Ptosis Surgery (Droopy Eyelid Repair)

Ptosis Definition, Symptoms & Causes

Ptosis is a condition that causes the upper eyelid to droop or drop. 

In severe cases, the upper eyelid droops far enough down over the eyeball to restrict vision partially or completely. 

Ptosis occurs in both childhood and adulthood, but the most common form is age-related.

Symptoms of ptosis include:

• Drooping eyelid(s)
• Limited or restricted field of vision
• Difficulty keeping eyes open
• Head tilting and eyebrow raising
• Headaches
• Frustration

Aging causes ptosis, but that’s not the only cause. Other causes include:

• Genetics
• Eye injury
• Opioid drug use, especially morphine
• Side effects of anticonvulsants
• Nerve damage from injury or illness
• Lasik or eye surgery complications
• Long-term use of rigid contact lenses

What is Ptosis Surgery (Droopy Eyelid Surgery)?

Some people opt to undergo ptosis repair surgery to correct the issue. However, not everyone benefits from ptosis repair surgery. A thorough ophthalmological exam is needed beforehand. 

If you’re considering ptosis surgery, your doctor will assess your medical history and your current ocular health before making a recommendation. 

Different surgical procedures help correct ptosis. These include:

Levator Muscle Tightening

This procedure can be either external or internal. 

In the external ptosis repair procedure, the surgeon makes an incision into the upper eyelid skin, usually in the crease. 

This provides access to the levator muscle. Once behind the eyelid, the surgeon repositions the levator muscle and stitches it to connective tissue to create a tighter adhesion. 

In the internal ptosis repair surgery procedure, the surgeon turns the upper eyelid inside out and shortens either the levator muscle or the Mueller’s muscle.

Frontalis Suspension

In this procedure, the surgeon attaches a small silicone rod from the levator muscle to the frontalis muscle under the upper eyelid. The levator and frontalis muscles hold up the eyelid. 

Who Performs Ptosis Surgery?

Although some people consider ptosis repair surgery cosmetic, it is usually not performed by a plastic surgeon. The surgery is highly specialized and poses a risk to the eye. It requires more than just tightening or cutting droopy eyelids.

In most cases, an oculoplastic surgeon performs the procedure. This type of surgeon has specialized training in addition to medical school and a residency in eye surgery or ophthalmology. 

Not only do they understand the function of the eye, but they are also experts in the surrounding area, including the muscles. They have experience performing precise eyelid and plastic surgery procedures.

What to Expect During Ptosis Surgery

Surgeons use local or general anesthesia in both types of ptosis surgeries, depending on whether the external or internal procedure is used. They might also consider the patient’s comfort level with the procedure. 

Patients are given numbing eye drops to further reduce discomfort. Like all surgical procedures, surgeons check a person’s general health in advance. 

It is essential to relax before the procedure to reduce anxiety and allow for proper eye measurement. Stress can affect the tension of the muscles in the face, which can result in less-than-optimal results. 

If the surgeon must make an incision during eyelid surgery, they do so in the crease of the eyelid to reduce the appearance of scarring. 

During the levator procedure to tighten the upper eyelids, dissolvable stitches are used on the incision and temporary sutures are used to tighten the tendon. 

In the frontalis suspension procedure, a tiny band or rod is inserted through the eyelid and used to attach the levator muscle to the frontalis muscle. 

Both procedures elevate the eyelid and create a more symmetrical appearance. They tighten the eyelid muscle and reduce droopy eyelids. They also correct vision problems caused by sagging upper eyelids. 

Ptosis repair surgery might be done in conjunction with blepharoplasty, which is the removal of excess fat, skin, and muscle from the eyelid and surrounding area. 

Both the internal and external eyelid surgery procedures usually take about 45 to 60 minutes. Most patients experience some mild discomfort and sensitivity once the anesthesia wears off, but this usually passes within a day or so.

How Long Does it Take to Recover From Ptosis Surgery?

It can take up to three months to fully recover from the eyelid surgery procedure. The recovery process occurs in stages, which helps someone determine if they are having a healthy recovery. 

For example:

• The first three days of recovery include mild to moderate discomfort and swelling that can be relieved by applying ice to the surrounding area. Patients should clean the area approximately six times per day according to the surgeon’s recommendations.
• Suture removal occurs approximately a week after surgery. Most people take about 10 days off of work or away from school or other activities that require the use of the eyes.
• If all goes well, exercise and regular daily activities can fully resume after three weeks.
• Minimal swelling occurs up to two to three months after the procedure before the appearance of droopy eyelids is completely eliminated. 

How Much Does Ptosis Surgery Cost?

The out-of-pocket cost for ptosis surgery varies based on how much your insurance provider is willing to cover. In most cases, they only offer coverage when surgery is deemed medically necessary. This means the drooping of the upper eyelid impedes vision.

When not covered by insurance, the out-of-pocket cost of ptosis repair surgery which might be accompanied by upper blepharoplasty ranges from $4,500 to $6,000.

Does Insurance Cover Ptosis Eye Surgery?

Health insurance covers ptosis surgery when the procedure is deemed medically necessary.

How Do You Know if Ptosis Repair Surgery is Medically Necessary?

Ptosis surgery improves a person’s appearance. Upper eyelid ptosis creates imbalance if it only occurs on one side of the face. 

The corrective procedure creates symmetry, makes it easier to apply eye makeup, and improves the overall look of the face. However, there are many instances in which ptosis surgery accomplishes more than aesthetic improvements.

If your drooping eyelid interferes with your ability to see clearly, your doctor will order the surgery as medically necessary. This is almost always the case with severe ptosis. 

There is no droopy eyelid treatment or non-surgical cure for ptosis. However, health insurance companies still require documentation of medical necessity before approving coverage.