Face & Skin
Ptosis Surgery (drooping eyelids repair) in Michigan
Blepharoptosis, also called eyelid ptosis, refers to a drooping eyelid or an upper eyelid that rests in a low position. This can cause the eyelid to interfere with vision. This is different from excess upper eyelid skin, which is corrected by skin removal. A drooping upper eyelid can also make one appear tired or disinterested. Reading and driving can be affected, and droopy eyelids can have significant social implications.
Why the Upper Eyelids Droop
Upper eyelid ptosis can be present at birth or can occur later in life. In cases that are present at birth, the drooping is usually due to an underdeveloped eyelid “lifting muscle” called the levator palpebrae superioris. Other “acquired” causes include injury to the eyelid, neurologic problems, or most commonly, a separation of the tendon of the eyelid “lifting muscle”. A separation of this tendon is similar to a hernia, in which the tissues pull apart. It is more common in hard contact lens wearers. It is also more likely to occur as we age.
Rare causes of a droopy upper eyelid include medical conditions such as Horner syndrome, cranial nerve palsies, tumors, infections, and others.
Before Droopy Eyelid Correction
Before undergoing a corrective eyelid procedure, a medical history is performed. Dry eyes and previous laser vision correction are issues that must be discussed. Any history of allergies is also considered. An examination is an important part of the evaluation, including a measurement of visual acuity, a visual field test to measure peripheral vision, the position of the eyelids, the appearance of the skin, and the eyelid characteristics. Photos are taken and other tests may be performed to determine the cause of the droopy eyelid. In some cases, imaging studies such as an MRI or CT may be requested.
In many cases, a procedure to correct a droopy eyelid will be covered by insurance. This is determined by the degree of visual impairment that is directly related to the position of the eyelid. On occasion, a neuro-ophthalmologist may be consulted for a portion of the evaluation.
If the droopy eyelid interferes with vision and daily activities, the corrective procedure may be covered by medical insurance. This determination is based on the specific requirements of each insurance carrier and on the results of the eyelid examination, visual field examination, and external photographs.
There are common medications and supplements that can promote bleeding. These are to be discontinued for a prescribed period of time before surgery, as directed by your physician. Lists are available which detail the types of substances that are associated with increased bleeding.
A droopy eyelid correction, or blepharoptosis repair, elevates the upper eyelid to a desirable position with a natural shape. It is a term that encompasses several surgical procedures. The specific procedure performed is selected for each patient based on the cause of the droopy eyelid, the effectiveness of the eyelid “lifting muscle”, and the preference of the surgeon. Incisions are performed with a laser, a radiofrequency device, an electrocautery device, or a scalpel. The incision is most often placed on the natural crease of the upper eyelid or behind the eyelid (on the conjunctiva).
If the eyelid muscle is working properly but the eyelid has a low position, a levator advancement or dehiscence repair is performed. The muscle tendon is approached from either the front or the back of the eyelid and repositioned or advanced. Another procedure, called a Mueller-muscle-conjunctival resection can alternatively be performed, which lifts the eyelid by shortening an eyelid structure named Mueller’s muscle.
In cases where the eyelid muscle has poor function, a sling procedure may be performed, in which a material (silicone rod or band, connective tissue from the leg, Gore-Tex suture, or others) is used to connect the eyelid to the brow. The eyebrow is then used to elevate the eyelid. Sling procedures are most common in cases of droopy eyelids that are present from birth.
Droopy eyelid repair can be performed at the same time as other procedures. Sometimes, both eyelids are droopy and need to be lifted at the same time. In other cases, there may also be excess eyelid skin, and a blepharoplasty (eyelid lift) can be done. Other cosmetic procedures can safely be done with droopy eyelid repair.
After the Procedure
A topical antibiotic ointment which is safe for use around the eyes is applied to the incision area. Cold compresses are used for 48 hours after surgery to prevent swelling. It is advisable to avoid strenuous activity for the first week, but light activities and showering are permitted.
Bleeding or infection are serious complications of any surgical procedure, but are rare with blepharoptosis repair. Other rare complications include visible scars and dryness of the eyes requiring eye drops. These conditions are treatable with scar therapies, dry eye therapies, and/or other procedures. Overcorrection or undercorrection can require further corrective procedures. It is also possible for repair of one droopy eyelid to uncover droopiness of the other side, which may be detected after surgery. In these cases, surgery can be performed on the other side at a later time. In young children, failing to correct a droopy eyelid can cause poor visual development.
At Allure Medical, our team offers these and other cosmetic procedures. Allure Medical was one of the first Medical Spas in the country, offering a variety of cosmetic surgical and non surgical procedures. We have offices located in Shelby Township, Livonia and Clarkston and serve all of Metro Detroit, Michigan.