Ptosis Surgery in London for Droopy Eyelid

What is ptosis surgery?

 

Ptosis surgery is the procedure used to correct a droopy eyelid and is normal carried out under local anaesthetic in adults and general anaesthetic in children. It is performed by oculoplastic surgeons and not plastic surgeons. Oculoplastic surgeons are part of the British Oculoplastic Surgery Society and are specialised in the eyelids and area around the eyes.

What is ptosis?

 

Ptosis is the medical name given to when an eyelid drops. A droopy eyelid can happen to one or both eyes. Ptosis that occurs at birth is known as congenital ptosis. Ptosis that develops later in life is known as acquired.

Congenital ptosis

Congenital ptosis can affect the visual development of a child if it is blocking the vision. For this reason children with a droopy eyelid are followed up closely by the paediatric ophthalmologist. If a child's vision is being affect then surgery is performed under general anaesthesia to lift the eyelid and allow the vision to develop. Ptosis is children may also be treated if a child is socially withdrawn, lacking in confidence or experiencing bullying because of it. Generally however if there is mild ptosis not affecting a child visually or socially, then it is best to wait to delay the surgery until it can be done under local anaesthetic with the chance of a better result.

Aquired ptosis

Aquired ptosis develops later in life and commonly develops from:

  • using contact lenses long term,

  • eyelid trauma,

  • having had cataract surgery or other operations to the eye.

  • rubbing your eye there may be a risk of it developing.

  • Less common causes include problems with the nerves that go to the upper eyelid such as Marcus Gunn or Jaw Winking ptosis which occurs on opening the mouth or chewing.

  • Other medical problems that can affect the eyelid muscle such as myotonic dystrophy and myasthenia gravis

How much does ptosis surgery cost in the UK?

 

You can expect ptosis surgery to cost between 2,000 and 5,000 pounds depending on whether the surgical procedure is being performed under local anaesthetic alone or requires an anaesthetist, the surgical technique used, the number of eyelids treated and if previous surgery has been carried out.

Can you get ptosis surgery on the NHS?

 

The NHS does offer ptosis surgery but not for cosmetic reasons. If your ptosis is significant and affects your vision your GP can refer you to an oculoplastic surgeon. They will assess your eyelids and medical history, take photographs and arrange a visual field test to see if you qualify for eyelid surgery on the NHS.

 

How long is the recovery from ptosis surgery?

 

A full recovery from ptosis surgery can take up to 3 months. In the first 2 weeks expect some eyelid swelling and bruising which will settle during the healing process. To speed up your recover try the following:

  • Place ice on your eyelids for the first 3 days following the ptosis correction

  • Sleep on 2-3 pillow at night to allow the swelling to drain

  • Use your ointment as instructed by your consultant ophthalmologist

  • Take 1 week off work unless you can work from home

  • Wear sunglasses when outdoors to protect the wounds from sunlight.

  • Make sure not to miss you follow up consultations during the recovery period.

Are you awake during ptosis surgery?

 

Ptosis surgery is usually carried out awake in adults. The procedure is performed under local anaesthesia and is painless. It takes about 1 hour to perform although can take longer. You are kept awake so that the eyelid height and curvature can be fine tuned. Getting the lids just right during the eyelid lift can only be done with you awake. Despite that 10% of patients will require a further procedure.

Children have surgery done under general anaesthetic as they are unable to tolerate surgery under local anaesthetic alone. The surgery cannot be fine tuned like in adults but the eye surgery is important if the ptosis is affecting the visual development.

 

What are the risks of ptosis surgery?

  • Infection to the wounds and the eyelids

  • Bleeding from the incisions

  • The eyelids not being perfectly symmetrical

  • Recurrence of ptosis

  • Reduced eyelid muscle movement

  • Inability to completely close the eyes

  • Worse vision

Can ptosis be corrected without surgery?

 

Ptosis Phenylepherine Test

For some people their ptosis may improve without surgery for an hour or so when phenylepherine drops are placed into the eye. This stimulates Müller's muscle to lift the eyelid. It only lasts a short while and then drops back down again. It is a test used to determine if a conjunctival Mullers resection is suitable for small amounts of ptosis.

 

Ptosis props

Ptosis props can correct ptosis without surgery. They are small crutches usually on glasses frames that the eyelids can rest on. A lot of people do find these difficult to tolerate however. and few people are able to use them long term.

Does insurance pay for ptosis surgery?

 

Your insurance may pay for ptosis surgery if your vision is blocked and it is not deemed to be cosmetic surgery. At you initial consultation your ophthalmologist will assess you and arrange for visual field tests and photographs to provide your insurance with the data needed to consider oculoplastic surgery to lift the eyelids.

 

What is the procedure for ptosis surgery?

 

There are 3 main procedures for ptosis surgery:

Anterior approach

An incision is made into the skin crease of the eyelid to access the levator muscle that lifts the eyelid. The muscle tendon is then reattached to the eyelid and the height and contour are assess and fine tuned if needed. The incision is closed with fine stitches and the scar is usually hidden in the skin crease.

Posterior approach

An incision is made on the under surface of the eyelid to access the levator muscle without a skin scar. The muscle is attached to the eyelid. The advantage is the scarless approach but the amount of fine tuning that is possible is far less than the anterior approach. Those who wear contact lenses may want to avoid a posterior approach as reintroducing lenses can take time and be uncomfortable.

Brow suspension

A brow suspension is used in cases of poor levator function. This is when the eyelid muscle is not producing enough lift. A synthetic material or tendon known as the fascia lata from the leg is used to lift the eyelid and have it supported by the eye brow. Using the forehead muscles to cause a brow lift, resulting in the eyelid lift. When the brow relaxes the eyelid drops. This procedure is different to brow lift surgery.

What is the difference between blepharoplasty and ptosis repair?

 

A blepharoplasty addresses any excess skin or eye bags in the eyelids. A ptosis repair address the upper eyelid height. A blepharoplasty can also be performed on the lower lid.

 

 

What should I do after ptosis surgery?

  • Follow all the instructions given by your eye surgeon

  • Use ice packs to calm the swelling

  • Get plenty of rest

  • Sleep on 2 or 3 pillows

  • Avoid smoking

  • Refrain from contact lenses for 4 weeks

  • Dont do strenuous exercise or heavy listing until the swelling settles

  • Try not to rub your eyes

  • Wear sunglasses when outdoors

Can ptosis return after surgery?

 

Ptosis can return after surgery and this is called recurrence. Early recurrence is within 3 months of your eye operations. Late recurrence is after years.

Recurrence is caused by failure of the procedure, the stitches holding the levator muscle coming loose or dissolving too soon, or by the muscle separating from the eyelid body again with time due to rubbing or age.

Recurrence would require a repeat procedure.

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