What is Ptosis?
Ptosis is a condition that causes the upper eyelid to droop or drop over the eye.
Sometimes, the upper eyelid droops low enough to cover the pupil (the black center of the eye). This can lead to impaired vision and other complications, such as amblyopia (lazy eye).
Symptoms of ptosis include:
- Drooping eyelids
- One droopy lid (eyelid creases don’t line up)
- Reduced or impaired vision
- Reduced peripheral vision
- Difficulty keeping eyes open
- Excessive rubbing of the eye or eyes
Two Types of Ptosis
Ptosis can develop in children and adults, but age-related is the most common form.
- Congenital ptosis. This type is present at birth and affects children.
- Acquired ptosis. This type occurs later in life due to aging or another condition.
What Causes Ptosis?
The cause depends on the type. Congenital ptosis can be caused by problems developing the muscle that lifts the eyelid (levator muscle).
Acquired ptosis occurs when the levator muscle stretches or pulls away from the eyelid. Causes of acquired ptosis include:
- Aging (most common cause)
- Eye injury
- Nerve damage from injury or illness, such as stroke
- Eye surgery complications
- Certain conditions, such as Horner syndrome and myasthenia gravis
What is Ptosis Surgery (Droopy Eyelid Surgery)?
Surgery is a common way to treat ptosis caused by aging. It involves elevating the eyelid to its proper position. Ptosis repair surgery might be done with blepharoplasty, which removes excess fat, skin, and muscle from the eyelid and surrounding area.
However, not everyone benefits from ptosis surgery. A thorough ophthalmological exam is needed beforehand. An ophthalmologist will assess your medical history and ocular health before recommending surgery.
Different surgical procedures help correct ptosis. These include:
Levator Muscle Tightening
This procedure can be either external or internal:
External Ptosis Repair
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.
Internal Ptosis Repair
In the internal procedure, the surgeon turns the upper eyelid inside out and shortens either the levator or Mueller’s muscle.
During this procedure, an eye 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?
In most cases, an oculoplastic surgeon performs the procedure. These surgeons have specialized training in eye surgery and 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.
How Much Does Ptosis Surgery Cost?
Ptosis repair surgery ranges from $4,500 to $6,000 without insurance.
The out-of-pocket cost for ptosis surgery varies based on how much your insurance company is willing to cover. In most cases, they only offer coverage when surgery is deemed medically necessary.
Does Insurance Cover Ptosis Eye Surgery?
Health insurance covers ptosis surgery when the procedure is deemed medically necessary. This means the drooping of the upper eyelid impedes vision.
How Do You Know if Ptosis Repair Surgery Is Medically Necessary?
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 eyelid ptosis. However, health insurance companies still require documentation of medical necessity before approving coverage.
What to Expect During Ptosis Surgery
Ptosis surgery is typically performed as an outpatient procedure, which means you can go home the same day. You must arrange for someone else to drive you home for safety reasons.
Here’s what to expect:
- You will receive local or general anesthesia. Local anesthesia numbs the area as you remain awake, while general anesthesia makes you fall asleep.
- Your surgeon will administer numbing eye drops. To further reduce discomfort.
- The surgeon will make an incision. They do so in the eyelid's crease to reduce the appearance of scarring.
The details of what happens next depends on the specific type of procedure you’re getting:
- Levator muscle tightening. Dissolvable stitches are used on the incision, and temporary sutures help tighten the tendon.
- Frontalis suspension. A tiny band or rod is inserted through the eyelid 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.
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. The recovery process occurs in stages.
Here’s a general idea of what to expect during recovery:
- Mild to moderate discomfort and swelling. This is normal during the first three days of recovery and can be relieved by applying ice to the surrounding area.
- Keep your eyelids clean. You should clean the area approximately six times daily (or per your surgeon’s recommendations).
- Plan to take some time off. Suture removal occurs about one week after surgery. Most people take about 10 days off of work or away from school or other activities requiring eye use.
- Reduce activity. If all goes well, exercise and regular daily activities can resume after three weeks.
- Give your eyelid muscles time to heal. Minimal swelling can last up to two to three months before the appearance of droopy eyelids is completely eliminated.
Common Questions About Ptosis Surgery
Is ptosis surgery worth it?
Surgery is the only effective ptosis treatment for drooping upper eyelids caused by stretched muscles. Your ophthalmologist may deem this treatment medically necessary if a drooping upper lid interferes with your vision.
Is ptosis surgery a high-risk procedure?
Ptosis repair is challenging, and choosing an experienced surgeon will help reduce risks. The primary risk involves ending up with upper eyelids that are asymmetrical.
Scarring and infection can also occur. Excessive bleeding is the most serious risk and can lead to blindness (rarely).
What are the drawbacks of ptosis surgery?
The main drawbacks of ptosis repair involve creating undesirable cosmetic results. The eyelid can be overcorrected (too high) or undercorrected (too low).
Scarring can create an unnatural-looking eyelid contour.
How painful is ptosis surgery?
Ptosis repair is painless because the area is numbed before surgery. But you might experience minor discomfort for a few days that can be relieved with ice.
Ptosis surgery is a treatment for upper eyelid drooping. Your ophthalmologist may recommend treatment with surgery if ptosis interferes with your vision. Some people choose surgery for cosmetic reasons.
Health insurance will only cover the cost of ptosis surgery if it’s deemed medically necessary, meaning vision is impaired. Out-of-pocket costs range from $4,500 to $6,000.
The most common complications of ptosis surgery are uneven eyelid height and an unnatural-looking eyelid contour. Serious complications are rare.
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