Drooping of the upper eyelid, “Ptosis”
Of key importance when considering eyelid surgery is a thorough evaluation of the eyelids to exclude subtle signs of a droopy upper eyelid, termed ptosis in medical jargon. The signs of drooping may be subtle however recognition is of key importance to ensure a good natural result after eyelid surgery. Oculo-facial plastic surgeons are specialists in this area of facial surgery.
Drooping of the upper eyelid is a relatively common eyelid condition that usually occurs with aging of the facial tissues.
“People have an exquisite ability to recognize less than one-millimetre asymmetry between the eyelid heights, and half a millimetre or more drooping of one eyelid can be noticeable,” says De Silva. “Meticulous detail is important”.
There is a small muscle behind the upper eyelid that opens the eyelid (the levator aponeurosis) and with facial aging or as consequence of genetics (inherited from your parents), the muscle can slip or is weak resulting a droopy eyelid.
Ptosis can be quite obvious and increase over a period of years. In addition, ptosis can also be subtle and vary during different times of the day.
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 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 the majority of NHS Hospitals as the treatment of choice. It is notoriously unpredictable with a need for further revision surgery in 10-30% of patients.
- Hidden incision (internal approach) is performed from the under surface 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 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.