Ptosis means droopy. Upper eye (blepharoptosis) means drooping of the upper eyelid(s), where the upper eyelid margin (where the lashes are) is lower than normal. It can be symmetrical, where both eyes have the same amount of droopy eyelid, or it can be grossly asymmetrical, making the two eyes look like different sizes. The droopy upper eyelid can range from very mild to severe. If mild, it can be subtle and not noticed by the patient or others, or it may just be a cosmetic problem, especially if asymmetrical, with one eye worse than the other, causing uneven eyes and eyelid fold/crease.
Eyelid ptosis can cause the patient to look sleepy, tired or even drunk! Fortunately, mild eye skin drooping usually does not affect vision. Cosmetic eyelid ptosis surgery can be performed to lift the upper eyelid, creating a more symmetrical, youthful, and wakeful eye appearance. If the droopy eyelid is severe, it can cause obstruction of the field of vision and the patient will have difficulty keeping his/her eyes open. In these cases, the patient will elevate or arch their eyebrow in order to assist lifting the upper eye fold. This visual obstruction can be relieved when the upper eyelids are lifted (eyelid ptosis surgery or droopy eyelid surgery). It is important to note that children with blepharoptosis may develop lazy eye (amblyopia) with permanent vision loss if not addressed promptly.
What Causes Droopy Upper Eyelid?
There are various causes of upper eyelid droopiness (ptosis), including congenital or inherited (born with it), traumatic, neurologic, and most commonly age-related loosening/weakening of the levator muscle tendon (muscle responsible for lifting the upper eyelids). The levator muscle lifts the upper eyelids about 20,000 times per day, every day! One can imagine that the tendon attachment can get loose, which causes the upper eye fold to drop (ptosis). This weakening of the levator muscle or tendon can be exacerbated by any previous eye surgery due to stretching of the muscle or tendon. Wearing contact lenses long term, especially hard contact lenses, have also been shown to affect the levator muscle and cause the upper eyelid to droop.
The most important factor to consider in evaluating true eyelid ptosis is to rule out other causes of pseudo-ptosis, including dermatochalasis (excess puffy upper eye fold skin/fat) and droopy eyebrows. As mentioned earlier, the position of the upper eyelid is determined by the levator muscle/tendon. Excess or puffy upper eye fold skin will NOT change the height but can give the illusion of it. The treatment for this would be upper blepharoplasty where excess skin/fat is removed from the upper eye folds.
Droopy eyebrows can also cause heaviness of the upper eyelids and give the appearance of hooded, saggy, droopy upper eyelids. The treatment for this would be brow lifting. Many patients have a combination of the three factors that contribute to “droopy” upper eye folds (ptosis, dermatochalasis, and droopy eyebrows), requiring a combination of eyelid ptosis surgery, upper blepharoplasty, and/or brow lifting.
How is Upper Eyelid Ptosis Corrected?
Upper eyelid ptosis surgery (true droopy eyelid surgery) works by surgically tightening the levator muscles to raise the droopy upper eyelids. There are various techniques available to tighten the levator muscle, also known as a levator resection, depending on the type and severity of the ptosis, strength of the levator muscle, and previous cosmetic eyelid surgery.
Eyelid ptosis repair can be performed through a posterior eyelid approach with incisions behind the upper eyelid (internal ptosis surgery, mullerectomy, or a muller muscle resection), resulting in scar-less treatment with an excellent eyelid contour. Eyelid ptosis correction could also be performed from the front skin approach (external ptosis surgery), where the incision is hidden in the upper eye fold crease line (same incision as in standard upper blepharoplasty). In congenital blepharoptosis or ptosis due to very weak levator muscle tendons, the upper eyelid has to be linked to the forehead muscle (frontalis muscle) in order to use the forehead muscle to lift the droopy upper eyelids. This technique is called frontalis sling.
