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Answered: your most burning questions about droopy eyelids

Answered: your most burning questions about droopy eyelids

Here are 8 commonly asked questions about ptosis or droopy eyelids that I will answer for you in this blog post. Knowing the answers to these questions will help you to find the best treatment for ptosis.

  1. Why do I have it?
  2. Can anything be done for my droopy eyelids?
  3. Does surgery hurt? 
  4. Does surgery work? 
  5. When can I go back to work after my droopy eyelid surgery? 
  6. Will the ptosis recur?
  7. Will other people tell that I have had eyelid surgery? 
  8. If I do not have surgery what will happen? 

1. Why do I have ptosis? 

Many patients asked me why I do have ptosis?  Why am I looking sleepy?  Why can I not open my eyes fully and they begin to look small?  Why are my eyelids distracting from how I feel about myself and why are falling? 

These are all different types of questions describing the same thing. People asking these questions want to about why the eyelids droop as we get older. 

There are many reasons why eyelids can get droopy.  Some patients wear contact lenses, particularly the older fashioned gas permeable contact lenses. When worn over 20-30 years, these cause slight rubbing underneath the eyelid. This rubbing thins the eyelid muscle called the levator aponeurosis. In fact, this is the front bit of the eyelid muscle, and that causes the eyelids to droop.

Many adult patients get droopy eyelids because of a combination of genetics, or because they have just aged and their tissue has got thinner, laxer and a lot of things begin to droop, including the eyelids. 

There is usually not a worrying cause as to why you have got droopy eyelids.  However, it is an excellent idea if you have droopy eyelids to get checked by your oculoplastic surgeon to make sure that you have not got a dangerous underlying condition. An underlying condition could be a nerve palsy, a weak muscle in the form of myopathy, or it could be that something is underneath the eyelid making it look droopy.  These are rare, but we must discount them before you consider surgery to put a droopy eyelid right.

2. Can anything be done about ptosis? 

Yes, a lot can be done about your droopy eyelids.  Your ptosis is a very well recognised condition, and it can affect one or both of your upper eyelids, either equally or asymmetrically.  The first thing to do is for you to go and see your eye surgeon, who will help you to find the best treatment for ptosis. This surgeon should be an eye surgeon trained in oculoplastic surgery, one who knows how to both assess and how to measure the upper eyelids when planning the appropriate surgery.  

Yes, I have used the word surgery. That is because the only way of effectively treating ptosis is by eyelid surgery.  Now, this may sound scary, but it is not.  Upper eyelid surgery for ptosis done by someone who is well experienced in this and has been doing this for many, many years such as myself find that ptosis surgery can be a very satisfactory operation for the patient. It is a beautiful surgery to do as the eyelid tissues are so delicate and done gently and carefully with you under local anaesthetic. It can have a very high success rate. 

 3. Does the surgery for ptosis hurt? 

No, eyelid surgery does not hurt. Of all the operations that I can think of, although eyelid surgery is near to the eye and it might seem a bit scary at first, it is a relatively safe operation. The reason is that we use local anaesthetic drops is to allow you are wide awake for your surgery but make your eyelid is wholly asleep and numbed. 

Although you can open the eyelids and you can look up and look down, which of course is very helpful to me as a surgeon during your surgery, you cannot feel anything, so it does not hurt.  Even when we finish the operation and you have gone home it is doubtful that you are going to need a Paracetamol tablet. Possibly you may like to take Paracetamol in the first 24 hours, but more for reassurance rather than being because the eyelid hurts. 

If you get pain after your ptosis surgery, then I would be concerned that you have gone and got a dry surface of the eye or a small scratch which would heal very quickly over 24 hours.  If the pain were a lot greater than that, then I would be concerned that you are having a haemorrhage.  However, with ptosis surgery having a haemorrhage inside the orbit is exceedingly rare. I have never seen it, and I have not even heard of it happening. I suppose everything is possible, but it is not on our main list of possible side effects of ptosis surgery. 

While we are on the side effects, I should mention that you will have bruising and you will have some swelling and redness which is obvious when you have had surgery on your eyelid or eyelids. They are going to look a little bit bruised and red for a few days afterwards.  Also, the eyelids do not want to move so well so you may have a reduced blink for the first couple of weeks which gives you slightly drier eyes. Always check your dry eyes to make sure that they are well before the surgery and that we cover them with lubricants after the surgery. 

