Ptosis Repair with Upper Eyelid Blepharoplasty

 

In some situations, patients have both ptosis and dermatochalasis; as such a single surgical procedure is adequate. Surgery to correct ptosis repair is directed to elevate the eyelid height (open the eye wider). In contrast, surgery to correct the dermatochalasis is called a blepharoplasty - and its goal is to remove the excess skin (and herniated orbital fat) that is present on the upper eyelids; this skin might or might not be interfering with peripheral vision.

 

 

Each surgical condition requires a distinct surgical approach. Let's initially elaborate on each of the two conditions: 

(1) What is Ptosis?

Ptosis, may also be called blepharoptosis refers to droopy eyelids due to an abnormally low upper eyelid in the relaxed primary position. This might lead to in loss of vision particularly while reading, headaches and eyebrow strain.

Upper eyelid ptosis is drooping of the upper eyelid margin in relation to the superior limbus and causes functional and cosmetic problems. A ptotic eyelid covers more than 2 mm of the upper limbus, and in severe cases it covers the pupils obstructing vision.

Who gets an Upper Eyelid Ptosis?

It is particularly seen in elderly patients who have undergone cataract extraction or lens replacement and is supposedly due to stretching or disruption of the levator muscle by retractors during lens surgery.

Causes of Upper Eyelid Ptosis

Upper eyelid ptosis might be true ptosis or pseudoptosis.

True ptosis can be congenital or acquired.

Ptosis might also arise due to complex facial injuries resulting in levator detachment from the superior tarsal plate.

Symptoms and Signs of Upper Eyelid Ptosis

Various techniques have been used for correcting upper eyelid ptosis. Some of the techniques include:

(2) Dermatochalasis - may also be called Pseudoptosis is presence of excess skin 

Surgical correction of dermatochalasis or pseudoptosis is performed via a blepharoplasty surgery.

Cosmetic eyelid surgery, Blepharoplasty, Eyelift

What is Blepharoplasty?

Defining Blepharoplasty

 

Indications of Combined Upper Lid Ptosis  with Upper Blepharoplasty

Presence of both conditions (1) Ptosis and (2) excess skin. Of note insurance generally will not pay for both procedures to be performed at the same time. Often, the upper blepharoplasty is performed at the same time as the ptosis surgery, but paid for by the patient. Altneratively, some patients elect to proceed in a staged-fashion: initially undergoing ptosis repair to elevate the eyelid and thereafter, in a separate surgery -months later- undergoing an upper blepharoplasty

Also, may be when the ptosis is corrected, the amount of skin on the upper eyelid becomes more prominent or noticeable. Thus might patients, opt to undergo cosmetic upper blepharoplasty to remove and sculpt the upper eyelid excess skin and fat. 

As the ptotic eyelid is elevated, restored to its normal position, the skin that is present on the upper eyelid bunches up and wrinkles more-slide the slider control to the write and note how when all the way to the right - the eyelid is more open, but NOW the skin is lapping over the edge of the eyelid.

The following figures show the before and after scenarios of upper blepharoplasty with ptosis.

As the eyelid ptosis is corrected (the muscle is adjusted to elevate the eyelid), the edge of the eyelid and the upper eyelid skin move closer together.

 

The animation below illustrates the scenario when there the patient has ptosis BUT ALSO has with some amount of excess upper eyelid skin

If there is excess upper eyelid skin, once the ptosis is corrected, the skin my OVERHANG the edge of the eyelid: Slide the control to the right to see a demonstration of this effect.



As the eyelid is elevated, the skin that is present on the upper eyelid, bunches up (accordion effect). The upper eyelid skin might roll over the edge of the eyelid); slide control to the far right to see this effect.

 

View the sample photographs below to see patients who have undergone COMBINED ptosis with upper Blepharoplasty.