Ptosis or Droopy Eyelids
Ptosis, pronounced toe-sis, is the medical term for drooping of the upper eyelids. The droopy eyelid can be mild to severe. People who have ptosis may complain that people tell them they look “tired or lazy.” Because of a constant effort to raise the eyelids it is not uncommon to also complain of fatigue and tension headaches. If this is a problem that you have, you may be interested in cosmetic eyelid surgery.
To schedule an appointment today, contact the team at the offices of Dr. Kami Parsa.
- What are the common causes of ptosis?
- Why is it urgent to see a doctor when my child has droopy eyelids?
- How is this procedure done on my child?
- What are the different types of droopy eyelid surgery?
- What kind of care will the patient require and what kind of post-operative effects should we expect following a child's ptosis surgery?
- When can my child go back to school?
- I am an adult, but I notice and/or I am told by others that I always look tired, is there anything that could be done for this?
- Does my insurance cover ptosis or droopy eyelids surgery?
- What type of anesthesia is used?
- I am interested! How should I proceed?
The most common reason for ptosis – the medical term for droopy eyelids — is what physicians call acquired ptosis, which develops as we age. As one can imagine, a lifetime of rubbing our eyes, washing our face and, for many, applying makeup and lotions will tend to stretch the tissue around the eyes. This often results in a rupture of the tendon that holds the eyelid up in its normal position. Another cause is congenital ptosis, which occurs when a child is born with droopy eyelids. This is a rather urgent medical condition for the child, and surgery may be needed to prevent permanent loss of vision in the affected eye. Other more rare causes of ptosis include myogenic ptosis from conditions impacting the muscles such as myasthenia gravis, neurogenic (nerve-related) ptosis and mechanical ptosis which is related to tumors or trauma.
In order for the visual system to develop normally, each eye needs to receive the visual information independently. In other words, if the child has droopy eyelids, this will result in blockage of the visual information to the brain, thus leading to irreversible poor vision since the child’s brain will not “learn” to see properly. Therefore, it is important to surgically raise the eyelids quickly to prevent permanent loss of vision.
All surgeries for ptosis are performed on an outpatient basis. This means the surgery will be done in the morning and the child will return home the same day. (It’s important that the child have nothing to eat after midnight the night before the procedure.) The surgery will vary depending on the type of ptosis, which will be diagnosed by Dr. Parsa during the initial exam. In general, most children with congenital ptosis will need what is known as a sling procedure. The sling is used to raise the eyelid to the correct level.
Although there are many types of ptosis surgeries, generally speaking, we can divide the treatment into three broad categories. Most of the lifting of the eyelid is done by a muscle called the levator muscle. The strength of this muscle, and a few other in-office tests, determine the type of procedure that will be performed.
- a) Internal approach (scar-less ptosis surgery or conjunctival mullerectomy): An in-office test is performed with a drop of phenylephrine (dilating drops). The test is positive if the eyelid lifts open and, then, this procedure is usually recommended. This treatment is very predictable and is performed through an internal incision, so no cuts are made on the outside of the eyelid. See surgery video .
- b) External approach (levator advancement): This procedure is performed if the patient doesn’t have a positive phenylephrine drop test, in other words the eyelid doesn’t rise with the eye drop. It is performed by making an incision on the outside crease.
- c) Frontalis sling procedure: Performed on patients who have a poor functioning levator muscle which focuses on the frontalis muscle in the eyebrow. Usually patients with congenital ptosis who are born with droopy eyelids will need this procedure. This procedure is called a sling procedure because we connect the eyelid internally to the eyebrow muscles. This way the patient learns to raise the eyelids by raising the brows. Here is an outstanding video of the sling procedure that was performed by Dr.Parsa
It is recommended to use ice packs or frozen peas over the eyelids as much as possible during the first 24 hours after surgery to reduce swelling. There is generally very little pain with this procedure, but if needed, Children’s Tylenol should be sufficient. You will be given an antibiotic ointment which should be applied to the incision site three times a day for one week. The first post-operative visit will be one week after surgery. Post-operative swelling for a few weeks is normal. The sutures used are absorbable and will not need to be removed.
Typically, the child will be able to go back to school after one week of rest.
Droopy eyelids can give the false impression that you are tired. Raising the eyelid surgically will give a more awake and alert, youthful appearance.
The insurance should cover most children with ptosis because of its urgency. In adults a visual field test is performed to determine how much of the superior vision is affected by the ptosis to determine whether the procedure is deemed medically necessary or is regarded as strictly cosmetic.
In children, the procedure is performed under general anesthesia. In adults, most eyelid surgery can be performed under local anesthesia. If desired, local anesthesia with sedation is also an option. This type of anesthesia, also known as Monitored Anesthesia Care (MAC), is performed by an anesthesiologist. The main advantages of this type of anesthesia are: (1) it does not require putting a breathing tube in the throat, (2) it does not require a breathing machine, (3) the recovery is much faster, (4) there is less risk of nausea after surgery. All of these elements translate into greater comfort and safety. During MAC anesthesia, an intravenous needle is placed into one of the veins of the arm or hand and medication is given to make the patient fall asleep. The amount is adjusted as needed. After the patient is asleep, numbing topical anesthetic is placed on the skin of the area that is being operated on. During the procedure the patient is unaware of anything going on, yet he or she is breathing normally.
If you are considering this procedure for yourself or a loved one, we encourage you to schedule a private consultation with Dr. Parsa. During this visit he will listen to the patient’s concerns and, after a comprehensive evaluation, will discuss the best treatment. If the individual is a suitable candidate for a procedure, depending on the gender, ethnicity, and age of the patient, a customized approach will be created. If you are a prospective out of town patient interested in visiting our Beverly Hills office, please do not hesitate to contact us to help arrange your travel plans.