What is ptosis and what causes it?
Ptosis, short for blepharoptosis, is an abnormally droopy upper eyelid. It can be barely noticeable or it can be severe enough to cover the pupil of your eye and impair your vision. It can also make you look as though you are half asleep.
Ptosis can be congenital, meaning you were born with it, and is caused by an undeveloped or underdeveloped eyelid muscle, otherwise known as the levator palpebrae superioris muscle. Ptosis can also be caused by a condition known as myasthenia gravis, which most often affects women under 40. Another less common cause is Horner Syndrome, which may cause damage to facial nerves (including the eyelids) due to a tumor or an injury to the spinal cord. As we age, however, some things may occur that cause our eyelids to droop or sag, such as trauma, the use of contact lenses, the after-effects of cataract surgery, and thinning or weakening eyelid muscles.
Many times both eyelids are droopy, but you may experience only one. In some cases, the condition may come and go; some days it’s better and other days worse. You may experience it as a result of an allergic reaction which is temporary and does not need surgical repair. Ptosis will usually get progressively worse over time.
Repairing a mildly droopy eyelid may be considered a cosmetic procedure if there is minimal blocked vision. In some cases, however, people who suffer from ptosis have to either prop up their eyelid with their fingers or tilt their head back to be able to see properly. In these cases, ptosis surgery may be necessary.
Ptosis surgery, a type of blepharoplasty, is the surgical procedure most commonly performed to treat the problem. In fact, it is one of the most commonly performed cosmetic procedures performed by plastic surgeons. Let’s discover all the details about ptosis surgery.
One Patient’s Experience with Ptosis (Droopy Eyelid) Surgery
Am I a good candidate for ptosis surgery?
To determine this, your doctor should do a complete exam and review your medical history. You should let him know how long the drooping has been happening, if you have had any traumas, if you have a history of severe allergic reactions, and so on. All of these things will help the doctor determine how best to treat your problem.
Most doctors will take photos and eyelid measurements, and possibly perform nerve functioning assessments, to find out the extent of the problem and the best potential solution. If you have no underlying medical condition and simply don’t like the look of your droopy eyelids, there are also non-surgical options you can discuss with your doctor.
To be a good candidate for ptosis surgery, you should be physically and emotionally healthy, at least 35 years of age (although there are exceptions), and not suffering from diabetes, glaucoma, dry eyes, high blood pressure, thyroid problems, or cardiovascular problems such as high blood pressure.
Ptosis surgery – how is it done?
Your oculoplastic surgeon will typically perform the ptosis surgery on an outpatient basis under local anesthesia. He or she will place some anesthetic drops in your eye and also numb the eyelid area.
A small incision is made in the eyelid’s skin crease and the levator muscle (the eyelid lifting muscle) is shortened to better lift the eyelid, improve your vision and improve your appearance. The surgeon will take care to create a smooth lift for the droopy lid, and to match one upper eyelid to the other upper eyelid. The incision will be closed with dissolving sutures both inside and outside the lid.
Occasionally, if the ptosis is severe, the surgeon may attach the eyelid under the eyebrow so that your forehead muscles can substitute for the levator muscles to lift the eyelids. This is known as a frontalis sling, or brow suspension. A sling of material, either synthetic or your own tissue, is placed between the forehead and the eyelid.
Ptosis surgery – are there potential complications or risks?
As with all surgical procedures, there are risks and potential complications. Ptosis surgery is relatively safe and effective but here are some complications that could occur:
- Bleeding. If there is excessive bleeding, the wound may have to be reopened to remove a hematoma or cauterize a blood vessel.
- Infection. Good blood circulation of the eyelids will usually prevent serious infection.
- Bruising and swelling of the eyelids and around the eye.
- Risk of over-correction (eyelid too high causing an opening between the eyelids), or under-correction (eyelid still droops enough to cause impaired vision). Both of these situations may require a second surgery.
- Asymmetry. After the surgery, the eyelids may not match. You may have to wait three to six months to see if the problem resolves but further surgery may be necessary.
- Dry eyes. This is caused by the inability to completely close your eyelids. It may be temporary or permanent and will require lubricating drops or ointment.
- Double vision.
- Anesthesia complications. Complications such as allergic reactions and heart and breathing difficulties may occur in any surgical procedure.
It is very important to consult with your surgeon, find out how many procedures he or she has done, and discuss the surgeon’s skills with ptosis surgery. You should also ask to see examples of before-and-after photos for the surgeon’s other patients. Do not hesitate to ask questions. You can prevent potential complications by being informed.
Eyelid surgery recovery
After your ptosis surgery, you will most likely have to wear an eye pad for a day or two and your eyelids will probably be swollen for at least a week. Older patients usually experience more swelling than younger patients.
You may be instructed to:
- Keep the wound dry and clean;
- Apply an ice pack during the first 48 hours;
- Lubricate your eyes with drops or ointment;
- Elevate your head while sleeping by adding extra pillows;
- Keep your physical activity to a minimum while healing.
In most cases, it takes about three to six weeks to see the full effects after ptosis surgery, but sometimes the recovery periods are longer (3-6 months). Most patients have a socially presentable appearance after a couple of weeks but your eyelid position will continue to stabilize for about six weeks.
Surgery can be done to repair congenital ptosis in children, even to 3-week old babies, but is usually harder to correct than in adults. If it’s not too severe, many doctors will recommend waiting until the child reaches pre-school age (3 to 5 years old). However, if the ptosis is interfering with vision, surgery can be done to help the child with proper visual development. If your child’s vision is being blocked by their eyelids, they can develop amblyopia. Amblyopia is the improper development of sight which is possible to improve at a younger age but, if left untreated, can become permanent. Visit a pediatric ophthalmologist or pediatric plastic surgeon for a full assessment.
Cost of Eyelid Surgery
Ptosis surgery costs will vary based on your geographical region and your surgeon’s qualifications. If you live in a rural area where qualified surgeons are not widely available, the cost may be more than in an urban area where there are more surgeons and greater competition where prices are concerned. On average, the price of upper eyelid ptosis surgery ranges from $2,000 to $4,000.
You may also have to pay a fee to use the facility (surgical suite), which increases with the amount of time you spend there. Some surgeons will include the facility and anesthesia costs in the price as a flat fee. Be sure to ask if this is the case so you don’t experience any unpleasant surprises.
Eyelid surgery costs can also depend on the purpose of the procedure. If you have droopy eyelids, you can choose to enhance your appearance by undergoing ptosis surgery. If, however, you have significantly impaired vision, your health insurer may consider the procedure to be medically necessary. It is very important for you to check this in advance because, if your health insurer considers your surgery to be cosmetic, you will have to absorb the entire cost out of your own pocket.
Again, as with any surgical procedure and particularly one involving your eyes, be diligent about getting as much information as possible so you can make the best decision.