Ptosis Surgery for a Droopy Eyelid

Droopy eyelid plastic surgery

Ptosis is the medical name given when one or both the upper eyelids are droopy.  The droopy eyelid causes ptosis which can affect the vision from the top part of the eye and give a sleepy or tired appearance.  You may have difficulty keeping your eyes open as a result of having ptosis which can  lead to symptoms of eye strain, an ache in the eyebrow as you start to use the muscles of the brow to keep the eyes open and symptoms of tiredness from the extra effort to keep your eyes open. 

Ptosis can be present at birth which is known as Congenital ptosis or develop in adulthood which is known as acquired ptosis.  

 

Acquired ptosis commonly develops with long term contact lens use, injury to the eyelid or after cataract surgery or other eye operations. Acquired ptosis may also develop with time and persistent eyelid rubbing is thought to have a risk of developing ptosis. There are less common causes of ptosis and drooping of the eyelid such as problems with the nerves to the upper eyelid or problems with the muscles of the eyelid.

Acquired ptosis can cause a droopy eyelid due a defect in the eyelid muscles or the nerves which can be due to ageing or injury to the eyelid.  A rare cause of eyelid droop and ptosis is weakness of the eyelid muscles caused by conditions such as Myasthenia Gravis or Myotonic Dystrophy.  If the nerves to the eyelid muscles become paralysed this can cause a droop and ptosis of the upper eyelid.  The eyelid can also develop ptosis if there is a weight pulling the eyelid down such as a large cyst or swelling of the eyelid.

 

Congenital ptosis where a droopy eyelid is present at birth may be a purely cosmetic concern affecting the appearance of the child but it can affect the visual development in which case surgery is required in childhood to correct the drooping of the upper eyelid. Surgery in childhood is also considered if there is an issue with confidence of the child and issues of bullying at school affecting their educational development.

Marcus Gunn or 'Jaw Winking Ptosis' is where the droopy eyelid rises with the opening of the mouth and jaw or when chewing.  It is usually noticed in children and most commonly affects one eye only.  It is caused by an abnormal connection of the nerves.  Although is only affects one eye performing surgery on the affected eye may result in drooping of the other eye. In such cases ptosis surgery is needed on both eyes to correct the eyelid drooping. Whether this is necessary will be clarified by your doctor.

There are different types of surgery done to treat ptosis and treat the drooping of the eyelid depending on the cause.  If there is a ptosis and your doctor finds that the eyelid muscle is working well then surgery is done to shorten the eyelid muscles and tendons to bring the upper eyelid up and correct the droop.  If there is ptosis and the eyelid muscle is not working well then the eyelid is suspended from the eye brow in order to provide the lift required to treat the ptosis. 

 

Why is Ptosis surgery done for a droopy eyelid?

Ptosis surgery is the surgical treatment to lift the eyelid back to a normal position. This treatment helps improve the vision caused by the eyelid drooping over the eye. It may also be done for cosmetic reasons if there is no blockage of vision to give a more youthful and left tired appearance and treat any aching in the eye brows as they strain to lift the eyelids.  In children ptosis surgery is done to help improve the vision and treat any issues of bullying and its effect on their educational development.  Ptosis surgery can also help improve a person's confidence.

Risks

 

Possible risks of ptosis surgery include:

Infection

Bleeding from the surgery

Dryness and irritation of the eyes

Difficulty closing the eyes

Scarring (although this is usually put into the eyelid skin crease to hide it as much as possible)

Skin discolouration

Facial asymmetry

Drooping of the other eye if one eye is treated

A need for follow up surgery

Temporary blurring of the vision

Rarely, loss of vision

Risks associated with surgery more general including anaesthetic reactions and blood clots

To know which risks most apply to you talk to your doctor to understand more about ptosis surgery  as well as the benefits and if they apply to you. This way you can decide with your doctor if ptosis surgery is a good option.

How you prepare for ptosis surgery

 

Before having ptosis surgery you will meet your Oculoplastic surgeon who specialises in ptosis surgery to discuss:

Your medical history including any previous surgery and current eye conditions.

Your expectations with an honest discussion about what can be realistically achieved.

A vision examination to check the eyes prior to surgery.

A physical examination of  the eyelids to ensure that this is the correct procedure.

Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.

It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during ptosis surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your ptosis surgery and will tell you how long before the operation.

Stoping smoking several weeks before surgery can help improve the healing after ptosis surgery.

You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.

What you can expect before the procedure

 

Ptosis surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your eyelids to numb the area and you can also have medication through a drip to help you relax. Mr Ahmad Aziz is specialised in ptosis surgery and is able to give just amount anaesthetic to remove any discomfort whlle not giving too much to distort the results. Surgery is usually done in Central London.

What you can expect during the procedure

 

If the eyelid muscle is functioning well, your surgeon will make an incision along the fold of the eyelid, shortening the eyelid muscle and tendon to lift the droopy eyelid. As your awake during the surgery they will ask you to look up and down to get the eyelid height just right. The surgeon then closes the incision to give a natural appearance and hiding the scar within the eyelids natural creases to hide the scar as best as possible.

If the eyelid muscle is not functioning well, your surgeon will correct the ptosis by suspending the eyelid to the eyebrow using small incisions in the brow and the eyelid skin crease. The suspension material remains under the skin so that it is not visible.

What you can expect after the procedure 

 

After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.

After surgery you may temporarily experience:

  • Blurred vision from the lubricating ointment applied to your eyes at the time of ptosis surgery

  • Watering of the eyes

  • Sensitivity to light

  • Double vision

  • Puffy, numb eyelids from the anaesthetic and ptosis surgery

  • Swelling and bruising similar to having black eyes which will settle within a week

  • Pain or discomfort

Your doctor will likely suggest you take the following steps after surgery:

  • Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling

  • Gently clean your eyelids and use prescribed medication.

  • Avoid straining, heavy lifting and swimming for a week after ptosis surgery.

  • Avoid strenuous activities, such as aerobics and jogging, for a week.

  • Avoid smoking.

  • Avoid rubbing your eyes.

  • Not to use contact lenses for about four weeks after surgery.

  • Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.

  • Sleep with your head raised higher than your chest for 3 days after the surgery.

  • After a few days, return to the surgeon to have stitches removed, if needed.

Seek medical attention immediately if you experience any of the following:

  • Shortness of breath

  • Chest pain

  • An unusual heart rate

  • Severe new eye pain

  • Bleeding

  • Vision problems

Results

 

Many patients are satisfied with the results of ptosis surgery and benefit from a more youthful appearance, better vision if the peripheral field was being obstructed and more self confidence. The results of the surgery can last a lifetime but for others the drooping may recur with time. 

The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. 

Scars from the surgery can take months to fully fade but should be within the skin crease and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.

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