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Ptosis Surgery in Young Adults aged 25 to 40

A drooping eyelid is called ptosis or blepharoptosis.
There are different types of ptosis, from thinning of the delicate eyelid tissue with age (involutional), traumatic from a direct injury and congenital, being born with a drooping eyelid.
A young adult aged 25 to 40 will often come to see me with a single drooping eyelid. They have noticed that one eyelid begins to fall and make the eye look smaller than the other one. There is more skin visible on the upper eyelid, and the other eyelid seems more open in comparison. If you’re a regular reader of this blog, you might recall this situation with my patient, Heidi.
Very often this group has what is called an early involutional or aponeurotic ptosis and can be caused by contact lenses, short-sightedness in a short-sighted person, or runs in the family.
In this younger age group, I, first of all, have to assess that it is genuinely unilateral and it is not a latent early ptosis in the other eye and once we have done we can proceed with surgery. That involves a thorough assessment at Consultation, with eyelid measurements and using the phenylephrine eye drop test which can help reveal a subtle ptosis on the other side, if present.
On the day of the surgery, they arrive about half an hour before the local anaesthetic procedure. It is done in our treatment operating theatre and starts with prepping and draping the patient, and then I sit them up and mark the skin crease. Usually, the skin crease rises higher in a unilateral ptosis in a young person, so I put it a little bit lower where it should be. I then ask them to lie flat, and I give the local anaesthetic to the eyelid, and local anaesthetic drops on the eye, and do the surgery to advance the delicate levator muscle aponeurosis.
I use TISSEEL fibrin adhesive to assist with the lid closure and healing as well as a few tiny stitches. They go home without an eye pad and just with a transparent shield to wear, and I see them a week later.
I am amazed by how the young adult patient with ptosis responds to so well to eyelid surgery. Ptosis patients in this young adult age group recover very quickly. When they come back to the clinic one week after surgery, I often say to them my goodness I cannot tell which side you had operated. The reason being is that they do not bruise badly and they heal very quickly without too much swelling.
Older people in contrast bruise a lot more and have more prolonged bruising and swelling. At the one-week post-op visit, I take out the stitches and then review them again a week or so later and then the last time at about two months.
Ptosis surgery in young adults is highly successful with success rates in the range of 85% complete symmetry with the other side and of the remaining 15% very few require refinement surgery. If the eyelid is slightly too high, then I ask them to lash tug, and if it is somewhat too low, I may keep the stitches for a bit longer. The number of patients that require a second operation is very few for this type of surgery and the effect, and the impact the surgery has on the young person’s life is incalculable.

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