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Droopy eyelids? Learn about Ptosis surgery options

What are the treatment options for my droopy eyelids?

Droopy eyelids are also known as ptosis and refer to the drooping down or dropping down of the upper eyelids. That can be either one side, which is called unilateral ptosis, or both sides which are called bilateral ptosis. Both unilateral and bilateral ptosis can be cosmetically unsatisfactory or interfere with your vision. 

Unfortunately, injectable treatments such as anti-wrinkle treatments and dermal fillers are not effective in treating droopy eyelids. 

Therefore in moderate to severe cases of drooping eyelids, the only possible option is surgery called blepharoplasty and ptosis surgery. That depends on the exact balance between whether it is excess skin or an actual droop of the eyelid. 

With ptosis surgery, the muscle that lifts the eyelid called the levator muscle is either thinned and elongated so that the eyelid is dropped, or it has been replaced by fibro-fatty tissue and is no longer elastic and efficient. The levator muscle has to be approached either through a small skin incision hidden in the skin crease of the upper eyelid or through a conjunctival incision from the under the surface of the eyelid and then advanced forwards or shortened towards the tarsal plate. That is the thick protective plate of the eyelid. It means that the eyelid becomes re-suspended at a better level eliminating the ptosis and giving a pleasing and good functioning upper eyelid. 

Specialist ophthalmologists who have trained in eyelid plastic surgery perform eyelid surgery

They are called oculoplastic surgeons. In particular, oculoplastic surgeons are the specialists for doing ptosis surgery for droopy eyelids. Some plastic surgeons and maxillofacial and ENT surgeons also do blepharoplasty surgery.

Every eyelids treatment is tailored to your specific requirements, and therefore each patient has to have an assessment by the expert oculoplastic ophthalmologist who will then specify the best approach to your droopy eyelid surgery and will also provide you with a definite price in the form of a quote for the operation to be done. 

Remember the quote must be transparently inclusive of not only the surgeon’s fee but also the clinic fee and the postoperative care – in other words: no hidden extras. 

Because you need to find out whether you are suitable for ptosis surgery you have to have a thorough assessment in consultation with the oculoplastic surgeon. That will usually be a half hour assessment in which history, photographs and measurements are done of the eyelids and the front of the eye surface. The eye itself is checked by the ophthalmologists to make sure that you are a good candidate for either cosmetic blepharoplasty surgery or ptosis droopy eye surgery. 

The oculoplastic surgeon will assess the relative proportion of excess skin obscuring the natural fold, eyelid fold; loose overhanging skin called lateral hooding on the upper eyelids. They will find out how much loose skin is impairing your vision, whether the upper eyelid skin is wrinkly and thin or whether it has bulges and fat bags. They will then tailor a surgical treatment plan for you which will tell you how much blepharoplasty is required and how much ptosis is required, whether unilateral or bilateral. They will provide you with an information sheet about the upper eyelid and ptosis surgery options. 

For instance, if you have both excess upper lid skin and you have drooping eyelids, you are likely to require both a blepharoplasty correction and ptosis corrective surgery on both upper eyelids. Therefore it is more likely that this will all be done through the skin, though some surgeons prefer to do the ptosis through the undersurface of the eyelid the conjunctiva. Through that route they cannot remove the skin though, so they have to have a skin incision as well. 

At Clinica London, I mainly do anterior approach through the skin crease incision, upper eyelid blepharoplasty and ptosis surgery because in my hands this is how I get the best results for you, my patient.  I base that on my experience as an ophthalmologist oculoplastic surgeon. I have been a consultant ophthalmologist in the NHS from 1994 to 2014 and in full-time private practice since 2014. 

I am intending to continue practising as an oculoplastic surgeon into 2024 and will use my expertise both in my assessment and surgical skills to help correct your upper eyelid excess skin with blepharoplasty and your droopy eyelids with ptosis surgery. I always provide you with a full report of your consultation together with a specific quote for your operation.

I like to use a fibrin adhesive to help quieten the wound and promote your fibrin cascade. That helps with healing, and I insist on GMC good medical practice recommendations that you have at least two weeks following your assessment with me to think about the information you have been given and decide whether you wish to proceed with the surgery.

When looking at droopy eyelids ptosis surgery options, you need to consider:

  1. Which type of surgeon you go to whether an ophthalmologist oculoplastic surgeon or other.
  2. What their experience has been in functional and cosmetic eyelid surgery.
  3. What will happen at the consultation?
  4. Whether you will receive an information sheet, report and quote.
  5. Whether you will be given a cooling off period to decide if you go ahead with surgery.
  6. Where the surgery will be done and whether it will be done under local anaesthetic. 
  7. Be sure that your surgeon who you have met will be carrying out the surgery and look after you in the postoperative period.
  8. That you are completely clear about what will happen during the surgery, in the aftermath of the surgery, and the cost of all of the assessment surgery and aftermath often called the eyelid cosmetic surgery package.

If you would like to learn more about ptosis surgery options you may contact Jenny Burrows, the Clinica London coordinator or Lizzie Grainger, our receptionist to discuss further with them how you may find out more. 

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