Blepharoplasty and Ptosis – Before and After Photos

Ptosis (pronounced to’sis) simply means droopy eyelid. It is one of the most common eyelid problems. The lid may droop slightly, or cover the entire pupil. Ptosis can restrict and even block normal vision. It can be present in children and adults, and is usually treated with surgery.

There is a difference between a droopy eyelid and a baggy eyelid. A droopy eyelid is low. A baggy eyelid (dermatochalasis) has excess skin and fat. The two often occur at the same time in adults. Blepharoplasty and ptosis are often repaired at the same time.

Ptosis can be inherited, be present at birth, occur later in life, and affect one or both eyelids. Signs and symptoms include: the drooping lid itself, looking up underneath drooping lids (a “chin-up posture”), raising the eyebrows in an attempt to lift the lids, loss of interest in reading due to forehead muscle fatigue, and headaches due to forehead muscle fatigue.

The most common cause of ptosis in adults is the separation of the levator muscle from the eyelid. This may occur due to aging changes, after an injury to the eyelid, after eye surgery such as cataract surgery, or with an eyelid tumor. Less commonly, ptosis in adults may occur with neurological disorders. Additional testing is performed to help diagnose these conditions.

Treatment is usually surgical and involves tightening of the levator (lifting) muscle within the eyelid (external levator advancement). This is performed as a same day surgery with light sedation and local anesthesia. If necessary, a blepharoplasty is performed first. Otherwise, a small incision is made in the natural upper lid skin crease. The levator muscle is tightened using a small, permanent suture. The patient is asked to open her eyes so that lid height, symmetry, and contour can be assessed. It is important for the patient to be alert during this part of the surgery to give the best results. Further adjustments are made, if necessary. The incision is closed using a fine absorbable suture. The patient is seen for a postoperative visit 1 week later. Sometimes, the lid height will need adjusting at that visit, which is comfortably performed in the office under local anesthesia.

Blepharoplasty (Blepharo- means “eyelid”, and –plasty means “change”) is the most commonly performed facial plastic surgery procedure. This is because the eyelids account for a large part of the expressiveness of the face. When you look at someone, you look at his or her eyes. If the eyelids are sagging, droopy, or puffy, the face will look fatigued, sad, and tired despite good health and adequate rest. If the eyes look bright and alert, an otherwise aging face will appear rejuvenated. Thus, blepharoplasty is a procedure that can rejuvenate the face as well as the eyes.

Blepharoplasty is tailored individually for each patient. The right combination of skin and fat removal, fat repositioning, and lid tightening is applied to achieve a more rejuvenated and youthful appearance in each individual patient. Sometimes, less is more.

Upper eyelid blepharoplasty is typically performed as a same day surgery under light sedation and local anesthesia. Excess skin is removed. Bulging orbital fat may be removed, sculpted or repositioned. Lateral sub-brow fat that contributes to upper lid fullness may be removed and/or sculpted.

Lower eyelid blepharoplasty is performed to soften the puffiness of the lower eyelids caused by prolapsed orbital fat. Fat may be repositioned to improve a tear trough deformity. Excess skin is removed, if necessary. Lower lid laxity or droop may be simultaneously corrected. Blending of the lid-cheek junction is performed with lower eyelid tightening and a cheek lift.