Ptosis surgery and other eyelid procedures can easily fix a drooping upper eyelid or a sagging undereye.
Due to the aging process, unprotected sun exposure, stress, and smoking, our facial skin can lose elasticity over time, giving you undesirable sagging eyelids. These unwelcome aesthetic changes not only can impact your appearance but also affect functionality with negative effects.
Indeed, these procedures are not primary cosmetic procedures. They aim at improving functionality first, although they can have a great impact on your overall look. They are minimally invasive yet effective.
These surgical procedures are performed along with cosmetic or reconstructive eyelid surgery when the eyelids need to be supported and strengthened.
Written by Dr Osama Bahsas Zaky
Updated on October 29, 2021
What is Ptosis?
Ptosis is the medical term to describe a droopy upper eyelid over your eye. It is a medical condition that can affect both children and adults, causing one or both upper eyelids to droop down lower than normal. Ptosis appears when the levator, the muscle that lifts your upper eyelid, stretches and weakens.
Children with ptosis are born with the condition (congenital) due to a defect of the muscle that lifts the eyelid. If left untreated, congenital ptosis can affect the child’s visual development with amblyopia (lazy eye) or misaligned (crossed) eyes.
Adults commonly develop ptosis (involutional or acquired ptosis) through aging, which stretches the tendon and muscle of the eyelid.
Also, ptosis can occur after eye trauma, eye surgery (e.g., cataract), or after repeated contact lens usage.
In other cases, ptosis can result from an underlying neurological condition, such as myasthenia gravis or third nerve palsy (Bell’s palsy).
Cosmetic issues aside, drooping eyelids can lead to several medical problems, including an interrupted vision field, blurred vision, or watering of the eye.
Patients constantly need to raise their eyebrows (leading to brow ache and headaches), lift their chin, or tip their head back to gain clear vision. You can also get fatigued and have eye strain.
So, many patients will decide to undergo surgery to improve the functionality of droopy eyelids. However, ptosis surgery can also be used for cosmetic reasons. It can improve symmetry and eyelid height, making you look younger. Although, not to the extent of full-on upper eyelid surgery (blepharoplasty) where excess skin is cut off.
Ptosis surgery changes the height of the eyelid so that it rests higher on the surface of your eye. The idea is that the eyelid doesn’t obscure the pupil and your field of vision.
Ptosis correction is performed in a way that keeps scarring to a minimum. The procedure involves a hidden incision within the upper eyelid’s natural skin crease.
Sometimes, the surgery can be performed from the inside of the eyelid, leaving no skin scar behind.
Then, your oculoplastic surgeon will place stitches in the levator muscle to strengthen its attachment to your eyelid and achieve a preferable height.
Other Eyelid Alterations
You may present with laxity of the lower eyelid. This, combined with an eyelid malposition, such as ectropion, can cause your lower eyelids to turn outward and sag.
Also, you can get an unflattering rounding of the lateral corner of the eye. This can leave your eye exposed, dry, and prone to corneal abrasions, and infections.
What is Canthopexy?
Canthopexy (not to be confused with canthoplasty) is a minimally invasive eyelid procedure. It is designed to improve the outer corner of the eye where the upper and lower eyelids meet.
Canthopexy is the ideal procedure to treat ectropion and lower lid laxity, as long as it is not severe. It involves the meticulous placement of sutures to tighten and stabilize the lateral canthal tendon (at the outer corner of the eyelid) and orbicularis oculi muscle. There is no detaching or reconstructing involved.
Canthopexy is essentially a lateral canthal tightening or resuspension procedure. It is usually performed with lower blepharoplasty (lower eyelid lift) to tighten the lower eyelid and create a more shaped almond eye.
What is a Xanthelasma?
A xanthelasma is a white spot or small yellowish fatty deposit that forms around the inner corners of the upper and lower eyelids.
In some cases, xanthelasmas are associated with high cholesterol levels in the bloodstream. So, they are essentially fatty cholesterol deposits around the eyes.
Your eyelid function is not generally affected. But, because xanthelasmas tend to grow, it is better to treat them early. Also, they can be a cosmetic nuisance for many patients.
For most xanthelasmas, you can get surgical excision to remove sections of the lid’s skin. Also, you could go for Yag laser techniques involving the vaporization of the affected tissue.
