Droopy eyelid is given the medical name of ptosis. Most commonly it is a change that develops with ago but it can also develop at any age due to trauma, neurological problems, and muscular problems, It ptosis is present at birth then is called congenital.
The muscle that lifts the eyelid is called the Levator muscle. Involutional ptosis is when the Levator disinserts from the eyelid which results in the eyelid drooping. Myasthenia Graves is another condition that can cause a ptosis that varies in severity.
Congenital ptosis which is present at birth can vary in severity and the eyelid surgery used to correct it may differ from the surgery done in adults.
What is ptosis surgery?
If your eyelids are droopy, blocking your vision or are giving you a tired appearance ptosis surgery may be indicated. This is an operation that is performed by surgeons specialised in Oculoplastics.
There are a number of different approaches used to correct ptosis.
As the most common cause of ptosis is involutional ptosis where the levator muscle disinherits from the eyelid, an aponeurosis repair is the most common procedure performed. This involves reattaching the levator muscle back to its original position in the eyelid and fixing the disinsertion. It can be performed through a skin incision that usually hides in the skin crease or from the underside of the eyelid without a scar.
A more simple yet highly effective procedure for small amounts of ptosis is the Muller's muscle resection. An incision is made on the undersurface of the eyelid and the Muller's muscle is tighten with stitches. It may not be the procedure of choice however for those who wear contact lenses, have dry eye or have a poor response to a phenylepherine drop test performed at the initial consultation.
For those who have a levator muscle that does not offer a good range of movement a different procedure known as a brow suspension or frontal suspension is performed. This is where the eyelid is suspended to the brow to keep it from drooping.
Can you get ptosis surgery on the NHS?
Ptosis surgery is offered on the NHS if it is interfering with your vision. Photographs are taken and a visual field test is performed to assess the degree to which any excess skin and drooping is blocking the vision. You cannot get ptosis surgery on the NHS if it is a cosmetic problem.
What is the procedure for ptosis surgery?
These are the steps in the surgery for involutional ptosis:
At the start of the procedure the eyelids are cleaned with antiseptic and numbing drops are put in the eyes.
The eyelid skin crease is marked to identify where the incision is placed.
Local anaesthetic is given to numb the eyelid.
The ptosis surgery is performed.
The patient is asked to open and close their eyes when the elevator muscle is reattached to ensure the lid height and curve is the same and symmetrical.
Any incisions are then closed.
How long is the recovery from ptosis surgery?
Following the surgery expect to have bruising and swelling that will last for about 2 weeks before it settles. In some people it may take a bit longer.
Your vision will be blurred after the operation due an ointment placed in the eyes to stop them from getting dry.
Eye patches are used to reduce the amount of swelling. If one eye is done it is advised to leave the patch on until the following morning. If both eyes are operated on then two patches are used and one patch can be removed an hour later.
Most people are able to go home the same day as the operation but make sure you have someone with you to take you home and stay with you until your vision is no longer blurred. You should not drive until the vision clears.
If you are able to work from home some people find they can get back to work the following day, otherwise take at least 1 week off work. For those that are not able to go out in public with bruising, 2 weeks off work may be needed.
You will usually be seen 10-14 days after the procedure to assess the eyelid height and remove any stitches. You are then seen again 2 months later to assess the near final result once all the swelling has settled.
Are you awake during ptosis surgery?
Ptosis surgery is very intricate and it is best formed whilst awake to get the best possible result. For those who are nervous a small amount of sedation can be used. If too much sedation is used then you will become too drowsy and your surgeon will not be able to fine tune the eyelid heights accurately.
What are the risks of ptosis surgery?
The biggest risk of the procedure is over or under correction which can occur in 10% of cases. This can be caused by failure of the procedure or by changes in the nerve signals to the eyelids that lift the eyelids following the surgery. It is why the surgery is mostly done under local anaesthetic to reduce the iris of over or under correction although it still occurs. Lid traction exercises by pulling on the upper lid lashes and then looking up can help reduce and over correction but an under correction will most likely need redo ptosis surgery.
Once the eyelids are no longer droopy there is a risk of dry eye. As the eye is more open it is more exposed to the wind and evaporation and any dry eye you previously had could get worse.
A skin crease incision approach usually gives an excellent result with a hidden scar in the skin crease. If you scar significantly or expose the scar following the surgery to a lot of sun without sunscreen if can become pigmented or more obvious.
Hang up is where the eyelid looks slightly higher when looking down. This can happen following the surgery. People tend to find this more acceptable than having a droopy eyelid as they don't usually look down when communicating with others.
Lagophthalmos is where the eyes remain slightly open when you close them. This can also result in increased dry eye and would require lubricants.
How much does ptosis surgery cost?
Depending on whether just one eye or both eyes need doing and whether it can be done under local anaesthetic alone or with sedation; ptosis surgery can cost from around 2000 pounds upwards. For those that have private medical insurance this procedure may be covered by your policy if the ptosis is blocking your vision and is not done for cosmetic purposes alone.
Is ptosis surgery for me?
Ptosis surgery is a good option if you are concerned about your droopy eyelid, it is blocking your vision or affecting your confidence. The approach taken for the surgery is tailored to the patient and is assessed at the initial consultation with Mr Ahmad Aziz who is very experienced in this surgical procedure. He also performs redo ptosis surgery for people who have had ptosis surgery elsewhere and are unhappy with their results.
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