Surgery for Ptosis (Blepharoptosis) There are three basic approaches to correcting ptosis surgically:
1) Trans-Conjunctival Muellerectomy This is an appropriate procedure for patients with mild to moderate ptosis and little excess skin. The surgery is done from the conjunctival side on the inside of the eyelid. After adequate anesthesia, the Conjunctiva and Müller muscle area is clamped, resected, and sutured. There is no external incision. The suture is run on the inside of the eyelid and the knot is externalized. Sutures dissolve over 2-4 weeks. The procedure can correct 2mm of ptosis and can be done under sedation or under general anesthesia.
If there is excess skin and fat, this can be excised from an external skin incision; however, this would not be covered by insurance, as it would be considered cosmetic. 2) External Levator Resection Most of Dr. Silbert’s ptosis procedures are performed in this manner. This technique involves shortening of the levator aponeurosis through an eyelid crease incision. A small crescent of skin is typically excised. The orbital septum is then opened, revealing the fat which is retracted from the levator aponeurosis. The levator aponeurosis is then disinserted from the tarsus, shortened, and reattached — typically with a running suture — which eventually dissolves. Except for children, this surgery must be done under Monitored Anesthesia and not General so that the eyelid height and contour can be adjusted. The skin is typically closed with dissolving sutures. While a small amount of skin and fat may be excised during the procedure, it is primarily reconstructive in nature.
This procedure can be combined with a cosmetic blepharoplasty. The cosmetic blepharoplasty takes more surgical time in order to remove additional skin and fat and create a crease. We like all of our patients to have the best cosmetic result possible and in light of this we have negotiated a special rate to add on a cosmetic blepharoplasty when a External Levator Resection is performed. 3) Frontalis sling This is done for patients with poor function of the levator muscle by attaching the eyelid to the eyebrow with a thick suture. It is a much less common procedure. It would be rare that a cosmetic blepharoplasty could be added to this procedure.
EyeBrow Ptosis Eyebrow ptosis is present when the eyebrow droops below the orbital rim. This droop causes a heaviness on the brow, thus placing more tissue on the eyelid. If the droop is severe enough, it can prevent adequate results from a ptosis repair or blepharoplasty. Typically, Dr. Silbert repairs eyebrow ptosis through the same eyelid incision used for a ptosis repair or blepharoplasty. He drills a small hole in the bone and place an implant (endotine) that dissolves over time (between 1-3 years). Scar tissue which develops at the muscle layer serves to keep the eyebrow lifted once the implant dissolves.