Ptosis is a term which means “droop”.
When the eyelid droops, we call it “eyelid ptosis” Ptosis or eyelid droop is often referred to as a “lazy eye”. If you or someone you know has one or both eyes looking partially closed, you may be looking at ptosis.
In most situations, appearance and vision can be improved with ptosis surgery. I’ll help you understand what is responsible for the most common types of ptosis as well as how I work with my patients to formulate a strategy that will have the most likelihood for success.
I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I routinely treat a wide range of ptosis patients in my practice.
Many of my patients are patients who’ve undergone previous ptosis surgery done elsewhere. When I meet a patient with ptosis, I start by reviewing the history to see if you were born with ptosis or if you developed ptosis later. When someone is born with ptosis, it’s referred to as “Congenital ptosis”.
If you develop ptosis later, its referred to as “Acquired ptosis”. In either situation, I first establish that there is no neurologic cause for ptosis before discussing surgical options.
Ptosis is essentially the result of a condition affecting the “levator muscle”. The “levator muscle” is the muscle that lifts the eyelid, like the word “elevator”
The type of surgery I recommend depends on the cause of the ptosis as well as the strength of the levator muscle. Surgical correction typically involves either some type of muscle advancement or shortening. If the muscle is too weak, then surgery is performed to connect the muscle that lifts the eyebrows to the eyelid.
When patients considering ptosis surgery come to our office, they express a desire to have their eyes look open and as symmetric as possible. Very often, patients come in requesting cosmetic upper eyelid surgery for sagging skin and don’t realize that they also have ptosis.
During my evaluation, I explain how excess skin over the eyelids which is referred to as “dermatochalasis” is different from drooping of the eyelid caused by the levator muscle which is of course “ptosis”.
There are often times when people have had cosmetic eyelid surgery or upper eyelid blepharoplasty elsewhere and they come in concerned that they still look tired. The reason for this is that they had upper eyelid skin removed but nothing was done to address the underlying muscle responsible for they eyelid droop.
Most ptosis surgery is for acquired ptosis due to a progressive stretching or thinning of the levator muscle. There are some patients who come in saying they’ve always had low upper eyelids which were referred to as “bedroom eyes” and that as time went on, the eyelids became lower and made them look tired. The objective in surgery is position the eyelid lifting muscles which include the levator muscle as well as another muscle called “Mueller’s muscle” in an advantageous manner to improve the position of the eyelids. I explain to my patients that these muscles are very sensitive and achieving the ideal result can be challenging.
The surgery is performed under local anesthesia with light intravenous sedation. In most cases, I have the patient open their eyes so I can monitor the height and shape of the eyelid. In fact, I routinely will sit the patient up during surgery and evaluate the appearance of the eyes in a way which more accurately reflects being vertical in real life.
This particular aspect of the surgery allows me to anticipate more accurately the outcome we’re aiming for. I do qualify the predictability of the procedure with my patients by explaining that 95% of the time, the eyes look right and there’s a satisfactory outcome.
Approximately 5% of the time, enhancements are necessary and are performed when swelling is significantly diminished which is usually after 3 months. Eyelid swelling is a normal part of the healing process.
The extent of the swelling is dependent on the extent of the surgery and the individual patient’s physiology. In the first 2 days after the surgery, cold compresses help decrease the initial swelling after surgery.
After the first 2 days, the clearing of swelling depends on the amount of swelling and circulation. I encourage my patients to be up and about walking, talking and smiling and if they’re planning to be more sedentary, warm compresses can help. Most people go back to work after 1 week.
I see our patients routinely more frequently in the first 2 months after surgery and then in approximately 3 month intervals for a year after surgery. Generally, I expect appearance to by close to the final appearance around 6 months. If a patient has a history of allergies, sinus problems, smoking or other circulation issues, swelling can persist longer than is typical.
Ptosis surgery can have a significant impact in your appearance and confidence. Functionally, eyelid ptosis can also affect your vision, and visual development in children who have it between birth and the age of 6.
If you’re questioning whether or not you have ptosis and if you should have surgery, meet with Fellowship trained Oculofacial Plastic Surgeon and learn about your situation and options.
I hope you found this information helpful…thank you for your question.