Droopy Eyelid Surgery (Ptosis)

In Miami, FL

Introduction

Introduction to Droopy Eyelid Surgery

At our practice in Miami, droopy eyelid surgery is a very common procedure performed by Dr. Lewen. Double board-certified oculofacial plastic surgeon, Gregory D. Lewen, M.D., offers droopy eyelid surgery for residents in Miami, Aventura, and the surrounding areas of Florida. Dr. Lewen is one of a select few plastic surgeons who specializes in plastic surgery of the eyes.

 

What is a Droopy Eyelid?

Ptosis (pronounced “tow-sis”) is short for blepharoptosis and is a term used to describe the sagging or drooping of an eyelid. A common complaint from patients with this condition is that they feel like their eyes look tired and heavy. Many patients will report that their eyes look small, or that they can barely see their eyes in pictures.

What Causes a Droopy Eyelid?

There are several different causes for eyelid ptosis. The most common form of ptosis results from a stretching of the muscle that moves the eyelid up and down over time. Although this can commonly occur as a part of age-related changes that involve the eyes, some other common causes for eyelid ptosis can include such things as excessive rubbing, eye or eyelid trauma, contact lens usage, prior eye or eyelid surgery, eye or eyelid infections, or even upper eyelid bumps that can grow and weigh the lid down. The natural aging process contributes to a loss of bone and soft-tissue volume over time, and this loss of volume around the eyes can sometimes cause the upper eyelid to sag lower.

Another form of eyelid ptosis can be congenital (from birth), meaning that it is present from the time of birth or shortly thereafter. The most common form of congenital ptosis usually involves a poor development of the normal eyelid muscle. This muscle weakness will cause the upper eyelid position to sit much lower than on the other side. Typically, with this form of ptosis, the affected eyelid will appear not to have a normal eyelid crease that will make it look significantly different in appearance from the other side. There are also other forms of congenital (from birth) or childhood eyelid ptosis that may still maintain normal eyelid muscle function, but in these cases, the muscle is somewhat stretched, similar to the adult acquired form.

A side profile shot of a woman with short hair and clear skin gently touching the side of her face with one hand. She is wearing a black shirt, and the background is softly blurred, emphasizing her serene expression. - Droopy Eyelids in Aventura, FL

What Are the Benefits of Droopy Eyelid Surgery?

In order to provide you with the best recommendation for droopy eyelid surgery or other options, Dr. Lewen determines the nature of the ptosis. Congenital (from birth) eyelid ptosis in a child should be evaluated by a pediatric ophthalmologist to determine if the eyelid is significantly blocking the child’s vision. For young children, any condition that causes the vision to be significantly impaired for any reason can lead to a risk of the child developing a condition known as amblyopia. Amblyopia is a potentially permanent condition of poor vision that develops in children when there is something causing the vision to be blurry, obscured, or blocked during the critical time period of early childhood while the normal connections between the eye and visual part of the brain are still developing. If this condition is not appropriately treated during the critical time of early childhood, the normal connections between the eye and the brain will never develop properly, and the child may never develop normal vision in the affected eye, even if the eye is otherwise healthy. The development of amblyopia is a primary cause for concern in any child who is born with congenital eyelid ptosis, and this should be properly evaluated when it is first identified, and while the child is still very young to reduce the risk of permanent visual dysfunction. In both forms of eyelid ptosis described above, the affected eyelid is always droopy. Usually, when this is the case, your body will try to compensate for a droopy eyelid by pulling stronger with your brow/forehead muscle on the same side. This helps to lift a droopy eyelid up a little higher and can help to improve vision in some cases. Sometimes, patients may describe eyelid ptosis as getting worse towards the end of the day, and this may be a sign of brow/forehead muscle fatigue.

An eyelid or eyelids that become droopy only occasionally can potentially be a hallmark of a neurological condition, and this requires a complete ophthalmologic examination by your primary eye care provider.

Where is Droopy Eyelid Surgery Performed?

Depending on your individual case, Dr. Lewen may recommend for your surgery to be performed in an outpatient (ambulatory) surgery center, where you will go home the same day. In these cases, IV sedation is typically given for the procedure to induce a “twilight sleep,” and then, local injections of anesthesia are administered. Standard medical clearance is required prior to surgery to ensure that you are healthy for surgery. This clearance typically includes basic blood work, medical history, and physical exam, a recent EKG from your primary care physician or your cardiologist, and a urine pregnancy test if applicable. Dr. Lewen only chooses to perform droopy eyelid surgery for his patients in specific facilities that meet his qualifications for providing exceptional patient care. These facilities have dedicated and attentive nursing staff and a board-certified anesthesiologist on site to ensure that your experience is as safe and comfortable as possible.

For some patients, Dr. Lewen may offer the option for your droopy eyelid surgery to be performed in his office procedure room. If performed in the office setting, Dr. Lewen may give you a light oral sedative prior to the surgery in order to help relax you and to make it easier for local anesthetic injections to be administered to your upper eyelid areas. Regardless of where your surgery is performed, you will require someone else to drive you home on the day of your surgery.

dr lewen in dark scale performing surgery | Top Miami Surgeon Gregory D. Lewen, MD

What is the Procedure for Droopy Eyelid Surgery?

If you are a patient who has eyelid ptosis, droopy eyelid surgery can make your eyes look more open and alert, and can dramatically improve a tired or aged appearance. This surgery can also brighten the appearance of your eyes, and help to provide a more youthful, refreshed, and energetic presentation to your face.

