Droopy eyelid or ptosis occurs when the upper eyelid droops over the eye. Depending on the severity, people with droopy eyelid may experience difficulty in keeping their eyes open, eye strain and brow ache from the increased efforts to raise the eyelid, or even fatigue when doing near tasks such as reading or writing. Ptosis can impair vision based on the extent of the eyelid obstructing the pupil (dark spot at the centre of the eye). In this article, we talk about droopy eyelid surgery.
Ptosis in a child and adult. (Source: The Clifford Clinic)
Droopy eyelid can occur at birth, due to ageing, or as a result of an eye trauma, surgery or disease. The natural aging process is the most common cause of droopy eyelid or ptosis. The levator muscle is responsible for lifting the eyelid and with age, that muscle stretches causing the eyelid to fall or droop.
The type of treatment depends on the cause of the droopy eyelid and how severe it is. Surgery is usually the recommended treatment for droopy eyelids.
Before and after ptosis repair surgery. (Source: Minnesota Eye Consultants)
If the droopy eyelid is interfering with vision, then ptosis repair surgery, to improve function is recommended. Ptosis repair involves tightening or shortening the eyelid muscle allowing it to once again lift and open the upper eyelid adequately.
Blepharoplasty or eyelid lift is a cosmetic procedure. In upper lid blepharoplasty, loose skin along the upper eyelid is removed to reduce the ‘hooded’ appearance. In lower lid blepharoplasty, excess fat is removed or relocated to fill spaces around the eyes to create a softer and more youthful appearance.
In ptosis repair surgery, the height of the lid is lifted. In blepharoplasty, the height of the lid is maintained but the excess fat and skin are removed to improve the tired and saggy appearance. Ptosis repair surgery and blepharoplasty can be performed independently or together.
To begin, the eye surgeon will numb the area around your eyelid with a local anaesthetic. A cut or an incision would then be made in the natural crease of the upper eyelid skin to tighten the levator muscle with stitches to raise the eyelid. The incision is then closed with more stitches.
You may experience temporary symptoms such as watering eyes, puffy and numb eyelids, swelling and bruising similar to having black eyes, and discomfort. You will have to return to the doctor’s office after a few days to have stitches removed if required.
Bruising and swelling will subside within 10 to 14 days and you will be advised to use ice packs on your eyes. As with most eye and face surgeries, you will be advised to avoid straining, heavy lifting, jogging and swimming for a week.
Possible risks include difficulty closing your eyes, noticeable scarring, injury to eye muscles and/or need for follow-up surgery.
Ptosis repair surgery is performed by an oculoplastic surgeon, an eye surgeon or an ophthalmologist that has undergone specialized training in the reconstruction of the functioning of the eye and the facial regions around the eye. The surgery is performed on an outpatient basis.
Blepharoplasty can be performed by an oculoplastic surgeon or a plastic surgeon together with a brow lift or face lift.
According to 2020 statistics from the American Society of Plastic Surgeons, cosmetic eyelid surgery costs about $4120. These fees exclude anaesthesia, operating room facilities or other related expenses .
Insurance coverage depends on the cause of surgery. If it is purely cosmetic, such as an upper and/or lower eyelid blepharoplasty to improve appearance, the cost probably won’t be covered by insurance.
Ptosis repair surgery, medically necessary to improve vision, is usually covered by insurance.
It’s recommended to speak with your eye care or medical care professional to weigh the benefits and risks of undergoing surgery to fix a droopy eyelid.
 American Society of Plastic Surgeons, “How much does eyelid surgery cost?,” Available: http://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery/cost. [Accessed: 03-June-2022]
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