 4. Does ptosis surgery work? 

Yes, ptosis surgery works well.  The aim of the ptosis surgery is several-fold.  First of all, I want to raise your eyelid so that it matches the other one, or raise both so that neither of the eyelids looks droopy, sleepy or ptotic. When lifting them, I want to make sure that you have a beautiful curve to the eyelid giving you a lovely shape of the open eye, an attractive form when you look down, but with full closure when you close your eyes. 

I mainly want to pay attention to the skin crease, the little fold above the eyelashes when you look up and down where the skin overlaps slightly.  I want to make sure that the skin crease height is attractive and suits your face and your eyes. I am aiming to restore the beauty that you had to your eyelids previously before you developed ptosis. It does work; ptosis surgery is effective. 

The surgery success rates are quoted as easily 70% full success.  Now that means for the remaining 30% there may be a slight asymmetry which in the majority of cases almost 90% is entirely acceptable and satisfactory. The redo rate of surgery, rather than redo I prefer to use the word refinement surgery to adjust afterwards is at the level of 9-11%. That can be because occasionally the eyelid can be fixed at a perfect position, but it can gradually droop again during the first year after surgery.  We usually judge the final result three months after surgery. By then all the swelling and bruising has completely gone, any redness that was there has disappeared, and the scar on the skin fold is not visible. 

There is a small number of patients who have come back 6-12 months later saying well it looked lovely, but it has gone down again. It may not have gone down again as far as it was before, but it may need a further tuck.  Fortunately, that is rare, so I can happily say that ptosis surgery does work. 

 5. When can I go back to work after treatment ptosis? 

I always used to say you can go out to dinner the same night after your ptosis surgery, well that is not strictly true.  I would say you can do most things after 48 hours. You cannot swim, you cannot do heavy weights or very active gym work or carry heavy bags. But you can walk around, you can have dinner with other people, albeit you can work from home. I would not recommend that you go to work for about a week as I do like to see that the wound has healed up adequately.

So, when I can go back to work?  I would say you can go back to work by day 8.  There are of course some patients who leap back to work around about day 3 or 4. That is because they are not concerned that they have bruising and some stitches visible and they are doing office type work, where there is not a risk of dirt or injury or infection.  It does depend as well on what your occupation is.  If you are a builder, I do not want you back at work for at least two weeks, but if you are working in an office and you are just doing gentle computer work or talking to people on the phone, then it can be a lot earlier.  

 6. Will a ptosis recur?

I have already talked about the minimal risk of recurring ptosis above.  Usually, if you have ptosis, it is going to recur or recur slightly within the first year, and that is only for a tiny number of patients.  So if you find the best treatment for ptosis, the surgery is effective long-term.

7. Will other people see that I have had eyelid surgery? 

Yes, to begin with, other people will see you have had surgery.  For that reason, I advise you to wear dark glasses. Glasses not only protect the eyes and the little skin incisions in the skin fold from air, wind, and dust, but they also hide the appearance for the first week. 

However, by about three weeks it will be challenging for other people to tell that you have ptosis surgery. Younger people can look perfect one week after ptosis surgery because they bruise and swell much less than older people. 

Sometimes even I cannot tell which eyelid they have had done when I see them back at the clinic.  I have used stitches, and I have used Tisseel fibrin adhesive to help quieten the wounds and support the healing. Older people tend to have a more lax tissue, so they get a bit of bruising and it spreads more, so it is more evident for a bit longer.  Usually, by three weeks 80% of the swelling has gone. By three months the eyelids look perfectly healthy as if they have been un-operated. They are looking natural in the right position, at the right height, with the right curve or contour and a good symmetry between the skin creases.  

 8. If I do not have surgery, what will happen? 

If you do not have surgery, there will be a gradual deterioration, and the ptosis will get worse.  You will start to use your eyebrows more to help lift the eyelids which may cause you to get tiredness and a headache feeling above the eyes at the end of the day.  You may also start to tilt the chin up a little bit and bend the neck backwards to facilitate seeing out from underneath the eyelids.  The ptosis will not get better by itself, and the best treatment for ptosis is by an oculoplastic surgeon who is very experienced in the assessment, management, operation and postoperative care of your ptosis.


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