Blepharoplasty & Ptosis
What causes drooping eyelids (ptosis)?
Droopy eyelids and skin changes are a common aspect of facial aging. The periocular region is best thought of as a continuum from forehead to the lower eyelids and treatment needs to be individualised to address all aspects.
Dermatochalasis refers to excess skin affecting the upper eyelids and this is removed in an operation called an upper lid blepharoplasty. The excess skin can be congenital (family history) or be caused from excess eye rubbing or significant weight loss. Similarly certain skin types (elasticky) can predispose to developing more of this excess skin.
Ptosis refers to the eyelid position being lower than normal and blocking the vision. Ptosis can be caused by a variety of conditions including involutional (age related), myogenic (abnormal weakness or muscles) and neurogenic (dysfunction of the nerves which control the eyelid muscles.
Brow ptosis is an abnormally low brow position where the brow sits below it’s natural position at the orbital rim.
Lower eyelid bags/festoons represent excess skin and/or excess orbital fat which prolapses into the lower lid giving a full appearance or a saggy appearance.
More information about blepharoplasty
What symptoms/signs does it cause?
Patients suffering from ptosis or dermatochalasis will often complain of heavy and tired eyes. They can often find by the end of the day they have to physically lift their eyelids to see the television or read a book in the evenings. Patients with prominent lower lids find they are bulky and may be sore and uncomfortable.
What treatment is available?
It is important to perform a thorough examination to evaluate the causes of the ptosis and excess skin to identify any life threatening causes and once these are excluded develop an individualised treatment plan for every patient. It is important to take into account facial features to deliver an outcome which looks natural and in keeping with the patient’s natural look.
Non-surgical options
These can include Botulinum toxin (Botox) to certain areas
Surgical options
Upper Lid Blepharoplasty
The excess skin is carefully measured and removed to create a naturally appearing upper eyelid.
Ptosis Surgery
This is often performed in combination with an upper lid blepharoplasty where an additional step of advancing the levator opens the eyelids further.
Brow Lift
This can be done through a direct or indirect approach and is often combined with an upper eyelid blepharoplasty.
Lower Lid Blepharoplasty
Lower eyelid blepharoplasty surgery is complex and addresses 3 components of lower lid aging. If applicable the excess orbital fat which prolapses is removed or repositioned through a transconjunctival approach. The orbicularis muscle is tightened and a small amount of skin may be removed.
Cosmetic or Functional Surgery
Upper or lower eyelid blepharoplasty, ptosis and brow ptosis may be functional or cosmetic. Dr Stewart will perform a detailed examination and discuss which category your planned surgery falls into and explain what this means in relation to your planned procedure.
AHPRA (Australian Health Practitioner Regulation Agency) have recently issued new guidelines in relation to cosmetic surgery including requirements for referrals, consultations and the locations where surgery can be performed. Dr Stewart will discuss how this applies to you during the consultation.
Where is the surgery performed?
Surgery is generally performed in a day hospital under twilight or general anaesthesia. In certain situations, upper eyelid blepharoplasty, ptosis, and brow surgery may be able to be performed as an outpatient. Dr Stewart will explain the best location to have your surgery performed as part of your consultation.
What is the recovery?
Sutures are generally removed at the post-operative visit at 1 week following surgery. From there building up of light duties over the next 4 weeks is recommended while the internal sutures dissolve and the wound stabilises and builds up strength. Antibiotic and steroid ointments are also used to modify the healing response if required. Patients are generally able to drive the following day after surgery.
What are the risks?
The significant risks relevant to you will be discussed in detail at your consultation. General risks include asymmetry of the eyelid height (ptosis) or the amount of skin removed (blepharoplasty).
