Ptosis is drooping of the upper eyelids, where the eyelid margin lays low and may cross the patient’s line of sight. Ptosis is caused by aging, muscle or nerve abnormality, trauma, or tumor. The majority of the time, it is due to aging, where the tendon of the levator muscle is stretched or even detached from the eyelid. Ptosis can be repaired surgically to lift the eyelid above the line of sight and improve peripheral vision. In more severe ptosis, the repair is typically performed in the operating room under intravenous sedation. An incision is made in the eyelid crease (external approach). The levator tendon is reattached to the eyelid, or the levator muscle is resected and tightened, depending on the severity of the ptosis. Half way through the surgery, the surgeon will have the patient awake and look in different directions in the upright position to adjust the lid height and contour. In less severe cases of ptosis, especially in younger patients, an incision is made on the back side of the eyelid (internal approach), where the Mueller muscle is shortened.

What to expect after surgery
The skin of the eyelid is the thinnest of the body, which means the incision here heals well and tends no to leave significant scaring. Furthermore, the incision is placed in the eyelid crease and hidden by the eyelid fold.

It is generally recommended that patients plan on staying home for three days after the procedure and apply ice to the eyelids to reduce bruising and swelling. It typically takes about 1-2 weeks for the bruising to disappear completely, although this can be effectively covered with makeup or sunglasses. Minimal restrictions are placed regarding exercise, bending and heavy lifting for one week to prevent bleeding or more swelling than necessary. Sutures are removed 7-10 days after the eyelid surgery, once the wounds are completely healed. Final results can be evident by 2-3 months when the last of the internal swelling resolves and muscle heals.

What are some of the risks of ptosis repair
Ptosis repair is one of the more challenging eyelid surgeries. The difficulty is in the unpredictability of the results. While the indications of the surgery are to elevate the eyelid, increase the opening of the eye, and, in many cases, improve peripheral vision, the results can be spot on, or one or both eyelids do not elevate, elevate partially or elevate too much. There is, therefore, the risk of asymmetry. This unpredictability is a result of the interplay between science, art, and unknown factor in how the muscle and skin respond to the surgery and ultimately heal, irrespective of an uneventful surgery. Fortunately, the success rate is still 90-95%.

When one of the unexpected outcomes occurs after surgery, it is disappointing and frustrating to the patient and the surgeon. But, it usually can be addressed. This often involves repeat surgery and the associated additional time, resource, and inconvenience. This risk, as well as all other risks associated with surgery, should be considered thoroughly beforehand.

Aside from a perfect surgery, if that is even possible with every surgery, reasonable and achievable goals guarantee success.