Ptosis treatment

Classification of Ptosis

There are three major types of ptosis.

1. Eyelid drooping at birth
2. Acquired ptosis (that occurs in adulthood)
3. Pseudoptosis (without actual muscle or tendon problems)

Eyelid drooping at birth

Sometimes, a person is born with a droopy eyelid.
This is almost always called “simple ptosis” and is caused by the muscles that raise the eyelid not developing properly and instead developing more rigid fibrous tissue.
Usually there is no problem with the movement of the other eye, but if one eye is ptotic, vision may be affected.
Therefore, early treatment may be necessary.

Acquired ptosis

Droopy eyelids often occur in adults, especially as a result of aging.
It is also more likely to occur in people who have used hard contact lenses for many years or have had eye surgery.
In this case, the muscle that raises the eyelid itself is normal, but the tendon where the muscle is attached is weakened, peeled, or punctured.

Pseudoptosis

Pseudoptosis is a condition in which the muscles and tendons that raise the eyelids are intact, but the eyelids appear to droop because the skin is sagging.
When the eyelid is raised, it rises properly, so there is nothing wrong with the muscles themselves.

Treatment of Ptosis

In many cases, surgery is used to treat a droopy eyelid.
The surgery is often performed by an ophthalmologist as well as a plastic surgeon.

Surgery to repair the muscles that raise the eyelids

If the area where the muscle that raises the eyelid is attached is weakened or detached, the area is reinforced or repaired.
If the muscles themselves are weak or the nerves are paralyzed, surgery is performed to raise the eyelids using the forehead muscles.
A tunnel is created between the brow area and the eyelid, and the eyelid is raised through artificial material or fascia.

• Method of cutting the skin
  An incision is made in the skin and surgery is performed along the double eyelid line so that the scar is not noticeable. With this method, sagging skin is also removed at the same time.
• Methods from the conjunctiva
  The surgery is performed from the back of the eyelid without cutting the skin.
  It has the advantage of inconspicuous scarring, but the difficulty of the surgery is high, and in some cases the skin must be cut to remove sagging skin.

Surgery by “Lifting” technique

If the muscles that raise the eyelids are weakened or there is nerve palsy, a method called “lifting technique” is used.
Using the forehead muscles, a tunnel is created between the eyebrows and eyelids, through which artificial material or fascia is passed to raise the eyelids.
This method is effective, but due to the large surgical area, a simplified suture method may be used for children.

Why ophthalmologists as well as plastic surgeons are involved in ptosis surgery

The reason why plastic surgeons as well as ophthalmologists are involved in ptosis surgery has to do with the nature of the procedure.
In addition to improving visual function, it is also important to consider the appearance and overall balance of the face.
For this reason, ophthalmologists and plastic surgeons often collaborate.

• Improve visual function (role of the ophthalmologist)
  Ophthalmologists have expert knowledge of eye function and vision and can evaluate the movement of the eyelids, muscles, and nerves in detail.
  If a droopy eyelid is affecting vision, the ophthalmologist will identify the cause and perform surgery with an emphasis on preserving vision and protecting the eye.
• Aesthetic finish (role of the plastic surgeon)
  Plastic surgeons specialize in the aesthetic balance of the face and the adjustment of the skin, muscle, and fat layers.
  In ptosis surgery, it is very important to improve the appearance of the eyelid, and plastic surgeons perform surgery to naturally adjust the line and shape of the eyelid, taking into consideration the beauty of the face as a whole.
  For example, removal of excess skin and fat and determination of incision location are important parts of the process.
• Postoperative Recovery and Care
  The ophthalmologist and plastic surgeon also bring their expertise to the recovery and care of the patient after surgery.
  The ophthalmologist pays attention to restoring eye health and function, while the plastic surgeon takes care of cosmetic results and scar management.

Treatment of Pseudoptosis

In the case of a false ptosis, there is no problem with the muscles or tendons that raise the eyelid, so treatment is tailored to the respective cause.

• Sagging eyelid skin
  When the skin has sagged due to aging or other reasons, surgery is performed to remove the sagging skin.
• Eyebrow ptosis
  If the eyebrows are lowered due to facial paralysis or aging, surgery is performed to raise the eyebrows.
• Blepharospasm
  This is a condition in which the eyelid becomes too strong to close and difficult to open. It can be treated with botulinum injections or eyelid surgery. If it is caused by an aneurysm, it also needs to be treated.

Day Surgery Flow

The general process of day surgery for ptosis is designed so that patients can return home the same day after surgery, and we also perform day surgery at our clinic.
The surgery itself is relatively short, and postoperative recovery is often relatively quick, but may vary depending on individual conditions.
The following is a guide to the day surgery process at our hospital.

Preparation (preoperative medical examination)

• Consultation and counseling
  Prior to surgery, you will have a consultation with an ophthalmologist or plastic surgeon. Here, you will receive an explanation of your eye condition, the surgical procedure, and the risks involved.
• Examination
  Vision tests, the condition of the muscles that lift the eyelids, and a check of the nerves are performed. In some cases, blood tests and imaging studies may be necessary.
• Preoperative Precautions
  Alcohol and food restrictions may be ordered the day before surgery. Medication restrictions are also in place if necessary.

Day of Surgery

• Anesthesia
  Surgery is often performed using local anesthesia, but in some cases intravenous anesthesia may be used to put the patient in a light sleep. In the case of local anesthesia, an anesthetic is injected around the eyelid so that the patient does not feel pain during the surgery.
• Perform surgery
  Ptosis surgery usually involves an incision at the top of the eyelid to repair the levator muscle (the muscle that lifts the eyelid) and to remove excess skin and fat. Surgery time is usually 30 minutes to one hour. In complicated cases, the time may be longer.

Postoperative Recovery

• Recovery room
  After the surgery is over, the patient rests in the recovery room for a while. This is to wait for the anesthesia to wear off and for the patient to awaken. Usually, the patient rests for about 30 minutes to an hour, and if all is well, prepares to leave the hospital.
• Eye Care and Cooling
  After the surgery, the eye may swell and cause mild pain. Therefore, cooling the eye reduces swelling and relieves pain.
• Explanation of precautions
  After surgery, the ophthalmologist or nurse will explain postoperative care and precautions. These precautions include not rubbing the eye too hard, not exerting excessive force, and avoiding heat therapy.

Returning home and postoperative stay

• Returning home
  If there are no problems after the surgery, the patient can go home the same day. It is recommended that you stay home and rest your eyes.
• Postoperative Prescription Drugs
  Antibiotics and painkillers may be prescribed. Take as directed and try to prevent infection.
• Restrictions on showering and face washing
  Showering and face washing may be limited for a while after the surgery. Usually, light washing of the face is allowed one to two days after the surgery.

Postoperative follow-up

• Observation
  After surgery, the patient will be seen again within a few days to a week to check the condition of the wound and recovery. Swelling and pain will be checked to see if they have subsided and if there are any signs of infection.
• Stitch removal (if necessary)
  If incisions are made, stitches are usually removed in about one week. Dissolvable threads are sometimes used.

Important point

• Postoperative swelling and internal bleeding usually diminishes within a few days to a week, but may take several weeks to fully recover.
• Improvement of vision can take time. It takes several weeks of adjustment before the eyes open clearly.

Our System of Blepharoplasty Surgery