Eyelid Procedures: Ptosis Surgery, Canthopexy, and Xanthelasma Removal
The procedures are usually performed under a local anaesthetic (numbs the area), with or without intravenous sedation. All ptosis correction in small children is performed under general anaesthesia, though. You won’t feel any pain. Just a pulling sensation may be noticeable.
Ptosis surgery is an outpatient procedure and takes between 45 to 90 minutes, depending on the cause of ptosis.
Canthopexy is pretty quick and can last under 30 minutes.
The ptosis/canthopexy surgery involves tightening the muscles (tendons) of the eyelid by placing sutures in strategic places.
Conversely, with xanthelasma removal surgery, the fatty lesion is excised entirely, and the incision is closed with a few small stitches. This procedure is highly effective but limited to patients with smaller xanthelasmas because removing too much eyelid tissue may leave the skin too tight.
For younger patients, radiosurgery or laser may be more appropriate. This is an outpatient procedure performed in the consulting room.
Aftercare And Recovery from Ptosis Surgery and Eyelid Procedures
A padded dressing will be placed on the eyelid to help reduce the swelling. This should be left on the first 24 hrs.
After the procedure, you are likely to be in a bit of pain and discomfort for a few days. But nothing that paracetamol cannot resolve.
Your doctor will prescribe ointment and eye drops to prevent dryness, itchiness or irritation. You should try to keep the wound clean and dry.
On day five after the surgery, you can start to wash your eyelids gently. This will help to clean the stitches and make it easy to remove them.
Also, your doctor may provide you with an antibiotic ointment to use for three to five days. After one week, he will ask you to come for a follow-up appointment and remove the stitches.
It is common to experience bruising and swelling while recovering from ptosis surgery and other eyelid procedures. The severity will differ depending on the patient, though.
For most patients, the bruising on the upper eyelid subsides within 7-10 days.
Swelling and bruising can be reduced by placing an ice pack on the eyelids. Also, sleeping in a semi-sitting position for the first couple of days can help.
To avoid irritation, swimming is out of the question for the first couple of weeks following surgery. Also, we suggest patients avoid bending down, heavy lifting, and strenuous physical exercise for two weeks.
We recommend not wearing contact lenses and make up the first weeks. Also, if you go out in sunlight, always wear sunglasses to protect your eyes.
The aftercare of eyelid surgery is quite minimal, with most patients returning to work soon afterward. Recovery times are generally fast, with complete recovery within 14 days.
Complications from Ptosis Correction and Eyelid Procedures
In the case of ptosis surgery and canthopexy, blurred vision is common for several days. Infection or bleeding is very rare.
Dry eyes are frequent after ptosis correction. You may present with sore eyes and a gritty feeling. As such, your eye doctor will prescribe you artificial tear drops or ointment to help lubricate the eyes and relieve any discomfort.
Asymmetry of eyelid shape, placing the lid too high or too low, or creating an unnatural lid crease can occur with ptosis surgery.
Also, beware that a patient with “unilateral ptosis” may actually have a bilateral condition. Hence, when the clearly ptotic lid is corrected, the opposite lid may look more asymmetric once the procedure unmasks the “hidden” ptosis of that lid.
With canthopexy, there is the risk of developing entropion (eyelid pulled inward) if the eyelid is pulled too tight. So, the success of the surgery depends on getting the correct amount of tightness: not too tight and not too loose.
Hence, you should put yourself in experience professional hands to avoid these unwanted complications. Always choose a highly skilled oculoplastic surgeon with experience in eye procedures.
Recurrence of ptosis can occur early post-surgery (3 months) or after a few years, though. This may happen due to stretching of the scar or early suture dissolution.
With xanthelasma surgery, the lesion can return in the same spot or a different one.
Also, care must be taken to avoid scarring, pigmentary changes, and everted eyelid (ectropion), especially with more aggressive xanthelasma treatment.
How much does Eyelid surgery cost?
Eyelid surgery cost depends on the technique performed.
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External links – Bibliography
Updates on upper eyelid blepharoplasty. Bhattacharjee K, Misra DK, Deori N.
Congenital ptosis. SooHoo JR, Davies BW, Allard FD, Durairaj VD.
Pathology Of « Post-Upper Blepharoplasty Syndrome »: Implications For Upper Eyelid Reconstruction. Steinsapir KD, Kim YD.
The Effect of a Ptosis Procedure Compared to an Upper Blepharoplasty on Dry Eye Syndrome. Zloto O, Matani A, Prat D, Leshno A, Ben Simon G.
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