Ptosis Surgery (Droopy Eyelid Repair) – by Leading Oculoplastic Surgeon, Dr Sabrina Shah-Desai, in London

What is Ptosis Surgery?

Ptosis Surgery, otherwise described as “Droopy Eyelid Repair”, is a surgical procedure designed to correct a droopy eyelid and restore balance to the anatomy. The primary aim of Ptosis Surgery is to address the causative factors: whether due to hereditary abnormal muscle development in childhood, or as a result of stretching to the muscle and tendon, which can occur with age.

If left untreated, a droopy eyelid can cause blurring of vision or watering of the eye due the weight of the eyelid pressing on the front of the eye. Meanwhile, ptosis in a child can cause affect visual development, and lead to amblyopia (lazy eye). It can also affect the superior field of vision causing patients to raise their eyebrows constantly, which can lead to headaches, or tip their head back in an attempt to gain clear vision. Ptosis can also become a cosmetic issue, affecting a person’s self-esteem and making them avoid having their photograph taken, as the ptosis often looks more pronounced in photographs.

What is Ptosis Surgery?

Ptosis Surgery, otherwise described as “Droopy Eyelid Repair”, is a surgical procedure designed to correct a droopy eyelid and restore balance to the anatomy. The primary aim of Ptosis Surgery is to address the causative factors: whether due to hereditary abnormal muscle development in childhood, or as a result of stretching to the muscle and tendon, which can occur with age.

If left untreated, a droopy eyelid can cause blurring of vision or watering of the eye due the weight of the eyelid pressing on the front of the eye. Meanwhile, ptosis in a child can cause affect visual development, and lead to amblyopia (lazy eye). It can also affect the superior field of vision causing patients to raise their eyebrows constantly, which can lead to headaches, or tip their head back in an attempt to gain clear vision. Ptosis can also become a cosmetic issue, affecting a person’s self-esteem and making them avoid having their photograph taken, as the ptosis often looks more pronounced in photographs.

What causes drooping eyelids?

The commonest cause of ptosis is as a result of ageing, which can stretch the tendon and muscle of the eyelid. Ptosis can also occur after contact lens wear, following an injury or previous surgery to the eye (e.g. cataract) or as a manifestation of another disease involving the eyelid muscle or its nerve supply, e.g. myasthenia gravis or third nerve palsy in diabetes. However, ptosis can also be present at birth (referred to as “congenital ptosis”) due to the abnormal development of the muscle that lifts the eyelid, which can be hereditary.

How does the procedure work?

Ptosis Surgery helps to restore the anatomy by correcting a drooping eyelid. The commonest operation for age-related ptosis is to tighten the tendon or muscle that lifts the eyelid. Less commonly, a strip of tissue from the thigh (called the “fascia lata”) or a silicone band is used to lift the eyelid. The cut can be hidden within the inside of the eyelid, resulting in a scar-less, minimally-invasive operation – otherwise the cut can be made within the skin fold, thus hiding the scar. Depending upon the cause of ptosis, surgery can range from a simple 30-minute procedure to a more complicated 90-minute procedure. Recovery times are generally quick, most patients achieving complete recovery within 14 days.

In adults, most Ptosis Surgery is performed under local anaesthesia with or without sedation. All Ptosis Surgery in children is performed under general anaesthesia.

Ptosis Surgery – Before & After Gallery

Disclaimer: Your results may vary. Any specific claims or length of results vary for each patient and are not guaranteed.
Brow suspension ptosis surgery before and after pictures
Scarless ptosis surgery before and after pictures

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Patient Questions

Commonly Asked Questions about Double Eyelid Surgery

What are the non-surgical alternatives to Ptosis Surgery?

Occasionally patients with eyelid trauma or a myopathic cause of ptosis (for example, with restricted eye movement as seen in chronic progressive external ophthalmoplegia) may benefit from ptosis props, crutch spectacles or a scleral contact lens. Although the outcome may not produce as good an aesthetic result, in certain cases they are an option to consider and can be discussed by your surgeon.

What are the risks and complications of Ptosis Surgery?

The risks of Ptosis Surgery include:

  • Infection: This is very rare; however, occasionally the stitches may become infected or inflamed. This can be swiftly settled with oral and topical antibiotics.
  • Scarring: Generally, scars are hidden in the skin fold. Stitches are normally visible for the first week, then, when they are removed, a faint scar is visible. While the scar may seem thickened and red for 6 to 12 weeks, it will gradually become almost invisible after that period. While not every scar heals equally well, silicone scar remodelling gel can improve the appearance of a thickened or reddened scar – however, the treatment needs to be continued for several months to have a good result.
  • Large bruise or haematoma: This is minimised by regular use of ice packs, avoiding heavy exercise for 2 weeks after surgery, and stopping aspirin and other anticoagulants (if safe so to do) 2 weeks pre-operatively. If you do experience a haematoma, you may have to go back into theatre to have the blood clot removed, and have your stitches redone. This runs the risk of a worse scar.
  • Theoretical risk to vision: Any eyelid surgery carries the risk that an undiagnosed infection or bleed could damage the optic nerve. This is so rare that, by comparison, a normal car journey poses a much greater risk to your vision.
  • Asymmetry of eyelid shape, height, upper lid fold or fullness: This is rare, but can occur. Often, asymmetry may be due to lid bruising and therefore settles as the swelling resolves. Rarely, this may require revision surgery. Occasionally pre-existing asymmetry of the face, eyebrow or eyeball position may be responsible; however. this will be discussed with you prior to the operation by your surgeon.
  • Blood stained tears: This can occur within the first 48 hours after surgery and should be managed by gentle, firm, constant pressure on the shut eyelid for 10-15 minutes.
  • Recurrence of ptosis: This can occur early post-surgery (3 months) or late (after a few years), due to early suture dissolution, or a weakening or stretching of the scar. This will need to be corrected by re-operation.
  • Contralateral ptosis: The eyelids are a pair, and often when one eyelid is droopy, the contralateral eyelid can appear to be in a “normal” position. However, immediately after surgery, the “normal” eyelid can droop. This can correct itself within a few weeks or require a ptosis correction.
  • Exposure of the buried stitches, with resultant foreign body or pricking sensation: If this happens, the offending stitch needs to be removed. Rarely, if the stitch is not removed, it can cause a corneal ulcer, which needs intensive topical antibiotic treatment.

1. Child with congenital left upper lid ptosis, with 6mm levator function. The droopy eyelid is occluding the visual axis and needs to be corrected to prevent development of ambylopia (lazy eye)
2. 1 week post-surgical repair of left upper lid congenital ptosis with levator resection
3. 2 years post-surgical repair of left congenital ptosis

1. Correction of congenital ptosis with resultant “Lagophthalmos” (incomplete eyelid closure) which is secondary to a dystrophic levator muscle that does not relax to allow eyelid closure
2. Correction of congenital ptosis with resultant “Lid lag ” (hang up of eyelid on down-gaze) which is secondary to a dystrophic levator muscle that does not relax to allow eyelid movement
3. Two years post-surgical repair of left congenital ptosis

Publications

A Skin Crease Preserving Modification of Open-Sky Mullerectomy for Blepharoptosis Correction

Dr Sabrina Shah-Desai has pioneered and published her scarless technique of ptosis surgery.

Read More

Scleral contact lens usage in patients with complex blepharoptosis

To evaluate the efficacy of scleral contact lenses (ScCLs) as an alternative or as an adjunct to surgical correction for the management of complex ptosis.

Read More

Ptosis Surgery Reviews

Ptosis Surgery Cost

Unilateral Ptosis Surgery from £4000
Bilateral Ptosis Surgery from £5000

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