See an expert for Ptosis (Droopy Eyelids)
As an Oculoplastic Surgeon and an Ophthalmologist who has the highest level of training for surgery of the eyelids, Dr. Sherman knows the eye and eyelid anatomy to the highest degree. This level of expertise allows her to use specialized techniques to produce a naturally proportioned result that improves the peripheral vision. Dr. Deborah Sherman has over 20 years of experience in ptosis surgery. Because she is an Ophthalmologist and Oculoplastic Surgeon, eyes are her first priority. At the Sherman Aesthetic Center, before and after surgery, we will carefully measure your eyelid position and examine your eyes under a special microscope called a slit lamp. This important pre-operative exam will help promote the health and comfort of your eyes during the recovery period. Ptosis surgery is Dr. Sherman’s forte, and she knows the details required to achieve the best result.
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What is ptosis?
Ptosis is the medical term for drooping of the upper eyelid. If the lid edge displaces downwards, it can cover part of the pupil and block the upper field of the vision. Symptoms of ptosis include decreased ability to keep your eyes open, eye strain and eyebrow fatigue from the increased effort needed to raise your eyelids, and vision impairment. In severe ptosis patients have to tilt their head back, or lift the eyelid with a finger, in order to see out well. If the eyelid ptosis is significant, it can cause a visual deficit, a functional problem that is usually covered by insurance to correct the problem with surgery. Mild ptosis can be a cosmetic problem and is not covered by insurance.
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Note the improvement of the droopy right upper eyelid after ptosis surgery. This gives the patient symmetric and natural eyes.
What is the cause of ptosis?
Congenital ptosis (present since birth) is due to a poorly developed muscle, and can occur in people of all ages.
Acquired ptosis is more common in older adults, where the muscle that lifts the eyelid thins and the eyelid drops. It occurs with age, frequent eyelid rubbing, contact lens wear, or trauma. Rarely, a tumor or a neurological problem, such as a nerve palsy or muscle weakness (myopathy), can cause ptosis.
How do I know if I am a candidate for ptosis surgery?
At the Sherman Aesthetic Center, we will examine the upper and middle part of the face to detect asymmetry. Eyelid measurements are made and photographs are taken of the eyelid position. The under surface of the lids and the front surface of the eye are carefully examined with a special microscope and visual fields may be mapped. Based on the findings, you will be advised of the best treatment.
Sometimes, a patient suffers from a combination of baggy eyelids (dermatochalasis), drooping eyelids (ptosis), and droopy brows. If only the eyelid ptosis is addressed and corrected, the final result will be disappointing. This is why a thorough preoperative evaluation must be performed. Your consultation at the Sherman Aesthetic Center will explore all possibilities so that you are fully educated about the steps that can be taken to correct the droopy lids, droopy brows, or baggy lids. In some situations, combination surgeries are performed.
What happens during eyelid ptosis surgery?
Eyelid ptosis surgery is usually done under monitored local anesthesia as a same day surgery. Local anesthetic drops are placed on the eye, and an injection of local anesthetic is given into the upper eyelid to numb the area. A short incision is made in the natural skin crease, and the eyelid raising muscle (the levator palpebrae superioris) is identified and shortened to lift the eyelid.
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| Note that the upper eyelids cover the pupil, blocking her peripheral vision. Also note the improved position of the upper lids after Ptosis repair, improving her peripheral vision. | |
What happens after surgery?
It is not unusual for the eyelids to have swelling for the first 7 to 10 days, and ice compresses can aid in healing and recovery. Instructions will be given on how to best care for the wound. Lubricating drops and antibiotic ointment is prescribed for best results.
What are the benefits of ptosis surgery?
- Improved upper part of your visual field and quality of vision, where part of the eye was previously covered by the upper eyelid drooping and interfering with visual function.
- Restoring the normal anatomical appearance of the eyelid.
What are the possible risks of ptosis surgery?
- Local bruising and swelling of the eyelids.
- A small risk of wound infection to the eyelid.
- Risk of over-correction (eyelid too high), or under-correction (eyelid still too low), which may require another operation.
- Inability to close the eyelids completely, which may be temporary or permanent. This requires lubricant drops and ointment. If it is permanent and threatens the vision, the eyelid will have to be lowered again to protect the eye.
- Ptosis repair may sometimes be complicated by overcorrection, undercorrection, irregularities of lid shape, or matching in appearance between the two eyes.
Can congenital ptosis be associated with other eye problems?
Children with congenital ptosis may also have an amblyopic (lazy) eye, strabismus or squint (eyes that are not properly aligned or straight), or refractive error (need for glasses). Therefore, all children with ptosis should have a thorough eye examination with a refraction by a pediatric ophthalmologist and his or her team. The oculoplastic surgeon will then see the patient with congenital ptosis and perform eyelid measurements.
What is the treatment for congenital ptosis?
Congenital ptosis is treated surgically and the operation is based on the individual child’s severity of ptosis and the strength of the levator palpebrae superioris muscle. If the ptosis is not severe, surgery can be deferred until the child is three to five years of age. However, if the ptosis is interfering with the child’s vision, surgery may be performed at a much earlier age, even as young as 3 weeks, to allow proper visual development.
How is the operation done on children?
Ptosis surgery on a child is done under general anesthetic, usually at a same day center. The stitches, or sutures, on the skin are usually dissolvable.
What is a sling operation?
A frontalis sling, or brow suspension, is where the muscle of the forehead (frontalis muscle) is used to help lift the eyelid by placing a sling of material, either taken from the child or synthetic, between the forehead and the eyelid. Tissue taken from the child is called autogenous fascia lata and is a small strip of tendon taken from the leg through a 1 cm incision just above the knee, on the side of the leg. Alternatively, synethetic material, such as silicone, prolene, or gortex, may be used instead.
What are the benefits of congenital ptosis surgery?
- Prevention of lazy eye or amblyopia and strabismus or squint.
- Improved appearance will improve the child’s self-confidence, especially if being teased at school
- Restoration of a normal anatomical position of the eyelid.
- Restoration of the normal cosmetic appearance of the eyelid.
- Care and recovery: The upper eyelid may not fully show the final results of the surgery until most of the swelling has disappeared which can take up to six weeks. After this time, patients will enjoy the full affects of the surgical repair.
What are the risks of congenital ptosis surgery?
- Bruising of the eyelids and around the eye.
- A small risk of infection of the eyelid or the eye.
- Possibility of under-correction or over-correction of the eyelid height, requiring another operation.
- Unable to close the eyelid completely, with the eye slightly open at night. This is usually not a problem and the parents should be warned of this. There is a strong protective reflex, called Bell’s phenomena, which protects the surface of the eye on blinking and eyelid closure, so that as long as the muscle that closes the eyelid is strong, there is usually no risk to vision as long as follow up eye exams are performed.
