Eyelid ptosis can be either hereditary or developed later on in life. Acquired ptosis denotes eyelid ptosis that occurs later on in life, while hereditary ptosis is ptosis that one is born with.
People with hereditary ptosis display differences in the levator muscle in terms of the levels of severity and muscle function. Ptosis that develops later on is caused when a physical volume, such as tissue, interferes and affects the function of the eyelid called “mechanical ptosis”.
Ptosis that is acquired may also develop due to muscular or aponeurotic ptosis. This refers to the stretching, thinning and eventual weakening of the levator muscle and can occur after a patient has had eye cataract surgery or Lasik vision surgery.
The position of the eyelid relative to the pupil is a key factor in determining whether you need blepharoptosis repair or blepharoplasty. Blepharoptosis pertains to the eyelid margin being lower than it should be and can be addressed by blepharoptosis repair. Dermatochalasis denotes excess skin over the eyelids, which causes that hooded, tired-looking appearance which can be corrected by undergoing a blepharoplasty procedure.
Unfortunately, it is common for ptosis to be overlooked because a plastic surgeon assumes that performing blepharoplasty will automatically improve the look of drooping eyelids. This leads to the eyelids still looking droopy, in spite of just having the surgery. On the other hand, it is not unusual for some people to have both dermatochalasis and blepharoptosis, which can sometimes pose a challenge when formulating a proper diagnosis and surgical plan.
During a preliminary checkup, Dr. Amiya Prasad determines whether a patient has ptosis by lifting up the excess skin to see if it improves the eyelid margin or not. If the eyelid margin is still low, then it is safe to assume that the patient has eyelid ptosis, which can be easily fixed with the proper surgery.
The risks of ptosis surgery can be categorized into two types:
(1) Risks common to general surgery
(2) Risks specific to ptosis surgery
Like any other type of surgery, there is always a risk with regard to the kind of anesthesia used–whether it is local, local with sedation, or general. There is also the concern of too much bleeding, swelling and risk of infection.
Risks that are directly connected to ptosis surgery are the following:
(1) Under-correction of ptosis (eyelid still sags even after surgery)
(2) Over-correction of ptosis (eyelid is too open even after surgery)
(3) Disagreeable cosmetic appearance, scarring, infection and swelling.
It is important for patients to discuss these risks with their surgeon in order to avoid complications.
If your eyelid ptosis concerns you from a cosmetic point of view and is already disturbing your vision, then ptosis surgery should be considered in order to correct it. Ptosis surgery can be executed safely with very little risk, given that the patient does a good amount of research on the process and meets with a qualified oculofacial plastic surgeon who can help them make informed decisions.
Ptosis is caused by physical factors that affect the way the levator muscle of the eyelid functions. Since this is a structural problem, surgery is often the best option to correct this type of problem. In some cases, a special type of eye drop can be used to briefly lift the Mueller’s Muscle, which is an accessory muscle that measures about 1-2mm. This can be done to make the eye appear more open for a certain amount of time and is usually used for aesthetic purposes such as posing for photography.
After ptosis surgery, most patients see an immediate enhancement in their vision, due to the correction of the eyelid position relative to the pupil. Some even say that their surroundings look “brighter” and that keeping their eyes open has become easier.
Dr. Amiya Prasad says that if needed, glasses may be worn after surgery, however he advises against wearing contact lenses for at least one week. This is because during this time, an antibiotic cream is placed on the eyelids and may hinder the effectiveness of your contact lenses. When patients start wearing contact lenses, they must constantly use lubricating eye drops in order to prevent eye dryness. Because the eye is more open, the tear film may need a little extra help. Dr. Prasad also recommends checking your contact lens prescription several months after the surgery, as having ptosis is known to cause mild astigmatism.
The purpose of ptosis surgery is to lift one or both eyelids, in order to attain balance and symmetry. The patient is instructed to open and close their eyes in a lying down and upright position to make sure the symmetry of the eyes is correct, or if any adjustments need to be made. When the right proportion is achieved, the patient is returned to a laying position and the procedure is completed. Ptosis surgery is performed under local anesthesia with intravenous sedation. Afterwards, ice packs are applied to the area and patients are able to go home without any bandages.
How well a patient recovers can be affected by a number of factors, such as:
(1) The type of ptosis surgery performed
(2) The medical status of the person recovering from surgery
(3) The patient’s experience in the operating room
(4) The patient’s experience in the recovery area
In order to make sure that the patient has a positive experience during and after surgery, Dr. Amiya Prasad chooses to improve the following factors in order to make the patient’s recovery process flow efficiently:
(1) The anesthesia method
(2) The surgical team
(3) The surgical technique
(4) The post-operative recovery process
Dr. Amiya Prasad performs surgeries using local anesthesia with intravenous sedation. In fact, he has developed his own modified sedation method, which allows his patients to wake up without the feeling of queasiness or dizziness, and also allows them to return home safely after surgery.
Longer surgery times can have a negative effect on how well or fast a patient recuperates from the surgery. Therefore, Dr. Amiya Prasad understands that it is important to have a talented and effectual surgical team to ensure that everything is on point. Dr. Prasad also works in his own Joint Commission-accredited operating rooms with the assistance of his own surgical team, which has led to in his patients to have a better recovery experience.
According to Dr. Prasad, in order to achieve the best results in cosmetic and reconstructive surgery, a surgeon must have the following qualities:
(1) An artistic eye
(2) Technical proficiency
(3) A significant amount of experience
Having been practicing for over 20 years, Dr. Prasad is able to respond well to different types of scenarios, much like how an experienced pilot is trained to manage any type of situation when flying a plane. Dr. Prasad asserts that properly executed surgeries result in a better recovery experience for the patient.
Before launching his own surgical and aftercare facilities, Dr. Prasad completed surgeries at hospitals and surgery centers. During this time, he observed that there was a significant disparity between the number of support staff and patients in the recovery area. This caused delays in the proper aftercare procedures, which directly affects the recovery time of the patient. Dr. Prasad is firm in his belief that one-to-one attentive care is essential for a faster recovery period.
The recuperation period from corrective surgery of one of the most common types of ptosis does not differ that much from the recovery period after a standard upper eyelid blepharoplasty procedure. Although in some cases, swelling may last longer, depending on specific issues that took place during, after, or in relation to the surgery.
Several factors will dictate whether you will need another surgery or not. These factors are:
(1) The type of ptosis present
(2) The age when you had the procedure
(3) Any changes related to aging
(4) The elasticity of your own tissues
A child who has congenital ptosis may have corrective surgery before the age of six, and then may need to have another procedure done in their teen or young adult years. On the other hand, surgery for mechanical ptosis (caused by the thinning of the levator muscle) can yield good results that can last for years without needing additional surgery. Ptosis surgery may only entail some improvement during the first few months or year if there are any concerns with height, symmetry, or contour.
The cost of surgery is generally based on the following aspects:
(1) Surgeon’s fee
(3) Facility costs
It must be said that surgical procedures should not be compared to other commercial commodities such as electronics and the like, as these practices are the product of painstaking study, training, research and technical skill by a surgeon. Understanding the amount of work that goes into providing a high level of care usually gives patients a better understanding of how surgeons arrive at their fees.