Ptosis Surgical Treatment

What is ptosis?

Ptosis is a condition that causes the upper eyelid to droop. A drooping eyelid can affect the patient’s appearance and drop down low enough that it obstructs vision. In ptosis, the upper eyelid tendon, called the aponeurosis, stretches out. The aponeurosis attaches to the levator muscle, which elevates the eyelid. When the aponeurosis is stretched, it makes it so that the levator muscle cannot fully lift the eyelid. Ptosis is typically the result of aging.

Surgical Treatment for Ptosis

Surgical treatment for ptosis is recommended when the drooping eyelid inhibits vision. It can also be performed for cosmetic reasons. The procedure is designed to tighten the upper eyelid tendon so that the levator muscle can lift the eyelid normally.

Levator Advancement (External Approach)

Levator advancement is the most common type of surgery to correct ptosis. The surgeon makes an incision in the natural crease of the eyelid, then repositions the tendon attached to the levator muscle by stitching it to the connective tissue in the eyelid. The wound is then closed. Most of the time, this effectively elevates the eyelid.

When the muscle is abnormal, it may be tightened or shortened. If the levator muscle is very weak, the forehead muscle will be used to lift the eyelid.

The operation is performed under local anesthetic because the surgeon needs the patient to be awake to help the surgeon determine the best position for the eyelids. Sedation may be used to help the patient relax. The stitches are usually absorbable, and the scar is usually hidden since the incision is made in the crease of the eyelid.

Internal Surgical Approach

When people have strong levator muscle function, an internal approach may be recommended by your surgeon.

In this procedure, the surgeon turns the eyelid inside out and shortens the eyelid muscles from the inside of the eyelid. The surgeon will then shorten either the levator muscle or Mueller’s muscle, which also plays a role in lifting the lid.

When you need less of the eyelid to be elevated, the surgeon typically shortens the Mueller’s muscle. The levator muscle is often shortened when you need more of the eyelid lifted. And internal ptosis surgical procedure requires either general anesthesia or sedation.

Frontalis Sling Fixation

For patients with poor levator muscle function, frontalis sling fixation may be an option.   The surgeon attaches the upper eyelid to the frontalis muscle, which is the muscle just above the eyebrows. The surgeon will run a small silicone rod through the eyelid, underneath the skin, and connect it to the frontalis muscle, so that the forehead muscles can elevate the eyelid. Frontalis sling fixation is usually performed using general anesthesia.

Patients may have difficulty completely closing their eye after this procedure as a common side effect. However, typically this resolves within 2-3 months. Eye drops and ointment will be provided by your doctor to ensure that your eye is remains properly lubricated.

What is the success rate of ptosis surgery?

Ptosis surgery has a high rate of success. However, ptosis can naturally reoccur over time. Studies show recurrence rates to range between 12% and 39%, 8-10 years after the procedure has been performed.

At Union Square Eye Care, our ophthalmologists specialize in surgical treatment for ptosis. With offices in Union Square and Harlem, we welcome patients from Greenwich Village, Soho, and Midtown Manhattan. Our precise surgical techniques are designed to correct drooping eyelids, restoring proper function and achieving natural-looking results.