Ptosis (Droopy eyelid)

One of the commonest conditions we treat, ptosis refers to the height of the upper eyelid drooping, leading to a smaller eye on one or both sides.

There are several causes for eyelid ptosis, commonest one being the gradual stretching and wear-and-tear of the muscle which lifts the eyelid.

A long history of contact lens wear, previous eye operations and trauma can lead to a droopy eyelid (Blepharoptosis).

Occasionally, individuals are born with one or both eyelids drooping and correction for this may be advisable at a younger age to promote good eyesight development. More rarely, a descended eyelid might be the sign of an undiagnosed medical condition for which tests ought to be carried out.

Ptosis should not be confused with hooding or bagginess of the upper lids which occurs due to excess skin or fatty tissue and requires different treatment in the form of blepharoplasty.

In the vast majority of cases, eyelid ptosis correction is offered as day surgery with downtime of no longer than one week. If a surgical incision is required, a small hidden incision is almost always employed in our practice, meaning no scar will remain visible. When carried out by specialist eyelid surgeons, Ptosis correction is a safe procedure, associated – in numerous clinical studies – with a very significant quality of life improvement.

When indicated, ptosis correction can be combined with blepharoplasty surgery, resulting in more open but also more youthful, restful and symmetric eyes.

How is eyelid ptosis corrected?

Upper eyelid ptosis surgery works by surgically tightening the levator muscle to raise the droopy upper eyelid. 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 or mullerectomy), resulting in scar-less treatment with an excellent eyelid contour. Eyelid height correction is sometimes best performed from the front skin approach (external ptosis surgery), where the incision is hidden in the upper eyefold 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.

What does the surgery involve?

Upper eyelid ptosis repair can be carried out under local anaesthesia, intravenous sedation or general anaesthesia, depending on your preference and what is deemed safest. Adult surgery is usually best carried out with the patient awake, as cooperation during the procedure allows for better adjustment of the final eyelid height.

In case of external approach ptosis repair, a fine incision is designed which follow the natural lines of your eyelids – hidden in the skin creases of the upper eyelid.

The levator muscle is identified and typically shortened and sutured with fine hidden stitches on the inside of the eyelid. The skin incision is then meticulously repaired with tiny sutures which are removed 6-10 days after surgery.

At the end of the procedure, antibiotic cream is applied over this area. Dr Koutroumanos will ask you to apply a similar ointment three times a day for five to seven days post-operatively.

Bandages or padding are seldom used and if required this will almost always be applied for a short period right after the procedure and removed by Dr Koutroumanos’ team before you head home.

An ice pack will usually be applied on your eye immediately after the procedure.

What can I expect immediately after surgery?

Recovery following upper lid ptosis repair is fairly comfortable with 1-2 weeks of variable amounts of swelling and sometimes some bruising in the eyelid skin. Depending on your activities and line of work, Dr Koutroumanos will advise anywhere between 1-2 weeks of down-time but most people can resume most activities within a few days.

You will be able to get up and about on the evening of the operation and minimal pain is to be expected if any, easily controlled with simple painkillers. Rest is advised for 48 hours after the procedure and any form of exercise can resume usually 3 weeks after surgery, though it is completely safe to go for a brisk walk anytime after day 3.

It is important to note that the amount of bruising and swelling as well as their speed of recovery varies from individual to individual.

Both however can be improved by using cold compresses and sleeping propped upright for the first few days after surgery.

It is important to remember that you will not be able to drive or operate machinery for 48 hours after a general anaesthetic and 24 hours after intravenous sedation.

Wound care is not complicated. You should try to keep the wounds dry for the first 48 hours, after which period gentle washing (but no scrubbing) is safe. By the time sutures are removed, around day-6 to day-10, normal washing can be resumed. Make- up is best avoided for the first 10-14 days post-operatively.

Within 3-4 weeks, most if not all of the eyelid swelling will have subsided.

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