Ptosis is commonly caused by dehiscence or detachment of the levator muscle. In this type of ptosis, the surgeon advances and reattaches the levator to the tarsus, where the muscle insertion is normally located. Resection of the muscle lifts the lid effectively for myogenic ptosis only if some function of the muscle is present. When the muscle has little or no function, frontalis sling procedures are required. Repair of blepharoptosis is a complex procedure that should be performed by an Oculoplastic Surgeon who has great experience with the delicate anatomy of the eyelids. Ptosis repair requires expertise to achieve normal lid level, contour, symmetry, appropriate crease and fold, and good lash position. “Functional” results are not always synonymous with optimal “cosmetic” results. Oculoplastic surgeons have training and experience to provide you with optimal cosmetic and functional results.
Before and After Photographs
Before & After Repair Left Upper Lid – Levator advanced and reattached. When unilateral surgery is performed, it is up to the patient to decide whether to remove skin on the other side. If blepharoplasty is not desired on the non-ptotic side, then little or no skin is removed from the ptotic side. This patient would have benefited from bilateral cosmetic blepharoplasty in addition to the levator repair on the left side.
Before & After Repair Both Sides – Levator advanced and reattached. This patient would benefit from lateral brow lift on both sides. Some of the skin laxity remains in the lid fold to allow brow lift at a later date, and to avoid pulling the lateral brows onto the eyelids.
Unilateral Congenital Ptosis
Congenital Ptosis Repair – Bilateral Fascia Lata Frontalis Slings Before & After.
Myogenic Ptosis Repair – Bilateral Fascia Lata Frontalis Slings – Before & After. This patient has myogenic ptosis and had several operations prior to visiting me. A bilateral fascia lata sling procedure allows her to open her lids with the frontalis, while permitting complete closure at night.
Ptosis – Levator Dehiscence
Before & After Repair both sides – Levator advanced and reattached.
Hering’s Law of Equal Innervation
Repair right side – Levator advanced and reattached – Before & After. Now the left upper lid is slightly lower because of Hering’s Law of Equal Innervation.
“Jaw Wink”, Synkinetic Ptosis
Congenital Ptosis repair Right Upper Eyelid – Levator resection. This young lady has Jaw Wink or Synkinetic Ptosis. The abnormal movements with jaw action were minimal, but the ptosis was bothersome – therefore, a levator resection was performed.
Bilateral Repair – Levator advanced and reattached Before & After.
What you may expect:
During surgery you will have either oral or intravenous sedation. After the local anesthetic is in place, you will not feel pain or unpleasant sensations. You may be aware of pressure, some movement, and gentle tugging. You will not be able to “see” the surgery as it takes place. After the procedure is complete, you will be able to open your eyes and will likely sense a greater field of vision. Your eyelids will feel “tight”, but you will be able to open and close.
It is wise to allow at least a week or two of healing time before getting back to an active lifestyle. For the first two days, cold compresses while you are awake will help to dissipate the swelling and bruising. Detailed instructions are provided prior to surgery. Antibiotic ointment applied to the incisions helps to dissolve some sutures, prevents infection, and soothes inflammation. It may temporarily blur the vision by getting into the tear film. Most patients have a tight feeling in the eyelids for a few weeks. This is normal and resolves usually by 8 weeks.
Total healing time varies from individual to individual, but generally you are “very presentable” by the beginning of the second week, sometimes as early as 3 days. Follow-up is very important – early to remove sutures and later to evaluate after swelling has disappeared and lid crease incisions have faded. The stability of the lid position, symmetry, contour, and lid crease are evaluated at the later visit to be sure that you are happy with your eyelid, and all parameters are optimal for the health of your eye and eyelids.