Ptosis Repair Surgery (Droopy Eyelid) Miami
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 patient will report that their eyes look small, or that they can barely see their eyes in pictures.
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, 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 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.
Congenital 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 neurologic condition, and this requires a complete ophthalmologic examination by your primary eye care provider.
PLEASE NOTE: New-onset eyelid ptosis that occurs in combination with any symptoms of double vision, eye pain, acute changes in vision, or severe headaches requires an urgent ophthalmologic evaluation, and may be a sign of a more dangerous medical condition. If you are experiencing a new onset of these symptoms, you should report to an emergency room immediately.
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, Ptosis Repair 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.
Dry eyes are the most common side effect of any eyelid surgery. Dr. Lewen typically advises all Ptosis Repair Surgery patients to use over-the-counter artificial tear or lubricating drops at least 3-4 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 Ptosis Repair 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 Ptosis Repair 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 Ptosis Repair Surgery.
Your brow position can frequently be affected by the position of your eyelids. In many cases, the brow muscle will try to compensate for an eyelid that has ptosis by pulling stronger on the same side. Often, a patient may not even realize that this is happening. Sometimes, patients who do not realize that they have eyelid ptosis may first notice a difference in brow position, or they may notice how one eyelid may appear to have more skin under the brow than the other one. After Ptosis Repair Surgery, your brow position may change. Sometimes, this change can be predictable. Other times, it can be somewhat more difficult to predict brow changes ahead of time. If you have concerns regarding how your brow position may be affected by Ptosis Repair Surgery, you should discuss these concerns with Dr. Lewen at the time of your consultation.
At times, Ptosis Repair Surgery may be needed for functional reasons, such as when the upper eyelid hangs low enough that it is causing a significant obstruction of your vision. In such circumstances, Ptosis Repair Surgery can be performed to improve vision and to decrease the heaviness of the eyelids. If you have any functional concerns related to your eyelids, Dr. Lewen will be happy to discuss these during your consultation.
It is important to note that there can be a big difference between cosmetic eyelid surgery and functional, medically-necessary eyelid surgery. The purpose of cosmetic eyelid surgery is to improve the appearance and shape of the eyelids to create a more youthful and rejuvenated appearance. Sometimes, this can involve altering the position of the eyelid (such as with Ptosis Repair Surgery), in addition to sculpting of excess skin, fat, muscle, and/or wrinkles. In contrast, functional Ptosis Repair Surgery involves a more simplified adjustment of the height of a droopy eyelid, and is only performed to improve vision.
How is Ptosis Repair Surgery performed?
If you are a patient who has eyelid ptosis, Ptosis Repair 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 Ptosis Repair 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 Ptosis Repair 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 Ptosis Repair Surgery. This drop can sometimes cause a 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 Ptosis Repair Surgery: After placing anesthetic injections in the affected eyelid(s), Dr. Lewen will carefully measure an 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 Ptosis Repair 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 1 week and are easily removed in the office with minimal or no discomfort.
For cases of congenital ptosis with poor eyelid muscle development, or in some case of trauma or disease processes where the eyelid muscle does not function properly, other forms of Ptosis Repair Surgery may be required to successfully elevate the eyelid to as point where vision is significantly improved. For many of these cases, a 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.
Due to the complex nature of eyelid ptosis conditions, and the intricate neurologic connections between the brain and the eyelids, an estimate of about 10-15% of all patients who undergo Ptosis Repair Surgery may require some form of touch-up procedure to achieve the best possible result. Typically, if a touch-up procedure is required, this is done as an office procedure within the first few weeks after the initial surgery. In these cases, a small amount of local anesthesia is injected into the affected eyelid, and the wound is re-opened through the same incision to adjust the muscle position or the contour of the eyelid. The skin incision is then stitched carefully once again. If a touch-up procedure is performed, there will usually be additional time required for the healing period.
It is important for all patients with eyelid ptosis to understand that Ptosis Repair Surgery itself will not do anything to correct, shape, sculpt, or remove any extra skin, fat, or fullness that exists in your upper eyelids. In some cases, if there is already some additional skin present in the upper eyelids, the appearance of this skin can potentially be more pronounced after Ptosis Repair Surgery. The primary goal of all forms of Ptosis Repair Surgery is to lift the actual height of the eyelid margin to open the eyes up more. If you are concerned about the cosmetic appearance of extra skin in your upper eyelids, you should discuss these concerns with Dr. Lewen at the time of your consultation.
If you desire the best possible cosmetic results, Dr. Lewen may also recommend other procedures to be performed at the same time as your Ptosis Repair Surgery. These procedures may include such options as:
- Upper Eyelid Blepharoplasty
- Brow Lifting
- CO2 Laser Skin Resurfacing for the eyelids and/or face
- Lower Eyelid Blepharoplasty
- Midface Lift
- Midface Augmentation with Fat Grafting
- Facial Filler injections
Does Ptosis Repair Surgery hurt?
Ptosis Repair Surgery is generally a very safe and relatively painless procedure. Pain tolerance amongst 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 Ptosis Repair 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.
Where is Ptosis Repair 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. A standard medical clearance is required prior to surgery to ensure that you are healthy for surgery. This clearance typically includes basic bloodwork, a 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 Ptosis Repair 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 Ptosis Repair 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.
What is the downtime/recovery after Ptosis Repair Surgery?
When considering any eyelid surgery, it is important to inform your surgeon of any abnormalities of your eyes, your vision, or your general medical health. Dr. Lewen requires all functional and cosmetic eyelid surgery patients to have a full eye exam with dilation completed by your primary eye doctor within the last year before scheduling surgery. Surgery should be scheduled for a time when you can relax for at least 1-2 weeks. It is important to avoid any strenuous activity, heavy lifting, or bending down during this time to avoid complications and to promote the best healing situation. Depending on your degree of eyelid ptosis, the type of procedure performed, and the amount of eyelid ptosis that was corrected, patients can have somewhat variable amounts of recovery time. For the average patient undergoing Ptosis Repair Surgery, most of the swelling and bruising is generally healed in the first few weeks after surgery.
It is also important to avoid taking any blood-thinning medications or supplements for at least 2 weeks prior to surgery. Dr. Lewen’s staff will review a list of common medications, supplements, and vitamins that can cause your blood to be thinner.
Please Note: If you have been placed on a blood thinning medication by your doctor for a medical reason, you will need to ask your doctor’s permission before stopping any such medications. Dr. Lewen will never instruct any patient to stop taking a blood-thinning medication without first consulting with a primary care physician.
How long will the results from Ptosis Repair Surgery Last?
Although Ptosis Repair Surgery is intended to be a permanent fix for eyelid ptosis, in some cases, eyelid ptosis can recur over time. In most cases, if this occurs, a revision Ptosis Repair Surgery can be performed.
It is also important to understand that while eyelid surgery can be expected to correct certain conditions more permanently, your body will continue to age naturally. Life-long sun protection and good skin care are important tools that will also help to maintain your results.