How does the recovery for eyelid ptosis compare to that of blepharoplasty?
In my experience, correction of the most common type of eyelid ptosis related to the thinning
of the muscle tendon called levator aponeurosis doesn’t make a significant difference in
the recovery period when compared to upper eyelid blepharoplasty.
In some situations, swelling can last longer depending on the specific issue during or
related to the surgery.
What is recovery like after Ptosis Surgery?
At one level, the recovery after ptosis surgery is related to the type of ptosis surgery as
well as the medical status of the person who’s recovering from the surgery. At another level,
a person’s recovery can be affected by their experience in the operating room as well as
the recovery area. It has been my assertion that the person’s experience during and
immediately after surgery has an impact on the short term recovery as well as the long
term recovery period. The factors which I have been successful in helping my patients
recovery after surgery include: the anesthesia method, the surgical team, the surgical technique
and the post operative recovery process.
In our practice, we help our patients recover faster by performing the surgery under local
anesthesia with LITE™ IV sedation. We rarely use general anesthesia which is usually associated
with longer recovery and in my experience, is also associated with more bruising and
swelling. In addition, we avoid any sedation which can cause nausea and grogginess afterwards.
In fact, we have developed our own customized approach to sedation which can consistently
results in our patients waking up fresh and comfortable allowing them to go home soon
after surgery.
I’ve performed surgery at numerous hospitals and surgery centers and had variable levels
of assistance in those institutions. When assistants and other medical personnel work
with many different surgeons, it’s difficult to perform any procedure smoothly and efficiently.
Longer surgery times can have an impact on recovery. Recognizing this as a challenge
for my patients, I perform my procedures in my own operating facilities which are accredited
by The Joint Commission. The Joint Commission is the same organization that oversees hospitals
and ambulatory surgery centers. I can state without any reservation that working with
my own team in my own facilities has resulted in our patients having a much better recovery
experience.
In my opinion, for optimal cosmetic and reconstructive surgery, the surgeon should have: an intrinsically
artistic eye, technical proficiency and a lot of experience. During my consultations,
I discuss that how I feel as a surgeon over 20 years of experience, I am able to handle
many different situations in a way an experienced pilot can handle different situations when
flying a plane. Generally, a well executed surgical procedure will typically result in
a better recovery experience.
Before I designed my own surgical facility, I performed surgeries in hospitals and surgery
centers where I was frustrated by my patient’s experience in the recovery area. Unfortunately,
I found that there was always a mismatch between the number of patients in the recovery room
and the number of people available to take care of them. This resulted in delay in proper
care for procedures such as eyelid surgery where ice and cold compresses need to be applied
as soon as possible. In addition, the patients did not receive the one to one attentive care
that I feel is appropriate for optimal recovery. In my facilities, we have systems and people
to attend to our patients immediately upon the completion of surgery which has helped
my patients recover faster.
As far as the home recovery processes are concerned, it is typical to have some swelling
and some bruising particularly in the first 24-48 hours. We see this improve daily such
that our patients are able to return to work in 5 to 7 days after surgery. Some application
of cover-up make-up and wearing tinted eyewear can be helpful at that time. A significant
part of the healing process occurs during the first few months. Healing can go on for
approximately one year after any type of surgery.
What happens during ptosis surgery?
Ptosis surgery in adults such as levator muscle advancement and levator muscle resection is
typically performed in our practice under local anesthesia with conscious IV or intravenous
sedation.
The goal of the surgery is to elevate the eyelids or both eyelids as well as to maximize
the symmetry and the cosmetic appearance.
In order to accomplish this, I typically have my patient open and close their eyes in both
the laying and upright position to confirm the appearance and to make adjustments.
Of course, the patient is comfortable and is not feeling anything when I’m doing this.
When I and my team are happy with the results, we lay the patient back and I complete the
procedure.
We place cold compresses afterwards and our patients go home without any bandages.
Will my eyesight change after ptosis surgery?
Most people after ptosis surgery appreciate an improvement in their vision through the
improvement of the eye position relative to the pupil.
My patients report that the world feels brighter and they don’t feel the strain of keeping
their eyes open anymore.
In terms of wearing glasses and contact lenses, I advise my patients that they can wear their
glasses if needed after surgery.
But as far as contact lenses are concerned, I usually recommend waiting about a week since
during that time antibiotic ophthalmic ointment is being applied to the eyelid and it can
get on the contact lenses and affect their quality of the vision.
When resuming contact lens wear, I advise liberal use of lubricating eye drops because
it’s expected that the eyes are going to be more dry in the post-operative period and
with the eyes being more open, the tear film may need supplementation.
In terms of your eyeglass or contact lens prescription, it’s possible, you may need
to adjust your prescription.
When the eyelid is drooping, it can affect the curvature of the cornea causing a very
mild astigmatism.
I generally recommend waiting several months before having the patients go to their ophthalmologist
to check if their prescription’s changed.
Can I fix ptosis without surgery?
Ptosis is typically caused by a physical condition affecting the levator muscle.
The levator muscle is which lifts the eyelid.
Since this condition is an anatomical issue, surgery is the most effective treatment for
ptosis.
In some people, an eyedrop can be used to temporarily contract an accessory muscle of
the eye called Mueller’s muscle which can lift the eyelid 1-2 mm for purpose for posing
such as for photography.
What are the alternatives to ptosis surgery?
If your ptosis is significant enough to be cosmetically concerning or is affecting your
vision, there are really no practical alternative to ptosis surgery to get an optimal result.
Ptosis surgery can be performed safely with minimal risk.
Meet with an experienced oculofacial plastic surgeon and learn what type of procedure is
right for you.
What are the risks of ptosis surgery?
The risks of ptosis surgery can be divided into typical surgical risks for any surgery
and risk specific to ptosis surgery.
In any surgery, there are risks associated with anesthesia whether it is local sedation
or general anesthesia.
Any surgery can be associated with excessive bleeding, infection as well as excessive swelling.
Ptosis surgery risks include under correction where the eyelid still droops, overcorrection
where the eyelid is still open as well as undesirable eyelid appearance, scarring and
eye problems related to exposure and other causes of inflammation and infection.
Since there are different methods for ptosis surgery, it’s important to discuss the specific
risks for the procedure you’re considering and how to minimize these risks.
Who should perform ptosis surgery?
Ptosis surgery is a specialized procedure typically performed by a surgeon called an
oculoplastic or oculofacial plastic surgeon.
An oculofacial plastic surgeon has combined training in ophthalmology and advanced training
in cosmetic and reconstructive surgery of the eyes and face.
How Can I Fix One Drooping Eye?
Addressing one drooping eye is a routine part of my practice.
If the drooping eye is due to extra skin referred to as “dermatochalasis”, a unilateral
blepharoplasty is performed.
If the drooping eye is due to ptosis, then a ptosis repair is performed.
Proper diagnosis is critical to determining which solution is right for you.
Do I have eyelid ptosis or extra skin?
Determining if your eyes droop because of ptosis or extra skin can be challenging.
Ptosis is defined by the position of the eyelid margin relative to the pupil.
If you have extra skin, the weight of your skin can affect the position of your eyelids,
this is referred to as “mechanical ptosis”.
When I evaluate a patient for ptosis, I lift the extra skin to see where the eyelid margin
is positioned.
If the eyelid level remains low, then it’s likely you have ptosis.
This means that if you have a blepharoplasty only, your eyes will remain low unless your
ptosis is also addressed.