As we age everything sags to some degree. Your upper eyelids are not immune. Drooping upper eyelids can be annoying to see in the mirror from a cosmetic standpoint, but as they advance downward, they can droop enough to actually impair vision. The clinical term for this eyelid sagging is Ptosis. As an Oculoplastic Surgeon, W. John W. Murrell M.D. uses surgery to correct Ptosis.
What is Ptosis?
Ptosis is simply a drooping upper eyelid. If a person has this condition, the border of their upper eyelid falls to a lower position than normal. Ptosis can affect one or both eyes.
It may be present at birth (Congenital Ptosis), or it may develop gradually as we age. Ptosis can be a cosmetic nuisance, or it can sometimes be a warning sign of a more serious condition affecting the muscles, nerves, brain, or eye socket. Ptosis that develops quickly, in a period of days or even hours, signifies a serious medical problem.
What are the symptoms of Ptosis?
The most obvious symptom of Ptosis is a drooping eyelid affecting one eye (unilateral Ptosis) or both (bilateral Ptosis). If your Ptosis is severe, your eyelid is beginning to block some of your vision. People with this degree of drooping may tilt their head back to see better, or they may need to raise their eyebrows to try and clear their vision.
This type of adult Ptosis is a gradual process. You can see the changes in your eyelid position by comparing facial photos from your younger days to now. The descension of your eyelids will be obvious, and for some, pronounced. In children the condition is congenital. It shows in the eyelid creases not being even between the eyes.
Children with Ptosis also have the tendency to tilt their head backwards or force their eyelids open wider to compensate. In children, severe congenital Ptosis can also lead to vision impairment if the drooping eyelid heavily blocks the vision in one eye. In these cases, the brain will begin to ignore the signals from that eye, and this can stunt the development of that eye, a condition known as amblyopia or lazy eye.
What causes Ptosis?
In children, Ptosis is congenital, as mentioned above. In adults, Ptosis usually develops over time as the levator muscle stretches or separates from the eyelid. In most cases, this is due to aging, as the skin and muscles around the eyes become weaker. But Ptosis can also develop following eye surgery, such as LASIK or cataract surgery. This can stretch the eyelid.
When is eyelid surgery necessary to correct Ptosis?
The drooping of Ptosis doesn’t require surgery in the early stages. And for some people who are not bothered by the sagging in their eyelids, surgery may never be necessary. But if the drooping eyelid or eyelids begin to infringe upon your field of vision, then surgery is necessary.
Once your vision becomes impaired by the drooping eyelid insurance typically will cover the procedure. Others don’t like the way their drooping eyelids age their face. After all, the eyes are the focal point of the face, so if your eyelids are sagging and droopy that will make your overall face look older.
This is the basis of blepharoplasty, cosmetic eyelid surgery. Ptosis surgery isn’t focused on removing excess skin, as in blepharoplasty, but on tightening the levator muscles.
How does Dr. Murrell perform Ptosis repair?
Unfortunately, one day you won’t awaken to tighter upper eyelids. Ptosis won’t correct itself, so surgery is usually necessary. In children, we’ll first consider age, strength of the eyelid muscles, and other factors. Other conditions such as lazy eye may be treated first. When surgery is appropriate, Dr. Murrell will usually tighten the levator muscle, or he will attach the eyelid to other muscles that can help lift the eyelid.
In adults, Dr. Murrell may only need to make a small adjustment to the levator muscle. But if the patient has excess saggy skin, Dr. Murrell will perform cosmetic eyelid surgery. This procedure removes excess skin and tightens the underlying support muscles.
If the levator muscle has separated from the eyelid, it will be reattached. The one benefit of having Ptosis is that if it requires surgery, Dr. Murrell can also perform the eyelid lift as mentioned above, and insurance will pay for the procedure.
So, you’ll not only see better, but you’ll also have younger looking eyes.
Who Is an Ideal Candidate for Ptosis Treatment?
People with droopy eyelids that interfere with their vision are ideal candidates for ptosis treatment. You may want to consider this treatment if you suffer from factors that can cause ptosis, like aging, nerve damage, and trauma.
Individuals with upper eyelid ptosis and adequate levator muscle function are ideal candidates for internal eyelid ptosis surgery. You might benefit from the treatment of ptosis if your eyelids are causing you vision problems.
How To Prepare for Ptosis Treatment?
If you are considering ptosis treatment, you should speak with Dr. Murrell first. If any tests or preoperative evaluations are needed, Dr. Murrell can provide you with specific instructions on how to prepare for surgery.
- Before the Treatment
Before surgery, avoid taking aspirin and other medications that increase bleeding. Dr. Murrell will provide substitute medicines if you take Marcoumar, Marevan, or Plavix. You may need to reconsider undergoing surgery if your doctor advises against stopping blood thinners due to your overall health.Ten days before the operation, you should stop taking blood thinners after consulting your doctor. On the day before the operation, pick up "ice glasses" from the pharmacy and painkillers like Dafalgan. You may also want to bring sunglasses or a protective hat.
- The Day of Treatment
On the day of the operation, you can eat as usual and take all your regular medication (except for blood thinners). Wear comfortable clothing, and don't forget to remove your contact lenses. However, avoid wearing makeup, mascara, earrings, or necklaces.You can also bring pictures of how you used to look so that you can compare them with your "after" photos. This will allow you to see the difference for yourself and assess the results of the surgery.
How To Clean Your Eyes After Your Ptosis Surgery?
After your ptosis surgery, Dr. Murrell will provide specific instructions on how to care for your eyes. This typically involves keeping your eyes clean and moisturized to prevent infection and promote healing.
To clean your eyes, you should gently wash your face with mild soap and water, taking care not to get any soap or water in your eyes. Avoid rubbing your eyes or applying any pressure to the surgical site. You can also use a damp cloth to clean your eyelids and the area around your eyes gently.
Are There Any Risks Associated With Ptosis Surgery?
As with any surgical procedure, there are some risks associated with ptosis surgery. The most common risks include infection, bleeding, and adverse reactions to anesthesia.
Other early postoperative complications include:
- Lash loss
- Conjunctival prolapse
- Ectropion or entropion
Dr. Murrell will be able to provide you with more information about the potential risks of the surgery and how to minimize them.
Will My Ptosis Return After Surgery?
Drooping of the eyelid may occur again months or years after successful surgery. This is more likely to occur if the underlying cause of the ptosis, such as nerve damage or muscle weakness, is not addressed during the surgery. Further surgery can correct this.
Dr. Murrell can give you more information about preventing ptosis from returning. It's essential to carefully prepare for your operation to ensure a successful procedure and a smooth recovery.
Recovery after Ptosis surgery
As with cosmetic eyelid surgery, surgery to correct Ptosis does not involve a difficult recovery. There will be some swelling and bruising, but we will provide you with a cold compress, and diligent use of it can really help to manage these issues in your recovery. Your eyelid has probably blocked part of your eye for some time, so your eye will now be more exposed, and it will take some adjustment.
During this period, we will provide you with artificial tears to keep your eye lubricated. Your sutures will usually be removed in about one week, and most patients can return to work at that time. Bruising can last up to two weeks. Some swelling can come and go over a few weeks, but it is not dramatic.
When should I expect the results of my Ptosis surgery to be fully evident?
These are immediate changes made by Dr. Murrell. Even with your swelling, you’ll notice a huge difference in how much more you seem to see. Just as telling will be your appearance. You’ll look more alert and refreshed.
You will have some swelling on and off that can continue for a while, but you’ll be pleased with your improved vision and improved appearance immediately.