Ptosis

What is Ptosis?

Description

Ptosis is a condition where the upper eyelid margin itself droops and can potentially block the pupil affecting your vision. It can give off a tired appearance affecting one or both eyes. Patients may notice it worsens when tired. Ptosis is a different condition from drooping upper eyelid skin where the skin fold itself is in excess and therefore, the treatments are different.

There are different causes of ptosis. The most common or important causes of ptosis are:

Age-related: most commonly, ptosis is caused by stretching or dehiscence of the levator aponeurosis muscle (the muscle responsible for lifting the eyelid). Long-term use of contact lenses can also contribute to the development of ptosis.
Congenital: one can be born with droopy eyelid where the levator muscle poorly developed and is weakened.
On very rare occasions, there may be a serious underlying cause of the ptosis such as 3^rd nerve palsy, Horner’s syndrome or Myasthenia Gravis. Therefore, if you have ptosis, you should be evaluated by an eye care provider to rule out these conditions.

Procedure

Ptosis surgery is an outpatient procedure that attempts to tighten/shorten the muscle that lifts the eyelid to strengthen it. The procedure can be performed in the office or in the operating room with light sedation. There are two primary methods of correcting ptosis.

External approach: an incision is made in the eyelid skin and the underlying levator aponeurosis muscle is identified and advanced with sutures.
Internal approach: an incision is made underneath the eyelid and the Müller’s muscle (another muscle that lifts the eyelid) is shortened. There are no visible scars with this technique.

Ptosis repair can be combined with a cosmetic upper eyelid blepharoplasty to provide the best functional and aesthetic results.

Recovery

There should be minimal to no pain after the procedure with itching and tightness being the most common symptom that resolves with time. Driving may be resumed after 3-5 days. Strenuous physical activity is resumed 10-14 days after surgery. Makeup may be used again 2 weeks after surgery though sooner if the surgery was performed from underneath the eyelid (internal approach) only. There will be mild to moderate bruising and swelling after the procedure that typically takes approximately 2 weeks to resolve, however this timeframe does depend on the patient’s health, age, medications, adherence to postoperative instructions, and if the procedure was performed externally or internally. In approximately 2 weeks, you should be presentable in public.

Why choose Dr. Patel?

Dr. Patel is a board-certified ophthalmologist that further subspecialized as an oculofacial plastic surgeon having completed a two-year ASOPRS fellowship. The combined training optimizes the cosmetic result of your ptosis repair while ensuring your eye health is not compromised. Dr. Patel has extensive experience in performing ptosis surgery with both the external and internal approaches having performed nearly a thousand such operations. In fact, Dr. Patel trained with the creator of the internal approach ptosis surgery, Dr. Allen Putterman in Chicago, Illinois.

Ptosis surgery is a much more complex procedure than an upper eyelid blepharoplasty where only excess skin is removed. By having your surgery performed by an eyelid specialist such as Dr. Patel, it will allow for the best possible natural results while minimizing risks as he will develop a customized surgical plan for your condition.

FAQs

All attempts are made to minimize the amount of bruising a patient has by utilizing meticulous surgical technique. However, all patients will have some degree of bruising and swelling that depends on the patient’s age, health status, medications, and adherence to post-operative instructions. In general, it takes about 2-3 weeks for most bruising to resolve with the external approach and about 1-2 weeks with the internal approach.

All surgeries carry risks such as infection, bleeding, scarring, and pain. Ptosis surgery inherently carries more risks than an upper blepharoplasty as it is a more difficult procedure. Risks specific to ptosis surgery include overcorrection or undercorrection as well as dry eyes. However, by trusting your eyes to an eyelid specialist such as Dr. Patel, all attempts are made to minimize these risks.

There should be minimal scar after ptosis repair. If an external approach is utilized, a small thin scar in the eyelid crease will be present that is essentially invisible to anyone else. Initially, the incision may look slightly pink, however, this resolves over time as the scar matures over the course of 6-12 months. Scar creams may be recommended by Dr. Patel to optimize the final appearance.

If an internal approach is utilized, there will be no scar as all the work is done from underneath the eyelid.

Dr. Patel’s preferred method of addressing ptosis is with an internal approach. This is a quicker procedure and tends to have a more predictable result. However, not all patients are candidates for this approach. In your consultation with Dr. Patel, he can perform specific tests to help determine which approach is best for you.

If ptosis repair is performed in the operating room with sedation anesthesia, there is typically no pain during or after the procedure. If the ptosis repair is performed in the office with oral sedation, there will be mild discomfort during the injection of the local anesthetic lasting about 30 seconds per eyelid. After this step, there should be no pain and music of your preference is played creating a relaxing, comfortable environment.

If your upper eyelid margin droops down enough to block the pupil, ptosis repair is typically covered by insurance. However, insurance does not cover removal of any excess skin of the upper eyelid so if a patient wants both ptosis repair and an upper eyelid blepharoplasty, the upper eyelid blepharoplasty would be deemed cosmetic.

Dr. Patel is an awesome surgeon that goes over and beyond for his patients. I was originally supposed. to have a skin graft under my lower eyelid. He knew I wouldn’t be satisfied with the appearance and he explained everything to me so he tried something totally different during surgery. I’m definitely glad he was able to correct my lower lid. I just had surgery on my upper lid for a scar revision and everything looks nice. It’s hard coming across a doctor that’s willing to make you satisfied and correct the issue vs just correcting the issue. I can’t thank Patel enough for correcting my issues.

Shakeima S.

Dr. Patel gets my highest recommendation for reconstructive surgery on my lower eyelid, which had 60% of my lower eyelid, including a nickel sized piece of skin, removed underneath the eye, due to cancer. Now, my eyelid looks just like the other eyelid and he did it without a skin graft!. Most people comment, “You would never know you had reconstructive surgery.” Dr and I were very pleased with the results. Dr. Patel was very professional, is talented in his field, and thorough in explaining the procedure and follow-up instructions. He was understanding and sensitive to my concerns about my face. He also had humor, which helped when I was anxious.

Colleen H.

Dr. Patel and his staff were wonderful to work with. I had DCR surgery (Dacryocystorhinostomy) to create a new tear drain. Dr. Patel is friendly, kind, knowledgeable, and easy to understand. The staff assisted me greatly in scheduling surgery and with followup appointments. I am so happy with a perfect outcome of my new tear drain. No more tears constantly running down my face.

Diana M.

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