“I use an analogy about correction of ptosis compared with routine upper eyelid surgery. I say it’s like piloting a plane compared to driving a car.” – Dr. Amiya Prasad
What is Ptosis?
Ptosis refers to the drooping of the upper eyelid due to the supporting muscles not being strong enough to raise the eyelid properly.
Ptosis surgery may be necessary when the ptosis has caused the eyelid to partially or completely block vision. The most common type of ptosis in adults is “involutional ptosis”, and results from the stretching or thinning of the supporting eyelid muscles, the levator muscle (specifically the levator aponeurosis), which is responsible for lifting the eyelid.
The drooping eyelids can occur slowly over time, and people assume that the eyes have gotten smaller. It can also be seen in younger people since it is sometimes congenital. For people dealing with ptosis, changing eyeglasses and undergoing other surgeries (i.e. cataract surgery) will not solve the issue; however, eyelid ptosis surgery can improve vision and appearance. Surgical correction of ptosis is a technically-advanced procedure and requires years of experience, so be sure to seek out a specialist to do your ptosis surgery.
Internal and External Causes of Eyelid Ptosis
Ptosis Surgery Before and After
Ptosis related to aging
Ptosis related to a disease.
Congenital ptosis (born with drooping eyelid).
Ptosis Surgery Frequently Asked Questions
What Causes Ptosis?
There are two types of eyelid ptosis—congenital or acquired. Congenital ptosis exhibits variations in the severity of the muscle function of the levator muscle and is a condition that one is born with. Acquired (or “mechanical”) ptosis develops later on in life due to a physical factor—usually tissue—that interferes with the function of the eyelids. Patients who have undergone laser vision surgery can sometimes develop mechanical ptosis, due to the weakening of the levator muscle.
Do I have Eyelid Ptosis or Extra Skin?
Ptosis is a physical condition concerning the eyes, wherein the margin of the eyelid in relation to the pupil is lower than average, making eyes look droopy or sleepy. When the presence of excess skin over the eyelid weighs down on it and causes it to droop, this is called “mechanical ptosis”. During an initial examination, Dr. Amiya Prasad will determine whether the droopiness is caused by ptosis or extra skin, and once this is identified, he will proceed with the appropriate procedure (ptosis surgery or blepharoplasty).
How Can I tell If I Need Blepharoptosis or Blepharoplasty?
The positioning of the eyelid margin relative to the pupil is a deciding factor on whether you will need blepharoptosis repair or blepharoplasty.
Blepharoptosis is defined by the eyelid margin being lower than it normally is, leading to tired and sleepy looking eyes. Dermatochalasis, on the other hand, refers to excess skin that weighs down on the eyelids and gives eyes a hooded appearance. Dermatochalasis can be easily corrected by undergoing blepharoplasty. In some cases, the presence of ptosis can be overlooked, especially when a plastic surgeon incorrectly assumes that a blepharoplasty will fix the problem of drooping eyelids. In other cases, it is not uncommon to find the presence of both dermatochalasis and blepharoptosis in a patient, although this can prove to be a little tricky when devising a surgical plan for.
What Causes One Eye to Droop and How to Fix it?
If dermatochalasis is present (excess skin weighing down over the eyes), Dr. Amiya Prasad can correct it by means of a blepharoplasty procedure. If ptosis is present, then ptosis surgery is performed. Like with any surgical procedure, it is important to seek out a specialist and get a thorough diagnosis first before any final decisions are made.
Who Performs Ptosis Surgery?
Ptosis surgery and eye surgery in general, is a complex procedure that requires the skills, training, and experience of an expert, Dr. Amiya Prasad recommends that patients approach an oculoplastic or oculofacial plastic surgeon to help them with their case. He also advises patients not to be completely dependent on the term “Board-certified surgeon” as an indicator of knowledge and experience, as many general surgeons that use this label lack the skills needed to perform such procedures properly.
Is Ptosis Surgery Dangerous?
In any surgery, the risk of bleeding, swelling and infection is possible. The type of anesthesia used—whether it is general, local, or local with sedation—also pose certain risks. It is important for patients to understand the risks that are specific to ptosis surgery. These include the following:
(1) Under-correction of ptosis, wherein the eyelid still looks droopy after surgery.
(2) Overcorrection of ptosis, wherein the eyelid is too open.
(3) Poor cosmetic appearance, scarring, and complications due to infection and swelling.
