UPPER EYELID PTOSIS REPAIR

1. What is upper eyelid ptosis repair, and how does it differ from blepharoplasty?

Upper eyelid ptosis repair is one of the most common procedures Dr. Abboud performs. It is a surgical procedure designed to correct drooping of the upper eyelid due to weakness or dysfunction of the muscles responsible for eyelid elevation. Unlike upper eyelid blepharoplasty, which focuses on removing excess skin and fat to create a more youthful appearance, ptosis repair directly addresses the underlying muscular issue to restore proper eyelid positioning and function. These are distinctly different procedures, though they can be performed at the same time or separately, depending on the patient’s needs.

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Ptosis can be congenital (present at birth) or acquired due to aging, trauma, neurological conditions, or previous eye surgery. Functional ptosis repair is typically performed when the drooping eyelid obstructs vision, while cosmetic ptosis repair is sought by individuals who feel their eyelid position contributes to a tired or aged look.

 

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2. What are the different types and causes of ptosis?

Ptosis can be categorized into several types based on its underlying cause:

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• Congenital ptosis: Present at birth due to improper development of the levator muscle, often requiring early surgical intervention to prevent visual development issues such as amblyopia (lazy eye).  LEARN MORE

• Aponeurotic ptosis: The most common acquired form, typically seen in aging individuals due to stretching or detachment of the levator muscle tendon.

• Neurogenic ptosis: Caused by nerve dysfunction, such as in Horner’s syndrome or third nerve palsy.

• Myogenic ptosis: Resulting from muscle disorders like myasthenia gravis or chronic progressive external ophthalmoplegia.

• Traumatic ptosis: Due to injury affecting the eyelid muscles or nerves.

• Mechanical ptosis: Caused by excessive eyelid weight from tumors, swelling, or scarring.

 

 

3. What techniques are used to correct upper eyelid ptosis?

The surgical approach to ptosis repair depends on the severity of the droop and the strength of the levator muscle:

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• Internal (Müller’s muscle resection): Best suited for mild ptosis. This "scarless" technique is performed through an incision on the underside of the eyelid and involves tightening Müller’s muscle to lift the eyelid.

• External (levator advancement or resection): Ideal for moderate to severe ptosis. This involves tightening or reattaching the levator muscle through a skin incision along the eyelid crease.

• Frontalis sling: Used for severe ptosis, particularly in congenital cases. This technique connects the eyelid to the forehead muscle (frontalis) using a small strip of fascia or synthetic material, allowing the forehead muscles to assist in eyelid elevation.

 

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4. What qualifies as functional ptosis surgery?

Functional upper eyelid ptosis repair is indicated when the drooping eyelid significantly impairs vision. The criteria for functional surgery include:

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• A significant upper eyelid droop, where the eyelid margin encroaches on the center of the pupil.

• Visual field testing demonstrating considerable superior visual obstruction.

• Symptoms such as difficulty reading, driving, or performing daily activities due to eyelid drooping.

• Compensatory forehead muscle strain from lifting the eyelids, leading to headaches or fatigue.
   

If these criteria are met, insurance may cover the procedure as medically necessary.

 

 

5. What type of anesthesia is used for ptosis surgery?

Ptosis repair is typically performed under local anesthesia with sedation or, in some cases, under general anesthesia. Local anesthesia may be necessary to allow the surgeon to make real-time adjustments while the patient opens and closes their eyes, ensuring optimal eyelid positioning.

 

 

6. What results should I expect from ptosis repair, and when will I see them?

The goal of ptosis repair is to restore a natural, symmetric eyelid position that enhances both function and appearance. While results vary, most patients experience improved vision and a more alert, refreshed look.

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Swelling and bruising may initially obscure the final outcome, but most of the healing occurs within 2 to 4 weeks. Subtle refinements continue for several months. Some patients may require minor adjustments or additional procedures to optimize symmetry.

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7. What are the risks associated with ptosis repair?

As with any surgery, ptosis repair carries some risks, including:

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• Temporary swelling and bruising.

• Mild asymmetry in eyelid height or contour.

• Under-correction (residual ptosis) or over-correction (difficulty closing the eye).

• Dry eyes or irritation.

• Uncommon but serious complications such as infection or vision changes.

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During your consultation, Dr. Abboud will thoroughly go over the risks of the surgery, particularly those pertaining to your procedure. These risks are minimized by choosing a skilled oculoplastic surgeon with extensive experience in ptosis repair.

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8. What is the recovery process like?

Most patients experience mild discomfort, swelling, and bruising for the first few days. Cold compresses and head elevation help reduce swelling. Light activities can resume within a few days, while strenuous activities should be avoided for 1 to 2 weeks. Full recovery and final results become more apparent over several weeks.

 

 

9. Will I have visible scars after ptosis surgery?

Scars from ptosis repair are minimal and typically hidden within the natural eyelid crease or under the eyelid, making them barely noticeable once healed.

 

 

10. Are the results of ptosis repair permanent?

While ptosis repair provides long-lasting results, factors such as aging, further muscle weakening, or underlying medical conditions may lead to recurrence. In some cases, a touch-up procedure may be needed to maintain optimal eyelid positioning.

 

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11. Am I a candidate for upper eyelid ptosis repair?

Candidates for ptosis repair include individuals experiencing drooping eyelids that affect vision, cause fatigue, or contribute to an undesired aesthetic appearance. Ideal candidates are in good overall health, non-smokers, and have realistic expectations about the results.

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If you are considering ptosis repair, a consultation with a board-certified oculoplastic surgeon will help determine the best treatment approach for your specific needs.​​