The upper eyelid droop is the weakening of the eye’s lifting mechanism or muscle strength which causes patients to look sleepy and tired. In more severe instances, ptosis can lead to obstruction of vision. Thus, shortening the levator muscles surgically can correct ptosis.
There are three degrees of the condition: good (when eyelid movement exceeds 10 mm), medium (eyelid movement is somewhere between 5 and 10 mm; and poor (eyelid movement is 0-5 mm). Ptosis can affect one eye (unilateral ptosis) or both eyes (bilateral ptosis), as well as facial expression. There is also true ptosis and pseudoptosis.
Levator resection is necessary when the levator function is greater than 5 mm. If this is a medical condition that causes difficulty with daily activities, part or all of the cost can go through with insurance coverage after filing an insurance claim.
If ptosis advances, in addition to asymmetrical eyelids, the drooping lid can cause loss of peripheral vision and worsen one’s quality of life significantly. Thus, the constant strain of the forehead muscles may also cause headaches. Untreated ptosis might result in astigmatism or lazy eye (amblyopia).
The good news is that with today’s innovations and advances in medical sciences, the condition doesn’t have to disrupt one’s daily activities. Patients don’t have to wear ptosis crutches either. There is a wide range of eye enhancement procedures that can address different aesthetic and medical problems like this one.
Cases of ptosis are typically fixed with upper eyelid surgery, known as upper eyelid ptosis correction surgery, upper eyelid blepharoplasty, and ptosis repair. It uses the fascia lata, extraocular muscles and frontalis muscle to restore the lid to its primary position. Excess skin is removed. The treatment can be paired with double eyelid surgery, where an upper eyelid crease is created alongside the repair of the muscle function.
There are two main types of ptosis – congenital ptosis and acquired ptosis. The surgical procedure can address both. Congenital ptosis is present at birth. In general, this is a rare occurrence.
Acquired ptosis is developed later in life, and there are various causes for it. For some people, prolonged use of contact lenses can be a huge trigger. For others, eye trauma is much more likely to disturb the function of the levator muscles.
In some cases, ptosis can result from ocular surgery (e.g. LASIK cataract surgery), recent eyelid swelling, or certain autoimmune disorders like external ophthalmoplegia and myotonic dystrophy. The latter is an autosomal dominant disorder, which affects the muscles in the entire body and could present with ptosis and retinal pigmentary degeneration.
Acquired ptosis can be further divided into various subtypes such as myogenic ptosis, neurogenic ptosis, aponeurotic ptosis (also known as involutional ptosis), traumatic ptosis, and mechanical ptosis.
Both types of ptosis can lead to a lack of eye muscle strength and restricted facial expressions. Despite treatment availability, ptosis recurrence is possible as tensile strength is reduced over time.
Oculoplastic surgeons can use either an external approach or an internal approach. Posterior approach ptosis correction is saved for moderate and mild ptosis. In most cases, surgical outcomes are more than satisfactory.
As the name implies, this technique consists of making actual cuts along the eyelid to expose the eyelid tissues. The goal is to get to the levator muscle so it can be shortened or strengthened, which will help to keep the upper eyelid open. If there is an excess of fats in that area, part of them will be removed. This method is great for people with moderate ptosis and severe ptosis.
Instead of the incision method where the plastic surgeon does on the upper eyelid, this time tiny openings are made in the skin where sutures could help to tighten the levator muscle. In this way, they can lift the eyelid. Non-incisional ptosis correction is ideal for people with mild ptosis.
With the frontalis sling technique, sutures are used in a similar fashion as with the suture method. However, they are suspended from the muscles on the eyebrows rather than the upper eyelid, which creates eyelid elevation, hence, the name frontalis sling surgery or frontalis suspension method. This approach is recommended for people with poor levator action, which technically is less than 4 mm.
Before your droopy eyelid ptosis procedure begins, you will have an honest conversation with your doctor. Eye assessment will be performed. The plastic surgeon examines the eyelid muscle to check the levator function and other things like the distance between the upper and lower eyelid margin. They want to see if the disorder has caused problems with the peripheral field of vision and how much it has affected the strength of the levator muscles. Furthermore, they show patients droopy eyelid surgery photos of other patients that have already been through this.
On the day of the droopy eyelid surgery, patients are given sedation or local anaesthesia and prepped for what is about to happen. The treatment takes about 30-60 minutes and is performed as a day procedure at an accredited clinic, meaning you can go back home on the same day. Note that you need to provide informed consent before surgery. If only one eye is going to be corrected, it is vital that both eyes are exposed, which facilitates assessment of the lid position during surgery.
In addition to tightness in the eyelid tissue, it probably will be sensitive to light, watery, sticky, and dry. The part of the skin that was cut will feel itchy, and your vision will be blurry (you may experience double vision) the first couple of days following surgery. There may be dark circles. This is normal. It is vital to keep the area clean at all times to deter infection. Don’t worry, your team will provide instructions on how to care for your eyes during recovery. They may also give you special eye drops to apply that will alleviate some of these side effects.
Do not rub your eyes as much as you want to do so as this can add pressure to the wound and will slow down healing. If excess skin was removed and the more incisions were made, the bigger the wound will be. You will be advised to add ice packs around the upper eyelid skin to minimise swelling and bruising.
Depending on the type of eye surgery and treatment option you had, the stitches may get absorbed by the body, in which case you don’t have to schedule an appointment for this. If they should be removed manually by a specialist, you will have to arrange it with your doctor.
When it comes to physical activity, you should take it slowly at first. Take a break when you feel tired and listen to your body. Sleep is essential, so make sure you catch enough Z’s. You will not be able to drive right away regardless of the type of surgery you underwent. Before you get back to this, don’t forget to clear it with your surgeon first.
Hence, individuals should avoid wearing contact lens for two weeks after the operation. If you feel overwhelmed or depressed by everything that is going on, you should have your mental health in focus as well. A few months after eyelid surgery, you can proceed with your normal activities again.