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BLEPHAROPLASTY 101
The Essential Patient Reference

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Topic 15 - 1
Eyelid Ptosis
Repair Basics 

ptosis of upper eyelid

Other names

Droopy eyelid repair, "cosmetic ptosis repair"


Primary goal

Elevation of a drooping (not baggy) upper eyelid that may be interfering with peripheral vision


Secondary goals

(May be performed in conjunction with blepharoplasty, as in this example)

Female with Ptosis
Before and After Photos


Special anatomy

The levator muscle begins in back of the eye and turns into an aponeurosis (similar to a tendon) as it enters the eyelid. Most cases of adult-onset ptosis are the result of thinning or tearing of the levator aponeurosis. Less commonly, neuromuscular diseases such as myasthenia gravis, muscular dystrophy, Horner's syndrome, or multiple sclerosis may cause the muscle itself to become partially paralyzed (requiring far different operations from those discussed here.)


Anesthesia

Local anesthesia with minimal sedation is all but mandatory to allow for active patient cooperation during surgery


Operative technique

Through an upper eyelid crease skin incision, the blepharoplasty is carried out as described above to the point through and including the removal of fat. Now on good display, the levator aponeurosis ("tendon") can be inspected by the surgeon (surgery photo). The aponeurosis is "tucked" using non-dissolving sutures. The surgeon must be careful to not only create a smooth lift for the droopy lid, but also match the one upper eyelid to the other upper eyelid and to restore the normal curve to the lid margin (which becomes flattened with ptosis).


Variations

Ptosis, especially when mild, may also be repaired by several different operations performed from the back side of the eyelid ("Müller's muscle-conjunctival resection" and "Fasanella-Servat procedure") in conjunction with blepharoplasty from the normal skin approach. While such less invasive "posterior approaches" work well in mild ptosis surgery performed as an isolated procedure, the advantage of using . . .

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