What are my best options to fix my eye?
I have begun to look through old photos and realized that I have had a drooping eyelid
for a very long time.
However I did not have it when I was born.
It just started to appear later on in my life.
I wonder if it is associated with my weight gain or if it is something more serious.
If I have surgery, will my insurance cover it?
Will there be a scar?
Thank you for your question!
You submitted several photos and you established in your question that you have a drooping
eyelid that has developed overtime and that you didn’t have it when you were born.
Then you asked a natural question about surgical concerns, insurance coverage and scars.
So I’ll explain to you a little bit about what we do in our practice.
I’m a cosmetic oculofacial plastic surgeon.
That means I have also have boarded in ophthalmology, did eye surgery residency as well as fellowship
trained in specialty trained plastic surgery of the eyes and face called oculoplastic or
oculofacial surgery and I’ve been practicing for over 20 years.
So the terminology that we would apply for someone who was wasn’t born with ptosis
and that happens to be congenital ptosis, born with ptosis, congenital, we call this
acquired ptosis.
When someone has acquired ptosis, we first need rule out any neurologic issue that could
be associated with the drooping of the eyelid.
So in terms of your understanding what to do before you make a decision about surgery,
meeting with an ophthalmologist or neuroophthalmologist is important to at least rule out any other
statistically unlikely but still important to check neurologic causes for ptosis.
There are conditions such as Horner’s Syndrome which causes a mild ptosis that may or may
not be associated with your situation.
Although the pupils look fine but we don’t make diagnosis based on photos alone.
Assuming that your ptosis is just acquired ptosis then it’s probably related to the
physical muscle that lifts the eyelid called levator muscle.
The levator like the world elevator to lift the eyelid and there’s a tendon called the
aponeurosis so it’s called levator aponeurosis that has to be addressed.
There are a few ways to address mild acquired ptosis and these are surgical procedures.
Some doctors are more comfortable by doing the procedure from the front, others are willing
to do it in the back posterior or behind the eyelid depending on the degree of your ptosis
and how much elevation your looking to perform.
Ptosis is tricky surgery in that the muscle that lifts the eyelid is very sensitive and
therefore it is a challenge to get the height, shape and contour and maximize the symmetry.
In our practice, when we perform ptosis surgery, we actually will have the patient open and
close their eyes and sit them up during the procedure.
And occasionally, we hand them a mirror to show them what their eye looks like.
It sounds strange but there is never any pain because they're numb but at least we’re
able to get that ideal close to ideal height, shape and contour because that’s predictive
of 95% of the time after the surgery that the appearance will match what was during
surgery.
Various factors such as the way the person heals, whether the muscle was slightly anesthetized,
multiple factors can lead to either to over correction, the eyelid too high or undercorrection,
the eyelid too low.
So ptosis surgery is always an option but first diagnosis is critically important.
So my advice to you is meet first with an ophthalmologist or neurophthalmologist first
to get an understanding whether or not there are other potential neurologic causes of the
ptosis and once those are ruled out, then exploring surgical options as I described.
So I hope that was helpful, I wish you the best of luck and thank you for your question!