Thank you for your question. You’ve submitted a single photo and you’re
19-years-old and you’re concerned about the appearance of your left eye. You describe
multiple folds and the appearance and you want to know if there is a non-surgical solution.
Well, in the absence of a full exam, I would just say that I can certainly give you some
guidance on what my impressions are based on this single photo. A little bit of background,
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
and my initial impression by looking at this photo is that you have a condition called
ptosis. Now ptosis specifically relates to the eyelid and is often referred to as eyelid
ptosis. And in the greater likelihood that you’ve always had this appearance, it would
be most likely something called congenital ptosis. Now if it is newly acquired or acquired
ptosis, well then I would certainly advise you to very quickly seek a physician for examination
because that is unusual for somebody your age to suddenly have ptosis. But assuming
that it is something that you’ve always had and may have gotten a little bit worse,
I’ll explain to you about what congenital ptosis is and what the solutions are.
To begin with, ptosis means droop and that eyelid drooping is due to a maldevelopment
or lack of proper development of a muscle called the levator muscle. Levator like the
word elevator is the muscle that lifts the eyelid. Now this muscle, when it doesn’t
develop properly, it doesn’t work as well as a normal muscle. And what does a normal
muscle do? It contracts and it relaxes so therefore this muscle will neither contract
strongly as a normal muscle nor will it relax as a normal muscle. Now when I do a ptosis
evaluation, it is a fairly involved examination. It’s basically taking measurements of the
height of the eyelid, the amount of movement of the eyelid and other ophthalmologic indications
of the degree of eye function and just to get a basic understanding as to how significant
the ptosis is relative to how much it blocks your vision as well as to the degree of the
action.
Now you ask if there is a non-surgical solution and I would say simply that there isn’t.
In the past, in the distant past, people used to try wearing glasses and have something
that is called eyelid crutch so that the eyelid will be pushed up with the glasses. Those
tend to not to work very well. That’s the only non-surgical solution that isn’t even
worth mentioning. There are situations where sometimes an eye drop for the purpose of pictures
can cause contraction of another muscle in the eyelid called the Mueller's muscle so
that the eyelid elevates slightly. That might be good for taking photos but in terms of
the more definitive solution, you are talking about a certain kind of surgery.
Now typically surgery for a muscle which has reasonable function is a procedure called
levator resection which is the muscle being shortened so that the eyelid is elevated and
then the alternative if the eyelid muscle doesn’t work very well at all and the eyelid
is very droopy, there is a procedure called frontalis sling. And typically people understand
this because when the eyelid is drooping, they tend to raise their eyebrows to try to
keep their eye open. Well that surgery and that muscle that raises the eyebrows is called
the frontalis muscle. So what we do surgically is we attach the muscle, the frontalis muscle
to the eyelid using a variety of different materials, everything from your own fascia
which is from your leg to banked fascia as well as other alternatives such as silicone
and GoreTex™.
Now these are all determined based on evaluation consultation. So I would suggest that you
meet with an oculoplastic surgeon and learn about your options. I would also encourage
you to actually see an ophthalmologist. Get a proper eye exam and determine if there are
any other visual issues that can also be managed. Sometimes people, when they have congenital
ptosis, if it blocks their vision for an extended period of time when they are very young between
0 and 6, they can actually have had a condition called amblyopia where the eve vision doesn’t
fully develop. So it is important that at least a proper eye exam will be done before
you undergo any eyelid surgery and then you can actually have more comprehensive understanding
of the eye health as well as the options for correction of the eyelid drooping.
So I am sorry that there isn’t a non-surgical option but I think that it’s important that
you understand the condition as well as what you should do to pursue the information you
need to make an informed decision. So again meet with an ophthalmologist, an eye doctor,
an MD who can evaluate your vision, evaluate your eye health and then an oculoplastic surgeon
who’s an ophthalmologist, who specializes in additional training in plastic surgery
in the eyes and face.
So I hope that was helpful, I wish you the best of luck and thank you for your question.