Ptosis is defined as drooping of the upper lid. In ptosis, there is a muscle weakness as opposed to dermatochalasis or blepharoplasty repair, which is surgery for redundant skin. Ptosis causes a tired, sleepy appearance and reduces vision. Repair is intended to provide a more youthful, vibrant appearance as well as to improve your sight.
An ophthalmologist who specializes in eyelid plastic surgery usually performs ptosis repair. This is called an oculoplastic surgeon. Ptosis repair is complicated and surgeons do a 2-year fellowship focusing only on surgery around the eyes. Special training is also required in order to ensure the proper lubrication of the eye after surgery. Many times a ptosis repair cannot be performed if the eye is too dry.
There are different causes of ptosis. It is important to choose a specialist that can identify the different causes of ptosis. The different types include involutional, muscular, traumatic, neurologic, and mechanical
Involutional – Involutional ptosis is caused by stretching of the tendon which supports the upper lid muscle. Involutional ptosis usually occurs with aging. Other causes include long-term rigid contact lens weaken the tissue of the upper lid.
Involutional ptosis is corrected by tightening the tendon that has stretched. Ptosis repair is performed through an incision in the normal crease in the upper lid.
Muscular – In some people ptosis is actually caused by a weak levator muscle that does not develop properly. The function of the levator muscle is to raise the eyelid. Muscular ptosis can occur in early childhood.
The ptosis can affect the child’s vision, early correction is necessary to prevent long term visual consequences. In some cases, the ptosis will actually keep a child from walking well and difficulty with coordination because the child must lift the chin in order to see.
How the surgery is performed in a muscular case, depends on the degree of muscle function. If some muscular function remains in the levator muscle, muscular ptosis is corrected by actually tightening the levator muscle (levator resection). When the muscle is first tightened you will not blink normally. It is common for the eye to stay open while sleeping and to cause a condition called lid lag when looking down. This may result in dryness of your eye. At first, you will need to frequently lubricate your eye with ointment and/or drops in order to keep the eye from drying out.
If the levator muscle is very weak, tightening the muscle will not adequately raise the lid. In that case, a suspension procedure is necessary. This is called a frontalis suspension. During a frontalis suspension, small strands are placed between the eyelid and eyebrow. These strands are tightened in order to raise the lid. When you wish to raise your eyelid you will unconsciously raise your brows. When you want to close your eyelids you will unconsciously lower your brows and squeeze your eyelids shut.
In children, a frontalis suspension is performed with fibrous tissue taken from the leg, either your child’s own leg or a donor. This usually produces a long-lasting correction, although adjustments later in life are often necessary.
In most adults, a frontalis suspension is performed with an elastic strand of solid silicone or fibrous tissue.
What to expect after Surgery?
After surgery, your eyelid will be swollen and your vision will be blurry. It can take up to 3 weeks before you will notice what the final result will be. It is important to elevate your head and use cold compresses as much as possible after surgery to reduce the swelling. If the swelling is excessive it could stretch the sutures and cause the eyelid to droop again.
It is necessary to use lubricating ointment and/or drops to prevent dryness. In most people these lubricants will be needed for a few weeks after surgery. Your doctor will discuss how to lubricate your eye properly.
You will see the doctor one week after surgery to ensure that your eye is adequately lubricated. You will need to see the doctor regularly until you can close your eyelid well.
Unfortunately, ptosis repair is not an exact science. The final position of the eyelid depends on the healing of the tissue. In some cases, later adjustment is necessary.
You may resume wearing contact lenses when your eyelid is closing well and your eye feels comfortable. Most people begin wearing lenses again about three to four weeks after surgery. Please consult with your doctor when you are able to wear your lenses again, as this may change from patient to patient. Rigid contact lens wearers may have some difficulty removing the lenses initially. A small minority of people have difficulty tolerating their lenses after surgery, as their eyes may feel dryer. In some cases, you may need to update your eyeglass prescription after surgery. You should wait until at least 6-8 weeks after surgery before being examined for new eyeglasses.
THE AGING FACE
Upper Eyelids: The skin on the upper eyelids is thin and loses elasticity as we age. This leads to excess skin and a tired appearance.
Lower Eyelids: The skin on the lower eyelids also stretches with time. The tensile strength of the eyelid decreases which results in a mild to moderate eyelid droop. Orbital fat protrudes which leads to a “puffy bag” on the lower eyelids. The volume around the eye also decreases leading to “hollowness” around the lower eyelids.
Eyebrows: With time, the soft fatty tissue beneath the eyebrows lessens. The fat in the temples also dissipates leading to a mild brow droop.
Midface: Loses volume and descends. Making the face look aged and tired. This creates lines around the mouth. A full midface creates a more youthful appearance.
Lips: Get thinner and lose volume as we age.
Nasolabial: The nasolabial lines is the line from the corner of your nose to the outer corner of the mouth. As we age, it becomes prominent because the midface droops and we lose volume.
Jawline: The jawline becomes less defined as we age.
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Dr. MacQuaid is a Board Certified Ophthalmologist and Oculoplastic Surgeon. An Oculoplastic Surgeon is someone who specializes exclusively in reconstructive, revision and cosmetic surgery of the eyes and surrounding tissue. She completed her fellowship at the prestigious Wilmer Eye Institute at Johns Hopkins Hospital.
Dr. MacQuaid's services range from cosmetic surgery of the eyelids and eyebrows to the midface. Dr. MacQuaid is a renowned expert in reconstructive surgery of the eyelids, eyebrows, tear duct surgery, thyroid eye disease, and tumors. She has advanced training in non-surgical facial rejuvenation such as Botox®, Restylane®, Juvéderm®, Radiesse® and Laser Resurfacing. She offers the latest technology available to patients.
Dr. MacQuaid is currently a member of the American Academy of Ophthalmology and is a Fellow of the American College of Surgeons. Aside from Ophthalmology, Dr. MacQuaid is a former Division One college athlete. In her free time, she enjoys playing tennis and spending time with her husband Jerry and their two children.
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