It is crucial for a patient to talk with their surgeon about the possible risks of surgery in order to decide on a procedure suitable for them.
What are the Alternatives to Ptosis Surgery?
If your eyelid ptosis significantly interferes with your vision and causes distress from a cosmetic standpoint, then ptosis surgery ought to be considered in order to improve it. Oculoplastic surgeon Dr. Amiya Prasad recommends that patients do research and meet with an experienced oculofacial plastic surgeon that focuses in this type of surgery.
Can You Fix Ptosis Without Surgery?
Ptosis is the result of a physical defect in the levator muscle of the eyelid, for which surgery is the best possible solution. If surgery is not preferred, a special kind of eye drop can be used to provisionally lift the Mueller’s Muscle (an auxiliary muscle 1-2mm in size). This can make the eye look more open for a certain period of time and can be used during special occasions, especially those wherein one needs to pose for many photos. Keep in mind, however, that this is not meant for long-term use.
Will My Vision Change after Ptosis Surgery?
Since eyelid positioned is corrected, most people notice an immediate improvement in their vision right after ptosis surgery. After ptosis surgery, most patients see an instant boost in their vision. Patients have expressed that their surroundings look brighter and that it has become easier to keep their eyes open.
Eyeglasses may be worn after surgery, but Dr. Prasad advises against wearing contact lenses for at least one week, mostly because an antibiotic ointment will periodically have to be placed over the eyelids and may reduce the effectiveness of the contact lenses. When one does begin using contact lenses a week after surgery, lubricating eye drops must be used regularly. It would also be wise to double-check your contact lens prescription, since ptosis can cause minor astigmatism.
How is Ptosis Surgery Done?
Ptosis surgery is intended to restore proper symmetry to one or both eyelids. To determine the proper symmetry before the surgery is done, the patient is instructed to open and close their eyes in both a lying and upright position. This will let the surgeon check to see if the balance between both eyelids is correct, or if any adjustments need to be made. After that assessment, the surgery can proceed. In Dr. Amiya Prasad’s practice, ptosis surgery is done with his LITE IV sedation technique. This sedation method allows patients to recover from surgery feeling more refreshed. While recovering, cold packs are applied and patients are usually able to go home without any dressings.
What to Expect After Ptosis Surgery
To give a patient a positive experience in both the surgery room and recovery room, Dr. Amiya Prasad has focused on enhancing the following areas: (1) the anesthesia method, (2) the surgical team, (3) the surgical technique, and (4) the post-operative recovery process.
How does the Recovery for Eyelid Ptosis Correction Surgery Compare to Blepharoplasty?
Recovery from ptosis surgery isn’t any different from recovery from an upper eyelid blepharoplasty procedure. In some cases, swelling may last longer depending on any complications that occur during or after surgery.
Is Ptosis Surgery Permanent
Some aspects that can determine whether additional surgery is needed are as follows:
(1) The type of ptosis the patient has
(2) The age when the patient had the procedure
(3) Any changes related to aging
(4) The elasticity of the patient’s tissues
For example, a child with congenital ptosis can have corrective surgery before reaching the age of 6, and then once more during their teens or young adult years. Patients with mechanical ptosis, however, can achieve long-term results with ptosis surgery, without needing additional surgery. One may consider having additional surgery if there are any concerns regarding height, symmetry, or contour that they would like to be addressed.
After Ptosis Correction Surgery, Will My Eyelid Look the Same as Before?
If ptosis is present in both eyes, then adjusting the height of the eyelids (by raising them) should improve their overall symmetry. If only one eye is affected by ptosis (unilateral ptosis), Dr. Prasad will simply match its shape and symmetry to that of the other unaffected eye.
How Much Does Ptosis Surgery Cost
Surgery costs are determined by the following: (1) surgeon’s fee, (2) anesthesia, (3) facility costs, and (4) aftercare. Keep in mind that the ability to perform surgical procedures well is the result of years of training, meticulous study, and rigorous practice. Understanding the value of the work that goes into providing a high level of treatment usually helps patients understand how surgeons arrive at their fees.
Take the next step to improve your upper eyelid ptosis and contact our offices to set up a meeting with Oculoplastic surgeon Dr. Amiya Prasad. Our staff would be happy to assist you with hotel accommodations and travel arrangements in New York City or Garden City, New York if needed. Please note, that we have several members of our staff who are fluent in Spanish should this be desired.