Ptosis Surgery
Correction of eyelid drooping at the muscle and connective tissue level
Eyelid drooping (ptosis) occurs when the upper lid is in a lower position than normal and can affect both aesthetic appearance and visual field. Ptosis surgery is a functional operation that aims to anatomically correct eyelid height by intervening in the muscles and supporting structures that lift the lid.
Unlike blepharoplasty, ptosis does not arise from excess skin but from loss of function of the muscles that lift the lid. Therefore, the treatment approach is entirely directed at the muscle level.
Who is it Suitable For?
- Patients with congenital or acquired eyelid drooping
- Individuals whose lid level partially covers the pupil
- Patients with tired appearance or significant lid asymmetry
- People who try to compensate for lid height by raising their eyebrows
- Individuals with weak muscle function or advanced ptosis
In preoperative evaluation, levator function, Müller muscle response, lid crease, lid–brow relationship, and eye surface are examined in detail.
Stages of the Procedure
1. Local anesthesia
Most of the procedure can be safely performed under local anesthesia. Lid height provides an advantage in allowing intraoperative adjustment.
2. Selection of surgical approach
Different techniques can be applied depending on the degree of ptosis and muscle function:
a) Müller muscle resection
Applied in patients with mild ptosis and good muscle function. Lid level is raised with minimal entry from the inner surface.
b) Levator muscle shortening (levator advancement)
The most commonly used method in moderate and advanced ptosis. The main muscle that lifts the lid is strengthened or shortened.
c) Frontal suspension (frontal sling)
Applied when levator function is very weak. The lid is suspended to the frontalis muscle through silicone, supramid, or the patient’s own tissue. Thus, the lid rises with the movement of the forehead muscle.
d) Frontalis flap
Applied in patients with congenital ptosis and very low muscle function. A wider tissue connection is created between the frontalis muscle and the lid to keep the lid at a stable level.
These two techniques (frontal suspension and frontalis flap) are standard approaches, especially in pediatric ptosis and severe function loss.
3. Adjustment of lid height
In patients using local anesthesia, height is evaluated during eye opening and closing, and personalized positioning is performed.
4. Tissue arrangement and closure
After muscles and connective tissues are anatomically arranged, the skin is closed with fine sutures.
Recovery Process
- Mild swelling and bruising may be seen in the first days.
- Cold compresses and keeping the head elevated reduce edema.
- Sutures are removed within 5–7 days.
- Lid height may be slightly variable in the initial period due to edema.
- Final position becomes clear within a few weeks.
Returning to daily life is possible in a short time.
Advantages
- Visual field functionally improves.
- Asymmetry at lid level is largely corrected.
- Levator and Müller techniques preserve the natural lid crease.
- Frontal suspension and frontalis flap are effective and reliable options in advanced ptosis.
Limitations
- Variability in lid level may be seen until edema subsides.
- When one lid is raised, the opposite lid may drop somewhat. Intervention on the second lid may be needed.
- In patients with very weak levator function, levator surgery is not sufficient; frontal suspension techniques are needed.
- Perfect symmetry may not always be possible depending on tissue structure.
Ptosis surgery is a procedure that provides satisfying results both aesthetically and functionally by strengthening the lid-opening muscles or directing them to supporting structures.