Droopy Eyelid & Brow (Ptosis) Surgery

When the edge of the eyelid falls and covers part of the pupil, it blocks the upper part of your vision. In severe cases, you may have to tilt your head back or lift the eyelid with a finger in order to see out from under the drooping lid.

This droopy eyelid, or ptosis, is generally age-related and occurs when the tendon that attaches the lifting muscle to the eyelid stretches, so the eyelid falls too low. Sometimes, there is a separation between the tendon and the muscle that lifts the eyelid.

It is not uncommon to develop a drooping eyelid after cataract surgery or long-standing contact lens use. A similar drooping may also affect the eyebrow and is known as brow ptosis — the word simply means downward displacement.

Ptosis can also be present at birth, or congenital. This form of the condition is often caused by poor development of the muscle that lifts the eyelid. If uncorrected, normal vision may fail to develop and the child may adopt an abnormal posture, with his or her head tilted backwards.

Ptosis surgery may be performed in combination with other procedures such as blepharoplasty or brow lift. Mr Kamalarajah will discuss all the possibilities with you in detail, so you are able to make an informed decision.

Your initial consultation is crucial to the success of any treatment.

It is your chance to explain and discuss your hopes and fears, so it may help if you write down a list of ideas and questions in advance. You may want to bring along a friend or family member for moral support or to ask additional questions.

It allows Mr Kamalarajah to review your medical history and lifestyle, photograph you (with your permission), assess your suitability for treatment and explain your options.

Finally, you can discuss possible procedures together so that you have a thorough understanding of what can be achieved and what risks there might be.

After the consultation, Mr Kamalarajah will write to your GP summarising the consultation.

Ptosis surgery shortens the stretched tendon or re-attaches it back to the eyelid — there is usually no need to make alterations to the muscle that lifts the eyelid, as this tends to remain strong.

It is usually performed under local anaesthesia, sometimes with intravenous sedation, as a day case procedure, with no need for an overnight stay in hospital. It lasts approximately an hour and aims to restore the symmetrical height and contours of the upper eyelids.

In most cases, Mr Kamalarajah carries out ptosis surgery through an incision under the eyelid (a posterior approach), which avoids the need to cut through the skin and leave any external scars. Occasionally, the procedure is similar to an upper eyelid lift, with a fine incision made in the existing eyelid crease to camouflage any scarring. Excess skin and muscle and, very rarely, fat can be removed and the tendon is re-attached or shortened. The incision is then closed with fine stitches, which are generally removed within one week, or dissolve.

Very rarely, the lids may be attached to the brow, using silicone or nylon thread or tissue from the upper thigh (fascia lata), allowing the forehead muscles to lift the eyelid. This is known as a brow-suspension ptosis procedure. It is not the same as a brow lift.

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Congenital Ptosis – Pre Op / Post Op

Ten days prior to surgery, if safe to do so, stop regular aspirin to minimise the risk of bleeding (I would have discussed this with you at your initial consultation). Avoid using ibuprofen or other non steroidal anti-inflammatory agents.

I would see you again immediately prior to surgery to allow you to ask any final questions. I usually perform eyelid surgery under local anaesthesia, which numbs the area around your eyes, sometimes with intravenous sedation. The initial 10 seconds of the injection sting before the eyelid becomes numb. You’ll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)

If you are having general anaesthetic or sedation, a vein in the back of the hand has a needle inserted, after which there should be no pain at all.

After surgery, I lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anaesthesia wears off, but you can usually control any discomfort with paracetamol. If you feel any severe pain, call me immediately.

Post-operatively, I recommend you to keep your head elevated for several days, and use ice packs (10 minutes in every hour) to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.)

The wound may ooze slightly, if there is profuse bleeding you should contact me.
The stitches will usually be removed a week after surgery. Once they’re out, the swelling and discolouration around your eyes will gradually subside, and you’ll start to look and feel much better.

Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing, you’ll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and sunblock when you go out.

Keep your activities to a minimum for three to five days, and avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. Minimise alcohol, since it causes fluid retention.

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line.

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Ptosis – Pre Op / Post Op

  • After surgery, you will experience some degree of swelling and bruising — cold compresses and elevation of the head will help to relieve any discomfort.
  • Your eyes may feel dry because they are more open than before, especially if very droopy eyelids have been corrected — the remedy is to use artificial tear solution, which Mr Kamalarajah will prescribe.
  • It is important to avoid strenuous activity for the first week after surgery but you can return to work if you want.
  • You may take walks during the first week and fly within two days but should avoid heavy lifting, strenuous gym work-outs or running for four weeks because of the risk of increased bruising and swelling.
  • Antibiotic eye ointments are prescribed for several days after surgery.
  • You cannot wear contact lenses for a minimum of two weeks after surgery, because the eyelids may be stiff and the eyes dry.
  • Some people experience blurred vision or sensitivity to light for a few days, mainly caused by dry eye.
  • In rare circumstances, tiny whiteheads may appear along the line where the stitches were — these can easily be removed in the clinic, using a needle.
  • In rare cases, there may be some imbalance between the eyes after healing is complete — this can easily be rectified in a subsequent minor operation.