments to the Müller’s muscle that reverses the droopiness of the eyelid.

Blepharoplasty (eyelid lift) can also be performed at the same time if you have aesthetic aging concerns such as eyelid skin hooding. A brow lift procedure should only be considered cautiously, as the Hering’s effect discussed earlier may resolve on its own once the eyelid ptosis is repaired.

In children, eyelid ptosis repair surgery is crucial, especially if the ptosis obstructs the child’s vision; a successful surgery can prevent developmental issues such as amblyopia, commonly known as a lazy eye. In children who have a levator muscle that is very weak or non-functional, a frontalis sling operation may be performed. This procedure involves connecting the eyelid to the frontalis muscle (forehead muscle) with a sling material. When the child raises their eyebrows, the sling lifts the eyelid, compensating for the weak levator muscle.

Have a thorough consultation with an oculoplastic surgeon to help determine which procedure is best for you or your child. Be sure to discuss all attendant benefits and risks.

Before you go

During the consultation and preoperative visit for eyelid ptosis repair, your surgeon will evaluate the degree of eyelid drooping, assess overall eye health, and discuss medical history. Your surgeon will perform tests such as visual field assessment, eyelid measurements, and sometimes imaging studies to ensure the ptosis is not due to Horner’s syndrome or other underlying conditions. Your surgeon should explain the procedure, potential risks, benefits, and expected outcomes.

It is important to ask about the surgeon’s experience with ptosis repair, the type of anesthesia used, recovery time, and any potential complications. The discussion should entail your aesthetic goals if you are contemplating having simultaneous blepharoplasty. Viewing before-and-after photos of previous patients can help set realistic expectations. Your surgeon will also provide preoperative instructions, such as discontinuing certain medications and arranging for someone to drive you home after the surgery.

During the procedure

On the day of your eyelid ptosis repair, arrive well-rested and without any makeup or contact lenses. After checking in at the surgical facility and completing any necessary paperwork, you will meet with your surgeon and anesthesiologist to review the procedure and anesthesia plan, typically local anesthesia with sedation.

Before surgery, the area will be cleaned and numbed. The surgeon will adjust the eyelid muscles during the procedure to correct the drooping. After surgery, you may experience mild discomfort but no significant pain. There will be no bandages, and you should be able to see immediately, although some blurriness may occur due to protective ointment.

Ptosis Repair Aftercare 

Post-surgery, expect to rest for a few hours before heading home. It is advisable to arrange for someone to drive you and assist you during the initial recovery period.

At home, prepare a comfortable, easily accessible rest area. Keep essentials like ice packs and prescribed eye drops within reach. Pain is typically managed with over-the-counter acetaminophen. Avoid non-steroidal medications such as ibuprofen and naproxen. Rest with your head elevated to reduce swelling, and apply cold compresses as recommended. Remember, gentle care and following your surgeon’s guidelines are crucial for a smooth recovery and optimal results.

The initial recovery period is usually about one to two weeks. Most people can return to normal activities within this timeframe, though healing and final results may take several months.