Ptosis Repair Sydney

Ptosis Repair

Ptosis is a condition where the eyelid droops due to weak muscles or other factors, and can either be something you are born with, described as congenital, or develop over time with ageing, long-term contact lens wear, previous eye surgery or trauma. Ptosis repair is the operation that raises the lid margin itself by tightening or reattaching the levator muscle that lifts it.

Ptosis is not the same as excess eyelid skin. Skin sits above the lid margin and can be removed, whereas with ptosis the margin itself sits low, sometimes covering part of the pupil and reducing your upper field of vision. Removing skin alone will not raise it, and the two conditions often occur together. Dr Maryam will assess whether ptosis repair is needed, which can be done alongside or instead of a blepharoplasty.

Dr Maryam Seyedabadi, Specialist Plastic Surgeon, MBBS FRACS, has a particular interest in eyelid surgery and sees patients at her Sydney rooms in Paddington, measuring lid height and levator function carefully, since millimetres change the outcome.

Who it may suit

• An upper lid margin resting low over the iris, or covering part of the pupil
• Drooping present since childhood, or a lid that has dropped gradually with ageing
• A lid that fell after cataract or other eye surgery, contact lens wear, or an injury
• Raising your brows or tilting your head back to see clearly
• A visible difference in lid height between your two eyes
• Adults in stable eye health who accept that adjustment surgery is sometimes needed

What ptosis repair involves

Ptosis repair is usually day surgery, often under local anaesthetic with sedation so you can open and close your eyes during the operation, which helps set the height. Where the levator has very little function, as in some congenital cases, a sling technique using the forehead muscle may be discussed instead.

1. Lid height, levator muscle function and crease position are measured, and the likely cause of the droop is identified.
2. Anaesthetic is given, most often local anaesthetic with light sedation.
3. The levator is advanced or reattached, either through an incision in the lid crease or from the inner surface of the lid, depending on the degree of ptosis and how well the muscle works.
4. Height and contour are checked, with you sitting up where possible, and adjusted before closure.
5. Excess skin is removed at the same time if an upper blepharoplasty is also planned.

Recovery

Most people go home the same day with ointment and a cold compress routine. Timeframes vary between patients and with the technique used.

• Bruising and oedema commonly settle over roughly two to three weeks, and lid height keeps changing as swelling resolves
• Sutures are generally removed at about five to seven days
• Many patients return to desk work within one to two weeks, and to exercise after two to four weeks once cleared
• The final lid position is usually judged at around three months, not in the first few weeks

Risks and considerations

Risks include under-correction, over-correction and asymmetry between the lids, an altered or uneven lid crease, contour irregularity, dry or gritty eyes, difficulty closing the eye fully, bleeding, haematoma, infection, scarring and reaction to anaesthetic. Rare and serious complications include injury to the eye and loss of vision. Ptosis repair has a higher revision rate than skin removal alone, because height is set within millimetres and swelling and muscle behaviour can shift the result during healing. A second, smaller adjustment procedure is sometimes required.

Congenital ptosis in children can affect visual development and warrants early assessment, including by an eye specialist. Ptosis can also be a sign of a neurological or muscular condition, so any recent or fluctuating droop is investigated before surgery is considered.

Your consultation with Dr Maryam

A referral from a registered medical practitioner is required before your consultation, and a GP referral is preferred so relevant medical and eye history can be reviewed. Dr Maryam measures lid height and muscle function, arranges a visual field test where vision appears affected, and takes preoperative photographs.

The risks, possible complications and alternatives are discussed before you decide, including blepharoplasty, monitoring, or no surgery. A cooling-off period of at least seven days applies between consultation and booking. Patients under 18 have a cooling-off period of at least three months and also require assessment by an appropriate registered health practitioner. Enquiries can be made on 1300 067 668.