Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). Excess skin hanging over the edge of the eyelid margin (where the eyelashes are) is called dermatochalasis, while ptosis is where the upper eyelid margin itself is too low. Ptosis can be caused by many things but is most often caused by the stretching of a muscle called the levator aponeurosis. In most cases the muscle is healthy but stretched out, leading to sagging of the upper lids and a sleepy appearance. Ptosis frequently blocks the superior portion of a patient’s vision unless they constantly raise their brows to see, which can lead to headaches.
There are 3 techniques to treat ptosis surgically. Dr Hellman may put phenylephrine eye drops in your eyes during your consultation to get a preview of the potential results of a posterior (through the back of the eyelid) ptosis surgery. This surgery is performed through an incision on the back of the eyelid.
In other situations, Dr Hellman will do an external levator advancement. This surgery involves an incision that is hidden in the eyelid crease, and dissection to the levator muscle. Dr. Hellman will tighten the stretched-out muscle with sutures and then inspect the lids and adjust the sutures until the lids are at the perfect height.
Finally, in cases where the muscle is not just stretched out but actually weak (this is called poor levator function), Dr Hellman will recommend a frontalis sling procedure. In this procedure the eyelid is connected to the brow by a piece of silicone so that lifting the brow elevates the upper lids.
Before (Top) & After (Bottom)
