Scarless Ptosis Surgery

Ptosis is a drooping of the upper eyelid. 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.

A Droopy eyelid commonly occurs due to an aging change, or chronic contact lens wear & after eye surgery (e.g. cataract).

If left untreated, a ptosis can cause affect the superior field of vision causing patients to raise their eyebrows constantly (leading to headaches) or tipping their head back in an attempt to gain clear vision. It can become a cosmetic issue, affecting a person’s self esteem.

ptosis-droopy-eyelid

1. Left upper lid age related droopy eyelid (involutional ptosis)
2. 1 month post surgical repair of left ptosis with a tarsoconjunctival mullerectomy procedure (with no scar on skin)

How can ptosis or droopy upper eyelid be treated?

The aim of surgical correction is to restore the anatomy, by addressing the various causative factors. Ms Shah-Desai generally prefers to perform adult ptosis surgery under local anaesthesia with or without sedation, however scar less ptosis surgery can be performed successfully under a general anaesthetic.

Surgical correction for ptosis or droopy upper eyelid

The operations for ptosis correction are generally based on the muscle function and the response to a drop called phenylephrine. The cut is hidden within the inside of the eyelids, resulting in a scar less minimally invasive operation, which produces natural results.

This surgery often takes only 20 minutes to perform, in Ms Shah-Desai’s experienced hands.

Recovery times are generally quick, most patients achieving complete recovery within 7 days.

Scarless Ptosis Surgery

What are the potential risks & complication of ptosis surgical correction?

The risks of ptosis surgery include

  1. Infection: this is very rare; occasionally the stitches may have an infective or inflammatory response, which settles with oral and topical antibiotics.
  2. Small bruise or haematoma. This can be minimized by avoiding heavy exercise for 2 weeks after surgery, stopping aspirin and other anticoagulants (if safe so to do) 2 weeks pre operatively, and regular use of ice packs. A haematoma may mean you have to go back into theatre to have the blood clot evacuated and then be re-stitched with the risk of a worse scar.
  3. 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 in comparison a normal car journey is a much greater risk to your vision.
  4. Asymmetry of eyelid shape, height or upper lid fold: this is rare, but can occur. Often asymmetry may be due to lid bruising and settles spontaneously as 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.
  5. Blood stained tears: This can occur within the first 48 hours after surgery & should be managed by gentle, firm, constant pressure on the shut eyelid for 10-15 minutes.
  6. 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/stretching of the scar. This will need to be corrected by re-operation.
  7. 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.
  8. Exposure of the buried stitches, with resultant foreign body/ 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.