In layman’s terms, ptosis surgery is performed to repair a droopy eyelid. Surgery is especially indicated if the eyelid is obscuring vision. The muscle that raises the eyelid is then shortened, or the eyelid may be connected to another muscle in the forehead that raises the eyebrows.
In this article, Drs. Gary D. Breslow and Jordan P. Farkas of The Breslow Center for Plastic Surgery in Paramus, New Jersey cover common questions about eyelid ptosis and the techniques employed to fix a droopy eyelid.
What Is Ptosis, and How Does It Affect Vision?
In medical terms, “ptosis” or “blepharoptosis” occurs when the eyelid droops down far enough to partially cover the pupil. This can be because of excess tissue, nerve damage, or trauma. Eyelids can droop unilaterally or bilaterally.
Drooping may be present at birth, or develop later on in life due to an acute condition such as trauma or Bell’s Palsy. This is considered a functional problem if the eyelid droops low enough to cover all or part of the pupil and obscure vision.
Mild ptosis occurs when excess skin or fatty tissue in the eyelid gives the eyes a tired appearance, and is generally associated with normal aging.
Can a Lazy Eye Be Corrected Without Surgery?
Facial exercises, sticky tape, and other “at home” treatments are often presented as solutions to eyelid ptosis. Unfortunately, these treatments are ineffective at addressing the underlying issues:
- The thin skin that drapes the eyelid on the outside can sag with age.
- The subcutaneous fat that sits beneath the skin can expand due to aging or obesity.
- The levator muscle that raises the eyelid can become inactive or stretched.
- Suspensory ligaments that hold the eyelid over the eye can become stretched.
Other complex tissues near to the site of a ptosis operation include the eyebrows and their related muscles, the hair and hair follicles of the eyelashes, the lacrimal glands, the tarsal plate (a fibrous cartilage which gives the edge of the eye its semi-rigid shape), and of course the eye itself.
Only an experienced surgeon can reliably shorten the levator muscle and correct the tissues that suspend the eyelid.
How Is Ptosis Surgery Performed?
Eyelid surgery, also known as blepharoplasty, is a procedure commonly performed by plastic surgeons, whereas ophtalmic surgeons are more specifically trained in complex procedures involving tears across the lash line, repair of the lacrimal gland, or missing tissue due to trauma.
On patients who have adequate levator muscle function, ptosis surgery is performed by shortening the muscle so it raises the resting point of the lid. This is known as “levator resection.” The incision is performed horizontally across the middle of the eyelid, leaving a barely visible scar in the eyelid crease.
In patients with weak or absent levator muscle function, a silicon tether is used to connect the eyelid to the frontalis muscle and restore function. This is known as a “frontalis suspension.” The procedure leaves an additional three small scars above the eyebrow, in addition to the usual mid-lid incision line.
Patients in whom silicon is contraindicated, such as children, might have a frontalis suspension but need to use a portion of the tensor fascia lata muscle in the leg as a tether. This muscle can also be supplied from donor tissue.
In this instance, scarring occurs along the mid-lid incision line, above the eyebrow, and along the incision on the outside of the thigh where the leg muscle is harvested.
What Is the Success Rate of Ptosis Surgery?
It is true that ptosis can recur, particularly over time. Reported recurrence rates range between 12% and 39%, 8 to 10 years after the procedure has been performed.
Can Ptosis Surgery Be Performed on Children?
Since congenital ptosis usually does not improve with time, early treatment is generally recommended. If a child with ptosis often lifts their chin to look at something, it may be a sign that the droopy lid is interfering with his or her vision. In this case ptosis surgery is indicated so that the eyes can develop normally.
What Are the Side Effects and Potential Complications of Ptosis Surgery?
Some patients experience difficulty blinking in the days following eyelid ptosis surgery. The use of lubricating ointment and/or eyedrops helps prevent the eye from becoming too dry.
Bruising and swelling in the eye after the operation, also known as chemosis, is the most common problem encountered after ptosis surgery. Because of the unique properties of the eyelid, the incisions and ensuing scars may also result in lid retraction or misalignment. In some cases further operations are required to correct this.
Any surgical procedure also carries a risk of scar formation, infection, and body fluids collecting in the site of the operation.
Because the eyelid is a complex structure and the surgery occurs adjacent to the eye, it’s important to have a consult with an experienced plastic surgeon before choosing to undergo ptosis correction.
Drs. Gary D. Breslow and Jordan P. Farkas have successfully performed eyelid surgery procedures on numerous patients from New Jersey and beyond — feel free to reach out to us if you have any further questions.
Additional Reading and References
- American Academy of Ophthalmology: Ptosis, Congenital
- Brazilian Journal of Otorhinolaryngology: Complications in Blepharoplasty: How to Avoid and Manage Them
- Medscape: Ptosis Blepharoplasty Treatment & Management