Droopy Eyelid Lifting (Ptosis, Ectropion, Entropion…)
Ptosis is a medical term for drooping of the upper eyelid and occurs when the fine muscle that opens the eyelid (termed the levator aponeurosis) has slipped or is weak. This is different to when there is excess upper eyelid skin that hangs down from the upper eyelid (termed Dermatochalasis). In facial ageing often there is a combination of upper eyelid ptosis in conjunction with dermatochalasis. This requires a specialist surgeon with experience in ptosis surgery as both an upper blepharoplasty in conjunction with ptosis repair are required to give a natural looking result. Ptosis repair is performed in one of two ways from the undersurface of the eyelid leaving no visible scars, or from the front through the skin. Either way the goal is to reattach the eyelid elevator muscle further down the eyelid in order to allow a wider opening of the upper eyelid. The most common cause of ptosis is a consequence of facial aging and detachment of the elevator muscle, however it can also be caused by a nerve problem or result from birth and worsen with age. Occasionally if the muscle is too weak a sling procedure would be necessary connecting the forehead muscle to the eyelid muscle to help elevate the upper eyelid.
Drooping of the upper eyelid, termed Ptosis, is a common eyelid condition that usually occurs with aging of the facial tissues. Humans have an exquisite ability to recognize less than one millimeter asymmetry between the eyelid heights, and half a millimeter or more drooping of one eyelid can be noticeable. There is a small muscle behind the upper eyelid that opens the eyelid (the levator aponeurosis) and with facial aging or as consequence of genes, the muscle can slip or is weak resulting a droopy eyelid. Ptosis repair can be repaired in two main ways:
- Traditional skin incision technique (termed Trans-Cutaneous Approach). The most common method for repairing a droopy eyelid in the UK and USA is by making an incision in the crease of the upper eyelid skin, reattaching the muscle and closing the skin with stitches. This method is used in over 90% of NHS Hospitals as the treatment of choice. It is notoriously unpredictable with a need for further surgery in 10-30% of patients.
- Hidden incision (Internal Approach) is performed from the undersurface of the eyelid leaving no visible scars. The levator muscle is reattached further down the eyelid in order to allow a wider opening of the upper eyelid. Less surgeons in the UK and USA are able to perform this surgical technique. This technique has a far higher success rate, with a need for further surgery in 3-10%.
- Ptosis could also be caused by a nerve problem or from birth and can require further investigations. Rarely if the muscle is too weak, a sling procedure is required that connects the forehead muscle to the eyelid muscle to help elevate the upper eyelid.
The hidden incision technique that involves internal access to levator muscle elevation is relatively unknown technique in the UK or USA. Dr. De Silva completed fellowship training in Los Angeles, and uses a modified hidden incision technique as it avoids scarring and more accurate result. In patients with a small amount of ptosis (approximately 1 millimeter) the hidden incision technique gives more predictable and natural looking results.