my eyelids are drooping again years after ptosis surgery what can I do
eyelid ptosis is a term to describe the eyelid position being lower than it
should be surgery for ptosis is performed to
elevate the affected eyelid or eyelids I often see patients who've had previous
ptosis surgery who are frustrated with needing to have another procedure the
underlying cause of the eyelid ptosis as well as age and other factors do affect
the longevity of results after ptosis surgery I'll discuss how I counsel my
patients who come to me for ptosis evaluation
I'm Dr. Amiya Prasad I'm a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I've been in
practice in Manhattan and Long Island for over 20 years I perform cosmetic and
reconstructive eyelid procedures every day in my practice this includes surgery
for under-eye bags for hooded eyes and Asian double eyelid surgery eyelid
ptosis correction surgery is essentially exclusively performed by oculoplastic or
oculofacial plastic surgeons as it is specialized surgery which is focused on
during fellowship training for surgeons who completed residency in ophthalmology
as is the case for any surgery people who come in for ptosis surgery want the
procedure to be done once and be good for the rest of their life as mentioned
earlier the underlying cause for the eyelid ptosis and other factors affect
the predictability and longevity of any ptosis procedure
eyelid ptosis is classified as either congenital meaning you were born with
this condition or acquired meaning the ptosis occurred after you were born the
type of ptosis surgery that is performed is based on the eyelid position and the
function of the muscle which lifts the eyelid and this muscle is called a
levator muscle word levator is like the word elevator without the letter e at
the beginning if someone has congenital ptosis this means that the levator
muscle did not fully develop the muscle may not contract as strongly nor will it
relax or stretch like a normal muscle imagine you can't extend your arm fully
because your bicep can't relax completely nor can it flex your arm
fully because your bicep muscle is under developed the goal of a ptosis procedure
is to lift the upper eyelid to a height and contour which improves appearance
and vision while still allowing the eyelid to close adequately for proper
eye protection and lubrication understanding the underlying issue with
congenital ptosis is what makes the management of congenital ptosis
challenging for example a procedure for congenital ptosis is called a levator
muscle resection in this procedure the levator muscle is shortened so the
eyelid can be elevated however since the levator muscle doesn't relax or stretch
like a normally developed muscle the eye may not close as well after surgery this
means that although a patient may look good during surgery and initially after
surgery the eyelid can drift lower than it was initially as the tissue stretches
to allow for eye protection with normal or forced blinking another procedure for
congenital ptosis is called a frontalis sling
in this procedure the muscle which lifts the eyebrows called the frontalis muscle
is connected to the eyelid margin so your eyes open by you lifting your
eyebrows I perform this procedure when someone has moderate to severe ptosis
with minimal to no levator muscle functioning in this situation the tissue
can stretch with blinking and changes occur over time with facial aging that's
requiring additional surgery later on although there are neurologic causes for
ptosis the most common cause for ptosis is called involution 'el ptosis which is
essentially the tendon of the levator muscle called the levator aponeurosis
becoming thinner or detaching from the structure called the Tarsus generally
people with involution 'el ptosis have good muscle function and correction can
be performed successfully with long term stability I routinely performed ptosis
surgery from the underside of the eyelid a muscle called Mueller's muscle is
behind the levator muscle and for people who have mild to moderate ptosis with
good levator muscle function I'm able to get consistently good results even with
a successfully executed procedure revision surgery may be needed for under
correction or over correction I know I can speak for any experienced
oculoplastic surgeon that ptosis surgery can be very challenging to achieve
satisfactory results regardless of the surgeons technical expertise I would go
so far as to say that it's a reflection of an oculoplastic surgeons real-world
experience to acknowledge just how complex ptosis surgery can become it's
no wonder that no other surgical specialty is trying to compete for these
procedures during my consultation depending on the type of surgery I'm
planning to perform I explained to my patient the variables
which can affect the outcome of the proposed procedure and that there may be
a need for a plan B during surgery as well as a need for revision after
surgery I actually have my patients sit up and during surgery so I can make
adjustments to improve the likelihood of a successful outcome although eyelid
ptosis correction surgery can improve your appearance effected by aging it
cannot stop the progressive effects of aging on the eyelids and the surrounding
facial areas in addition for age-related ptosis the tendon of the levator muscle
can continue to become thinner or detach requiring additional surgery I routinely
perform ptosis correction surgery under local anesthesia with LITE IV sedation
in addition to being able to make fine adjustments with my patients sitting up
avoiding the risks and recovery from general anesthesia in my experience is
optimal for my patients if I place skin sutures I removed them in about 5 to 7
days my ptosis surgery patients usually
return to work in about a week after surgery in spite of some complexity the
results of ptosis correction surgery can last for years depending on the cause of
your ptosis and the strength of the levator muscle and other I related
anatomic and functional factors the predictability and need for additional
procedures is part of the risks of having this type of surgery it's
important that you have a proper examination and enough time during your
consultation to understand the risks that apply to your specific ptosis
condition I hope you found this information helpful thank you for your
question