Treatment for ptosis

Nowadays, there are many ways to treat ptosis, ranging from cosmetic surgery to adjustments in daily lifestyle habits. Depending on each case and the underlying cause of ptosis, the doctor will recommend the most appropriate treatment method.

Levator Muscle Shortening

This is a surgical method used to strengthen the function of the upper eyelid levator muscle, effectively treating ptosis.

Indications:

• In cases where upper eyelid levator function is fair or good.

Advantages:

• Restores a natural eyelid crease.
• The small incision provides a high aesthetic result, helps minimize swelling, reduces bleeding, and avoids unsightly scarring.
• Quick recovery time.

Limitations:

• The results are not long-lasting and recurrence is common.
• Potential risks include eyelid lagophthalmos, conjunctival prolapse, etc.
• Not effective in cases of poor levator function.

The surgical procedure for upper eyelid levator shortening in ptosis treatment is as follows:

Step 1: The doctor examines the eye area and administers local anesthesia so the patient feels less pain throughout the procedure.

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

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

Step 4: The incision is closed and a double eyelid crease is created.

Step 5: Postoperative monitoring and care are provided according to the doctor’s instructions.

Using the Frontalis Muscle to Indirectly Elevate the Eyelid via a Sling

This method lifts part of the eyelid to the frontalis muscle using autologous tissue (fascia lata, superficial temporal fascia) or synthetic material (non-absorbable suture, silicone rod, etc.) so that both eyelids become more symmetrical.

Indications:

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

Advantages:

• Simple technique, quick to perform, and minimally traumatic.
• Applicable to all types of ptosis, especially bilateral ptosis.

Limitations:

• Prone to recurrence.
• Risk of ptosis on upgaze, eyelid lagophthalmos leading to keratitis, or excessive frontalis suspension that may pull the eyelid away from the globe.

The procedure for indirect frontalis suspension is as follows:

Step 1: The doctor examines and directly assesses eyelid laxity, then orders several general health tests to ensure the minor surgery is performed safely.

Step 2: The doctor administers anesthesia around the eyes, helping the patient feel no pain or discomfort.

Step 3: The doctor performs the surgery

Step 4: The incision is closed and postoperative monitoring is carried out.

Direct Frontalis Suspension of the Eyelid

The doctor uses an autologous frontalis muscle flap (which may be a C-shaped flap, split frontalis flap, advancement flap, or orbicularis oculi-frontalis interlacing flap) to directly suspend the eyelid, while also removing excess lax skin from the eyelid, correcting drooping eyelids that obstruct vision and restoring the eye’s natural function.

Indications:

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

Advantages:

• Effective treatment for severe ptosis caused by congenital factors or trauma.
• Uses autologous tissue, ensuring maximum safety.
• Long-lasting results with low recurrence.

Limitations:

• The technique is quite complex and requires the doctor to have a thorough understanding of upper eyelid anatomy and adjacent structures.

The procedure for direct frontalis suspension is as follows:

Treatments for Skin Laxity Causing Pseudoptosis:

For eyelid drooping caused by aging and loose skin, doctors may recommend the following procedures:

(1) Blepharoplasty:

• The doctor removes excess skin from the upper eyelid, recreating a larger and more defined eyelid crease. This is applied in cases where the patient has a large amount of excess skin (>15-20 mm), usually excess skin at the inner corner of the eye, and no eyelid crease.

• Removes excess skin from the eyelid that obstructs vision, creating a natural new eyelid crease without affecting the shape of the brow arch.

Procedure:

(2) Sub-brow Lift Surgery:

• This technique removes excess skin beneath the eyebrow arch to correct eyelid drooping. It is suitable for cases of skin laxity, patients who do not want to change their existing eyelid crease, those with thick and high-set eyebrows, or patients who have previously tattooed their eyebrows.

• The procedure is simple and quick.
• High effectiveness, restoring a natural eyelid crease and harmonious brow arch.

Procedure:

(3) Combined Blepharoplasty and Brow Lift Surgery:

• For patients with high brows and excessive excess skin (both at the inner and outer corners), and asymmetrical eyelid creases, using each surgical method separately will not achieve comprehensive functional and aesthetic results. Therefore, in this case, the doctor will perform a combined brow suspension and blepharoplasty.

• High effectiveness and fast healing.
• Avoids long scars at the outer eye corner and brow tail.
• The technique is complex, so it should be performed by an experienced doctor.

Procedure:

In general, women experiencing ptosis should undergo an examination and consultation with a skilled doctor so they can choose the appropriate surgical method and timing.