Ptosis Correction

Nowadays, droopy eyelids can be treated in several ways, including cosmetic surgery and changes to daily lifestyle habits. The most suitable treatment depends on each person’s condition and the cause of the eyelid ptosis, so the doctor will recommend the right option for each case

Levator Muscle Shortening

This surgery helps strengthen the muscle that lifts the upper eyelid and can effectively improve droopy eyelids.

Indications:

• When the muscle that lifts the upper eyelid still has fair to good function.

Advantages:

• Helps recreate a natural eyelid crease.
• The small incision provides a highly aesthetic result, helps minimize swelling, reduces bleeding, and lowers the risk of noticeable or unsightly scarring.
• Recovery time is relatively fast.

Limitations:

• The results may not be long-lasting, and recurrence can occur.
• There is a potential risk of complications such as inability to fully close the eyelids (lagophthalmos), conjunctival prolapse, and others.
• This method may not be effective in cases of poor levator muscle function.

Surgical Procedure for Upper Eyelid Levator Muscle Shortening to Treat Eyelid Ptosis

Step 1: The doctor examines the periocular area and administers local anesthesia to help reduce discomfort throughout the procedure.

Step 2: An eyelid skin incision is made, and the skin flap is excised depending on the degree of excess eyelid skin.

Step 3: The skin edges and orbicularis oculi muscle are dissected to expose the upper eyelid levator muscle.

Step 4: The incision edges are sutured, and a double eyelid crease is created.

Step 5: The patient is monitored after surgery and follows postoperative care instructions provided by the doctor.

Frontalis Sling Suspension for Indirect Eyelid Elevation Using Frontalis Muscle Contraction

This method involves suspending part of the upper eyelid to the frontalis muscle using autologous materials, such as fascia lata or superficial temporal fascia, or synthetic materials, such as non-absorbable sutures or silicone rods, to improve symmetry between both eyelids.

Indications:

• In cases where upper eyelid levator muscle function is weak or absent.

Advantages:

• The technique is simple, quick to perform, and minimally traumatic.
• It can be applied to all types of eyelid ptosis, especially bilateral ptosis.

Limitations:

• There is a risk of recurrence.
• Potential complications include eyelid drooping on upgaze, lagophthalmos that may lead to corneal inflammation, or overcorrection from excessive frontalis suspension, which may pull the eyelid away from the globe.

The procedure for indirect eyelid suspension to the frontalis muscle is as follows:

Step 1: The doctor examines and directly assesses the degree of eyelid laxity. The patient is then instructed to undergo several general health tests to help ensure the minor surgical procedure can be performed safely.

Step 2: The doctor administers local anesthesia to the eye area to help prevent pain or discomfort.

Step 3: The doctor proceeds with the surgical procedure.

Step 4: The incision is sutured, and the patient is monitored after surgery.

Direct Eyelid Suspension to the Frontalis Muscle

The doctor uses an autologous frontalis muscle flap, which may include a C-shaped flap, a tri-split frontalis flap, an advancement flap, or an orbicularis oculi–frontalis interlacing flap, to directly suspend the eyelid. At the same time, excess lax eyelid skin is removed to correct eyelid ptosis that obstructs vision and to help restore normal eye function.

Indications:

In cases where upper eyelid levator muscle function is weak or absent.

Advantages:

• Effective treatment for severe ptosis caused by congenital factors or trauma.
• Uses autologous tissue, which helps maximize biocompatibility and safety.
  Provides long-term results with a low recurrence rate.

Limitations:

The technique is relatively complex and requires the surgeon to have a thorough understanding of upper eyelid anatomy and the surrounding structures.

The procedure for direct eyelid suspension to the frontalis muscle is as follows:

Step 1: The patient undergoes an examination of the upper eyelid area, along with a general health assessment, and receives consultation from the doctor.

Step 2: The doctor administers local anesthesia to the eye area.

Step 3: The doctor creates two incisions along the brow and upper eyelid, allowing the frontalis muscle flap to be rotated downward for eyelid suspension. This helps create an aesthetically pleasing eyelid crease while effectively preserving motor and sensory nerves.

Step 4: The incisions are sutured, followed by postoperative monitoring and care.

Treatment Options for Skin Laxity Causing Pseudoptosis:

For eyelid drooping caused by age-related skin laxity, doctors may recommend the following treatment options:

(1) Upper Blepharoplasty:

• The doctor removes excess skin from the upper eyelid and recreates a larger, more well-defined eyelid crease. This method is indicated for patients with a significant amount of excess skin (>15–20 mm), often involving excess skin at the medial canthus, and with an absent eyelid crease.

• Removes excess eyelid skin that obstructs the visual field and creates a new, natural-looking eyelid crease without affecting the shape of the brow.

Procedure:

Step 1: The doctor performs a comprehensive examination of the eye area and instructs the patient to undergo a general health check.

Step 2: The doctor calculates the amount of excess skin and precisely designs the incision line.

Step 3: The doctor disinfects the surgical area and administers local anesthesia to the upper eyelid.

Step 4: The doctor performs upper blepharoplasty, then uses sutures to recreate the new eyelid crease.

Step 5: The procedure is completed, followed by postoperative monitoring.

(2) Sub-Brow Lift Surgery:

• This technique involves excising excess skin beneath the eyebrow to correct eyelid drooping. It is indicated in cases of skin laxity, for patients who do not wish to change their existing eyelid crease, those with thick and high-positioned eyebrows, or patients who have previously had eyebrow tattooing.

• The procedure is simple and quick to perform.
  It can provide good aesthetic results, helping restore a natural eyelid crease and a harmonious brow contour.

  Procedure:

  Step 1: The doctor performs a comprehensive examination of the eye area, explains the treatment plan, and may request a general health check to help ensure safety during the procedure.

  Step 2: The doctor assesses the amount of excess skin to be removed, then measures, designs, and marks the surgical area along the brow.

  Step 3: The surgical area is disinfected, and local anesthesia is administered.

  Step 4: The doctor performs the direct sub-brow lift procedure, then carefully places the sutures so the incision is well concealed and visible scarring is minimized.

  Step 5: The procedure is completed, followed by postoperative monitoring.

(3) Combined Upper Blepharoplasty and Brow Lift:

• For patients with high-positioned brows, excessive redundant skin involving both the medial and lateral canthal areas, and asymmetrical eyelid creases, performing each surgical method separately may not achieve comprehensive functional and aesthetic improvement. Therefore, in these cases, the doctor may combine brow suspension or brow lifting with upper blepharoplasty.

• High efficacy with rapid wound healing.

• Helps reduce the risk of long scars at the lateral canthus and the tail of the brow.

• Because this is a complex technique, it should be performed by an experienced surgeon.

  Procedure:

  Step 1: The doctor performs a comprehensive examination of the eye area, explains the treatment plan, and instructs the patient to undergo a general health check.

  Step 2: The incision lines are designed, and the total amount of excess skin at each treatment site is calculated. This is the most challenging step and requires extensive professional experience from the surgeon.

  Step 3: The surgical area is disinfected, and an appropriate amount of local anesthetic is administered.

  Step 4: Brow suspension surgery is performed while excess skin is removed from the outer one-third of the eye area.

  Step 5: Upper blepharoplasty is then performed along the pre-designed incision line.

  Step 6: Cosmetic suturing is performed, followed by postoperative monitoring.

  Overall, individuals with eyelid ptosis should be examined and consulted by an experienced doctor to choose the most appropriate surgical method and timing.