Ptosis Repair

What ptosis is

Blepharoptosis, usually shortened to ptosis, is a drooping upper eyelid margin. It is not the same as excess skin in the fold, though the two often occur together and are frequently mistaken for one another.

The most common cause is dehiscence or detachment of the levator, the muscle that lifts the lid. The muscle itself still works, but its attachment has stretched away from where it should sit.

How it is repaired

Where the levator has detached, the muscle is advanced and reattached to the tarsus, the firm structure in the lid where the insertion normally sits. Where the ptosis is myogenic and the muscle retains some function, resection of the muscle may be required instead.

When the muscle has little or no function, a frontalis sling procedure is used, connecting the lid to the brow so that the forehead muscle does the lifting.

Why the surgeon matters here

Ptosis repair is a complex procedure and is best performed by an oculoplastic surgeon with substantial experience of the delicate anatomy involved. The operation has to deliver normal lid level, contour, symmetry, an appropriate crease and fold, and good lash position, all at once.

A functional result and an optimal cosmetic result are not automatically the same thing. A lid can be lifted clear of the pupil and still look wrong: too high, asymmetric, with a peaked contour or a crease that no longer matches the other side. Training in oculoplastic surgery is specifically about achieving both at the same time.