Ptosis Repair with Upper Eyelid Blepharoplasty

 

In some situations, patients have both ptosis and dermatochalasis; as such a single surgical procedure is adequate. Surgery to correct ptosis repair is directed to lift {the} eyelid height (open {the} eye wider). In contrast, surgery to correct {the} dermatochalasis is called a blepharoplasty - and its goal is to remove {the} excess skin (and herniated orbital fat) that is present on {the} upper eyelids; this skin might possibly or might possibly not be interfering with peripheral vision.

 

 

Each surgical condition requires a distinct surgical approach. Let's initially elaborate on each of {the} two conditions: 

(1) What is Ptosis?

Ptosis, sometimes referred to as blepharoptosis refers to droopy eyelids due to an abnormally low upper eyelid in {the} relaxed primary position. This might possibly result in loss of vision particularly while reading, headaches and eyebrow strain.

  • Ptosis is classified in numerous ways based on a variety of characteristics.
  • Based on origin, it might possibly be congenital or acquired.
  • Based on etiology, it is classified as aponeurotic, myogenic, neurogenic, or mechanical.
  • Based on levator function, it is divided into ptosis with poor levator function (0-5 mm), moderate levator function (5-10 mm), or good levator function ( 11 mm)

Upper eyelid ptosis is drooping of {the} upper eyelid margin in relation to {the} superior limbus and causes functional and cosmetic problems. A ptotic eyelid covers more than 2 mm of {the} upper limbus, and in severe cases it covers {the} pupils obstructing vision.

Who gets an Upper Eyelid Ptosis?

It is particularly seen in elderly patients who have undergone cataract extraction or lens replacement and is supposedly due to stretching or disruption of {the} levator muscle by retractors during lens surgery.

Causes of Upper Eyelid Ptosis

Upper eyelid ptosis might possibly be true ptosis or pseudoptosis.

True ptosis can be congenital or acquired.

  • Congenital ptosis might possibly have neurogenic or myogenic origins.
  • Acquired ptosis might possibly be mechanical, traumatic, and senile lid ptosis.

Ptosis might possibly also arise due to complex facial injuries resulting in levator detachment from {the} superior tarsal plate.

Symptoms and Signs of Upper Eyelid Ptosis

  • High tarsal fold
  • Persistent wrinkles in {the} forehead due to contraction of {the} frontalis muscle
  • Asymmetric elevation of {the} eyebrows with greater effect on {the} affected side
  • cases present with restricted visual fields

Various techniques have been used for correcting upper eyelid ptosis. Some of {the} techniques include:

  • Suspension of {the} lid from {the} frontalis muscle: Done for patients with poor levator function (
  • Resecting segment of {the} levator muscle: Done in patients with poor levator function but having severe ptosis ( 4 mm).
  • Plication of distal levator muscle aponeurosis: Done in patients with good levator function (>10 mm) to achieve long-term correction of ptosis.
  • Fasanella-Servat mullerectomy:  For patients with minor ptosis (10 mm excursion).
  • Transpalpebral blepharoplasty plication of {the} levator aponeurosis: In patients undergoing cosmetic facial surgery.
  • Müller muscle–conjunctival resection repair: In patients with mild-to-moderate ptosis alone under general anaesthesia.
  • Levator advancement under local anaesthesia: In patient with moderate-to-severe ptosis using patient cooperation during {the} surgical procedure.

(2) Dermatochalasis - sometimes referred to as Pseudoptosis is presence of excess skin 

  • blepharochalasia
  • Excess skin and / or herniated orbital fat
  • Changes in ocular volume

Surgical correction of dermatochalasis or pseudoptosis is performed via a blepharoplasty surgery.

Cosmetic eyelid surgery, Blepharoplasty, Eyelift

What is Blepharoplasty?

  • Your eyes including your eyelids, are perhaps one of {the} initially things people notice in you. This makes your eyes and eyelids one of {the} most important components for an appealing facial expression and aesthetic appearance. Any visible change in {the} shape or size of {the} orbital or periorbital region can spoil {the} look of your face.
  • As you age and grow older, your eyelids might possibly become ‘droopy’ or ‘baggy’ due to {the} stretching of your eyelid skin and gradually decreasing tone of your eyelid muscles. Your droopy eyelids and brow together cut a sorry figure for your face making you look tired, sleepy and haggard, further leading to eyelid or brow straining or both. In extreme cases, your saggy, baggy eyelids can even obstruct your vision, particularly peripheral vision causing difficulty in reading or driving.
  • Blepharoplasty ensures cosmetic or functional corrections to {the} area around your eyes to improve your look or to correct any abnormalities in function.

Defining Blepharoplasty

  • The term blepharoplasty is derived from {the} Greek ‘blepharon’ which means ‘eyelid’ and ‘plassein’ which means ‘to form’. Simply put, blepharoplasty is a plastic surgical procedure that is used for correcting defects, deformities, and disfigurations of {the} eyelids, and more recently, it has been used for achieving aesthetic modification of {the} periorbital region of {the} face.
  • Blepharoplasty is sometimes erroneously referred to as an ‘eyelift’ or “eyelid lift” as {the} procedure does not involve lifting of {the} eye or eyelids in any manner. It might possibly be done to achieve either functional or cosmetic ends or a combination of both.
  • Blepharoplasty involves removal or repositioning of excess tissue as well as reinforcement of surrounding muscles and tendons to reshape {the} upper eyelid, lower eyelid or both.

 

Indications of Combined Upper Lid Ptosis  with Upper Blepharoplasty

Presence of both conditions (1) Ptosis and (2) excess skin. Of note insurance generally will not pay for both procedures to be performed at {the} same time. Often, {the} upper blepharoplasty is performed at {the} same time as {the} ptosis surgery, but paid for by {the} patient. Altneratively, some patients elect to proceed in a staged-fashion: initially undergoing ptosis repair to lift {the} eyelid and thereafter, in a separate surgery -months later- undergoing an upper blepharoplasty

Also, frequently when {the} ptosis is corrected, {the} amount of skin on {the} upper eyelid becomes more prominent or noticeable. Thus might possibly patients, opt to undergo cosmetic upper blepharoplasty to remove and sculpt {the} upper eyelid excess skin and fat. 

As {the} ptotic eyelid is elevated, restored to its normal position, {the} skin that is present on {the} upper eyelid bunches up and wrinkles more-slide {the} slider control to {the} write and note how when all {the} way to {the} right - {the} eyelid is more open, but NOW {the} skin is lapping over {the} edge of {the} eyelid.

The following figures show {the} before and after scenarios of upper blepharoplasty with ptosis.

As {the} eyelid ptosis is corrected ({the} muscle is adjusted to lift {the} eyelid), {the} edge of {the} eyelid and {the} upper eyelid skin move closer together.

 

The animation below illustrates {the} scenario when there {the} patient has ptosis BUT ALSO has with some amount of excess upper eyelid skin

If there is excess upper eyelid skin, once {the} ptosis is corrected, {the} skin my OVERHANG {the} edge of {the} eyelid: Slide {the} control to {the} right to see a demonstration of this effect.



As {the} eyelid is elevated, {the} skin that is present on {the} upper eyelid, bunches up (accordion effect). The upper eyelid skin might possibly roll over {the} edge of {the} eyelid); slide control to {the} far right to see this effect.

 

View {the} sample photographs below to see patients who have undergone COMBINED ptosis with upper Blepharoplasty.

Procedures
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