Patients develop ptosis, drooping upper eyelids, for a variety of reasons. Traumatic injury, congenital defect or weakness and some neurologic diseases, may cause the eyelid to droop. Ophthalmologists and Oculo-Plastic Surgery Specialists see many cases resulting from a stretched tendon-like apparatus called the levator aponeurosis attached to the levator palpebrae superioris muscle. This levator is the primary muscle responsible for lifting the eyelids and unfortunately, the aponeuroses tends to stretch as we age.
Drooping may be mildly inconvenient where arching the eyebrow helps improve the field of vision, or severe enough for people to have to manually raise the eyelid to be able to see. Ptosis repair isn’t just a cosmetic procedure, although it does improve the physical appearance and lift self-confidence for many people. There is a connection between drooping eyelids and vision loss. Early intervention is the best preventive measure for all age groups. Some children experience developmental delays from vision limitations. And, children may develop amblyopia, commonly called “lazy eye,” as a result of drooping eyelids. Lazy eye may lead to non-correctable vision loss, blurriness and problems with depth-perception.
Ptosis Repair: Outcomes and Expectations
A thorough examination and testing protocol will help the doctor determine which procedure is best for each patient. Surgically improving the tension, by tightening the levator, allows the muscle to lift the eyelid. Patients with minimal interference often respond well to surgery performed on the inner lid muscles. In the most severe cases, Dr. Landmann may perform an operation that enables forehead muscles to compensate for an extremely weak levator.
Ultimately, the goal of corrective ptosis surgery is to two-fold. Enable a full field of vision and achieve bilateral symmetry, where both eyelids look and function similarly.
The procedure is performed in an outpatient procedure room, with minimal anesthesia, typically mild sedation and a local anesthetic combination, allowing patient participation during the procedure. Through an incision in the eyelid, the surgeon examines the levator and aponeurosis for defects and damage.
Depending on the exact cause of the drooping lid, the surgeon may choose one of many techniques, including working from the back side of the eyelid. Along with repairing structural deficiencies to improve vision and enable opening the eye fully, fat and excess skin is removed as a cosmetic approach to maintain symmetry in both eyelids.
Most patients report the procedure is painless or only mildly uncomfortable. Post-surgical discomfort is usually manageable with an over the counter Tylenol.
Recuperation and Recovery
Recovery usually takes place in stages. During the first one to two weeks, it is normal to have some bruising and swelling. Over the next month or so, most of the bruising diminishes, but there may still be swelling up to six weeks after the procedure. But the results will continue to improve over the next 12 months!
Cutting edge technology and minimally invasive techniques reduce post-surgical discomfort. Cool gel masks may relieve puffiness and bruising around the eyes, but patients should avoid cosmetics to mask the bruises for at least seven to ten days. Dr. Landmann may recommend a reduced work schedule and limited physical activity for the first few post-operative days.
Ptosis repair is a delicate, precise surgery. One of the joys of practicing Oculo-Plastic Surgery is helping patients protect their vision while maintaining or improving their appearance. If you need more information about treatment options for ptosis, contact Dr. Landmann’s scheduling team.