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Ptosis is the drooping of the upper eyelid caused by the weakening of the muscles that raise the eyelid, disease, nerve problems, or trauma. Many patients seek to have their sagging eyelids surgically corrected for cosmetic reasons but in some cases, the low position of the eyelid may interfere with vision. The main types of ptosis surgery are levator resection, Müller muscle resection, Fasanella-Servat surgery, and frontalis sling operation.
Levator resection ptosis surgery is performed on patients with mild to moderate ptosis. An ophthamolic plastic surgeon makes a small incision in the eyelid, usually along the natural crease, exposing the levator muscle underneath. A portion of the muscle is separated from the tissue that forms and supports the eyelid. The surgeon adjusts the muscle to correct the sagging before reattaching it in a new position. This procedure effectively shortens the levator muscle and allows it to hold the eyelid up higher, exposing more of the eye.
Müller muscle resection, or Müllerectomy, is another type of ptosis surgery. The eyelid is turned inside out and the Müller's muscle, which is another small muscle responsible for eyelid control, is gently dissected away from the underlying tissues. The muscle is then adjusted and reattached. The surgeon can also make minor adjustments to eyelid height and fine tune the eyelid contour when sutures are put into place.
A similar type of ptosis surgery is called the Fasanella-Servat procedure. Like a Müller's muscle resection, this technique involves approaching the eyelid from underneath. In the Fasanella-Servat procedure, the surgeon makes adjustments to both the Müller muscle and the mucous membrane and tissues that line the inside of the eyelids. This type of ptosis surgery is only appropriate for patients with mild ptosis.
Frontalis sling surgery, reserved for severe cases of ptosis, involves lifting the eyelid mechanically. The surgeon makes an incision in the eyelid and then uses non-absorbable thread to create a sling to support the drooping eyelid, which is then secured to the frontalis muscle under the brow. A thread support attached to the patient's brow muscle holds in eyelid muscles up.
Ptosis surgery lifts the eyelid into the proper position, but does not change the amount of skin and fat surrounding the eye. To remove excess skin and fat, patients sometimes undergo a blepharoplasty procedure at the same time. This is usually done for cosmetic reasons, but in some cases it is necessary to ensure that the extra skin does not droop down to obstruct vision.
Pain associated with ptosis surgery and recovery is usually mild. Following any type of ptosis surgery, patients will experience swelling, which might affect vision and prevent eyelids from closing completely for one or two weeks. The final results of the procedure will not be apparent until all of the inflammation is gone, which takes approximately three to six weeks.
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