It is worth emphasizing the following points again: The term “droopy” upper eyelid is often used loosely. It can mean true droopy upper eyelid (ptosis), or puffy upper eyelid (dermatochalasis), droopy eyebrows, or any combination of these three things. By the same token, the term “Eyelid or Lid Lift” is often used incorrectly or broadly to mean either an eyelid ptosis treatment (levator tightening to raise the upper eyelid) or an upper blepharoplasty (removing excess skin/fat) or an eyebrow lift, or a combination of these. It is crucial for the eyelid specialist to evaluate the patient’s anatomy and figure out which of these factor(s) are involved and discuss the best comprehensive treatment, through either eyelid ptosis repair, upper blepharoplasty, brow lift, or a combination of these treatments. If more than one problem is present, each problem can and should be addressed, which is best done together so the patient doesn’t have to go through multiple operations at different times.
IMPORTANTLY, eyelid ptosis treatment surgery is easily (and should be) performed under local anesthesia with oral sedation (similar procedure as having a dental procedure) or local anesthesia with IV sedation (similar to that used for colonoscopies), to give the best possible result. During this procedure, the patient’s eyelid is numbed using local anesthesia while the patient is relaxed. The patient is able to open and close his/her eye fold during the procedure which helps achieve best eyelid contour and eye symmetry. To better understand your options for droopy eyelid treatment, contact expert eyelid ptosis surgeon Dr. Taban to schedule your initial consultation in our offices in greater Los Angeles area (Beverly Hills or Santa Barbara).
Dr. Taban is also an expert in REVISION eyelid ptosis surgery, using a special technique that takes advantage of existing scar tissue in the eyelids. He has presented on this topic nationally and internationally and has treated many patients from around the world who have had up to three failed ptosis repairs, with great success. Please visit our website, under Revision Eyelid Ptosis Surgery, for more details.
Read more about ptosis eyelid surgery from WebMD.com.
Recovery after Eyelid Blepharoptosis Surgery
The recovery process after eyelid ptosis surgery is practically painless, but there is bruising/swelling of the eyelids for about 7-10 days. Vision remains intact since no patch is needed. The sutures are taken out about 1 week after surgery (although absorbable stitches can also be used), at which time the person can resume normal activities.
Who Should Perform Droopy Eyelid Repair Surgery?
Eye fold corrective surgery should be performed by an oculoplastic surgeon who is a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and a board-certified ophthalmologist who has completed an additional 2-year fellowship training in cosmetic and reconstructive eye plastic surgery.
Dr. Taban is double board-certified by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Board of Ophthalmology (ABO/AAO), and a diplomat of the American Board of Cosmetic Surgery (ABCS). Dr. Taban is an oculoplastic surgeon with expertise in eye fold ptosis treatment and revisional eyelid ptosis surgery.
During your consultation with Dr. Taban in Beverly Hills/Los Angeles or Santa Barbara, he will evaluate your eyes and face and perform tests to determine the best technique for reconstructive or cosmetic droopy eye folds surgery (eyelid ptosis surgery), customized to each individual patient, depending on their exact anatomy/problem and desired goals. Other complimentary cosmetic eyelid procedures can be performed at the same time, if deemed necessary, such as blepharoplasty, canthoplasty, brow lift, eyelid fat injection, etc.
Before (left) and 3 months after (right) Quad-Blepharoplasty (with fat transposition), ptosis surgery, and Braiserre brow support.
Before (left) and 3 months after (right) Quad-Blepharoplasty (with fat transposition), ptosis surgery, and lateral pretrichial brow lift.
Before (left) and 6 months after (right) upper blepharoplasty, ptosis surgery, brow contouring.
Before (left) and after (right) 3 months after maximal ptosis treatment.
Before (left) and 3 months after (right) quad-blepharoplasty and blepharoptosis surgery.
Before (left) and 3 months after (right) quad-blepharoplasty and blepharoptosis surgery.
Before (left) and 3 months after (right) revisional right upper eye fold ptosis treatment.
Before (left) Female patient with right upper eyelid ptosis (droopy upper eyelid). Note the right eyebrow is raised in order to help lift the droopy eye fold. After (right) 2 months after right upper eyelid blepharoptosis treatment (ptosis surgery). Note the right eyebrow is now more relaxed.
Before (left) 32-year-old female, with droopy upper eyelids (ptosis). After (right) 3 months after cosmetic droopy upper eyelid (ptosis) surgery and fat injection.
Next, read about eyelid ectropion and eyelid entropion.