For most acquired forms of eyelid ptosis, Dr. Lewen will commonly use either an internal or external approach for droopy eyelid surgery. The decision regarding which procedure will be best for your specific condition depends on a variety of specific eyelid measurements and will be made by Dr. Lewen at the time of your consultation. During this visit, Dr. Lewen will discuss all your treatment options and will make his recommendations regarding surgery. Not all patients are good candidates for certain forms of droopy eyelid surgery. Depending on your condition, Dr. Lewen may use an eye drop during your office visit to get an estimate of the improvement in your eyelid height with droopy eyelid surgery. This drop can sometimes cause temporary dilation of your pupil, although it should not affect your vision the same way as when you have your eyes fully dilated for a dilated eye exam. The effects of this drop are only temporary and can last for a few hours.

Internal Approach to Droopy Eyelid Surgery

After placing anesthetic injections in the affected eyelid(s), Dr. Lewen will carefully measure the amount of tissue on the inside surface of the eyelid. The muscle tissue on the internal surface of the eyelid will be sutured and shortened to provide a lift to the eyelid. The stitches that are used for this type of procedure are completely absorbable and do not need to be removed. Most commonly, there are no incisions made on the outside skin during this procedure, and therefore, this procedure generally has a lower risk for visible scarring.

External Approach to Droopy Eyelid Surgery

After placing anesthetic injections in the affected eyelid(s), Dr. Lewen will precisely construct the incision in the most appropriate eyelid crease to create the best symmetry between both sides. This careful placement hides the incision in the eyelid crease so that it will be virtually unnoticeable when your eyes are open. Dr. Lewen will delicately isolate the levator muscle that moves the eyelid, and then this muscle is advanced and tightened to create a lifting effect on the entire upper eyelid, which opens up the eye. The position and contour of the eyelid will be carefully evaluated to produce the best symmetry to the other side, and then the muscle will be secured in its new position. The desired lid crease position will then be set, and then stitches are placed in the skin to close the incision. The skin stitches typically stay in place for about one week and are easily removed in the office with minimal or no discomfort.

For cases of congenital (from birth) ptosis with poor eyelid muscle development, or in some cases of trauma or disease processes where the eyelid muscle does not function properly, other forms of droopy eyelid surgery may be required to successfully elevate the eyelid to a point where vision is significantly improved. For many of these cases, the graft material may be required to be used as a sling to help connect the weak or non-functioning eyelid to the forehead muscle on the same side. This connection can then allow a patient to use the forehead/brow muscle to help raise the eyelid to a point where vision is improved.

What Should I Expect from Droopy Eyelid Surgery?

During the consultation, Dr. Lewen may ask certain patients to bring in some older pictures for his review. If you have had previous eye or eyelid surgery, whether for functional or cosmetic purposes, it is important to know the details of your previous surgery, including how long ago it was, which eye or eyes had the surgery, and what type of procedure was done. If you have had previous facial trauma, sinus, or nasal surgery, this information may also be an important part of your evaluation. In some cases, Dr. Lewen will request to review your past surgical records if they are available, in order to determine the type of ptosis repair surgery that will give you the best benefit.

In some cases, where there is one eyelid that has more ptosis than on the other side, droopy eyelid surgery for the droopy eyelid can run the risk of developing a droopy eyelid on the other side. This is referred to as a Herring effect and is controlled by the same part of the brain that allows both eyes to move together when looking in different directions. For some patients, the development of this side effect may be predicted before surgery with certain testing in the office. In other instances, the development of drooping in the other eyelid is somewhat less predictable. If a Herring effect does occur following ptosis repair surgery that is performed for only one eye, a ptosis repair surgery can be planned for the other eye to correct this drooping issue as well.

What is the Recovery like After Droopy Eyelid Surgery?

Droopy eyelid surgery is generally a very safe and relatively painless procedure. Pain tolerance among patients can vary considerably. However, Dr. Lewen and his staff routinely show careful consideration to individual patient sensitivities in this delicate area around the eyes. Typically, if there is discomfort after droopy eyelid surgery, this is usually related more to a dry eye condition. Dr. Lewen will spend significant time with you during your surgical consultation discussing your dry eye risk factors, along with the precautionary steps that he recommends for you to take to ensure that you have the easiest time and least amount of discomfort through the healing process.

Dry eyes are the most common side effect of any eyelid surgery. Dr. Lewen typically advises all droopy eyelid surgery patients to use over-the-counter artificial tear or lubricating drops at least three to four times per day before and after eyelid surgery for best results and comfort. Depending on the extent of dryness, Dr. Lewen may also recommend a nighttime lubricating ointment for inside the eyes, such as Refresh PM, Systane Nighttime, or GenTeal gel. Dry eyes are a known side effect of any droopy eyelid surgery, and most people who undergo this surgery can expect some degree of dry eye symptoms in the post-operative period. Very often, these dry eye symptoms will settle down considerably after your initial healing period has passed. However, dry eyes can sometimes persist for a longer amount of time following droopy eyelid surgery. Dry eye conditions are actually very common in the general population, whether people realize that they have symptoms of dryness or not, and particularly as people age and their bodies do not make the same amount of moisture as when they were younger. Most dry eye conditions can be easily treated with over-the-counter artificial tear drops and lubricating ointment at bedtime. Dr. Lewen will review your specific dry eye risk factors during your consultation, and he will then be able to give you a better idea of how likely you may be to have dry eye issues following your droopy eyelid surgery.

 

Droopy Eyelid Surgery (Ptosis) Cost

How Much Does Droopy Eyelid Surgery Cost in Miami?

Dr. Lewen answers your questions during the consultation, which takes about 1 hour. His staff can also help you with other details, such as the cost of droopy eyelid surgery and your options for financing.

 

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