why did my eyelids droop over time we routinely see people in our office who are concerned
about the appearance of their drooping eyes they frequently express having difficulty
keeping their eyes open particularly as the day progresses some of these patients will describe
straining to keep their eyes open while driving for an extended period of time
I often see patients who come in after having Botox treatments for their forehead lines
only to discover that their eyes appear to be smaller after their treatment these same patients
are surprised to learn that the lines in their foreheads were getting deeper because they were
straining to raise their eyebrows unconsciously in an effort to open their drooping eyes
the Botox injections in actuality revealed how low their upper eyelids were all along
they often assume that their drooping eye appearance is due to the presence of
excess skin weighing down on the eyes which would be an indication for cosmetic upper eyelid
blepharoplasty where this excess skin would be removed although blepharoplasty may be helpful
removal of excess skin alone will not address another common issue called
upper eyelid ptosis the diagnosis of upper eyelid ptosis is made by looking at specific measurements
of the upper eyelid position relative to the center of the eye or the pupil
if the upper eyelid is closer to the pupil than it should be we refer to this as eyelid ptosis
this means that if you don't recognize the presence of ptosis and undergo upper eyelid
blepharoplasty alone you'll still feel like your eyes are drooping and that you still look
tired afterwards there are different causes for eyelid ptosis I'll discuss the more common causes
for ptosis which we see a lot of in our cosmetic eyelid surgery practice and what we do to help
our patients look and feel better I'm Dr Amiya Prasad I'm a Diplomate of the American Board
of Cosmetic Surgery and a fellowship-trained oculofacial plastic and reconstructive surgeon
I have been in practice in New York City and Long Island for over 25 years
I perform a wide range of cosmetic eyelid procedures in my practice for
example I help people with under eye bags using a specialized technique where there is no incision
on the external or on the eyelid skin I treat hooded upper eyelids I also specialize in creating
natural eyelid creases for what commonly referred to as double eyelids for patients of Asian descent
amongst the other advanced procedures I perform I help patients with conditions such as thyroid eye
disease or graves disease and I perform revision surgery for complications of cosmetic eyelid
surgery performed by other surgeons eyelid ptosis can affect one or both eyes which is referred to
as unilateral or bilateral eyelid ptosis can be present when you were born and is referred to as
congenital ptosis eyelid ptosis that occurs after you were born is referred to as acquired ptosis
generally speaking apart from neurologic causes for ptosis we determine treatment strategies
based on certain characteristics of a muscle that lifts the upper eyelid called the levator muscle
the levator muscle which is spelled like the word elevator without the letter e
I typically see people who noted that their eyes appear to have become smaller when they looked at
photos of themselves they often report that they have some of the symptoms I mentioned earlier
such as eye fatigue as the day progresses although conditions such as thyroid eye disease
is typically characterized by upper and lower eyelid retraction or the eyes appearing too open
there are some situations in people who have graves disease where the upper eyelid can droop
resulting in upper eyelid ptosis acquired ptosis can also happen due to an injury such as a motor
vehicle accident where significant swelling can cause permanent stretching or detachment
of the levator muscle ptosis can even occur after routine cosmetic upper eyelid surgery
this situation can be due to swelling post-surgery or from the surgery itself
sometimes it occurs when someone already had a degree of ptosis which became worse
after upper eyelid surgery was performed and the condition became more obvious generally speaking
I see a lot of acquired ptosis caused by age-related changes to the levator muscle
this typically means that the tendon of the muscle referred to as the aponeurosis
has stretched or has separated resulting in the upper eyelid displacing downwards
i also see a lot of patients who are aware that they've had sleepy looking eyes since they were
younger and that their eyes drooped more as they got older acquired ptosis is typically
best managed with surgery eyelid ptosis surgery is deceptively complex and is not routinely
performed by plastic surgeons who haven't done specialized training in oculoplastic surgery
although eyelid surgery ranks every year in the top five cosmetic procedures in the united states
it's far from a type of procedure performed with a consistent and uniform technique amongst surgeons
a systematic approach to diagnosing the presence of ptosis and having a clear understanding
of what the cosmetic results are likely to be is critical to having a successful
outcome when it comes to treatment planning for any procedure my approach is to minimize risk
to achieve great results and for you to have a quick and uneventful recovery
surgical risk is generally minimized by having a high level of technical proficiency and working
with a team of skilled assistants in a dedicated facility for example we're all familiar with
hospitals that specialize in orthopedic surgery or laser vision correction centers in the same
spirit in our offices I designed my own surgery facilities to my specifications so I and my team
have the most control in performing the technical aspects of your procedure in the best way possible
as far as the actual surgery is concerned i often perform ptosis surgery by working on muscles
that lift the eyelid from the underside of the upper eyelid this approach has
worked consistently in my hands working from the underside of the eyelid is particularly effective
when you don't have the need to perform any skin removal making recovery even faster
i also perform other types of ptosis surgery from the front of the upper eyelids such as
levator muscle advancement as well as procedures where there is no levator muscle function referred
to as a frontalis sling i also focus on reducing risks to your health and recovery through the type
of anesthesia we administer for your comfort we do this by not using general anesthesia
general anesthesia is the method where you are unconscious and paralyzed during your surgery
in this situation you need a tube in your throat for you to breathe with the assistance
of a mechanical respirator or ventilator common side effects from general anesthesia include
nausea vomiting constipation and longer recovery time in distinct contrast i routinely perform
cosmetic eyelid surgery and ptosis correction using local anesthesia with light iv sedation
our patients are comfortable throughout their surgery and feel good immediately afterwards
they typically require no pain medications or skilled nursing care during their recovery
I routinely see our patients after one week when they're generally able to go back to work with
minimal bruising as well as minimal swelling
the objective of cosmetic eyelid surgery is to help you look less tired and to have a more
vibrant appearance if you don't recognize ptosis being present you won't realize the full potential
you have to looking your best a proper evaluation where acquired ptosis is identified and addressed
can have a significant impact on how you look and how you feel I hope this information from
my experience helped you if you are interested in recommendations for your individual situation
you may contact us through our websites or call our offices to schedule a consultation thank you