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Is Minor Ptosis Best Left Alone?

I have what are considered "big" double eyelids, unfortunately I have ptosis in both eyes, a very small amount, about 0.5mm in right eye (covers A TINY portion of the black pupil) and about 1mm in left eye (covers also a tiny portion of the black pupil). I don't know whether to get this corrected or leave it alone; I don't think my vision is being blocked, but I think I might be straining my eyes at times..isn't ptosis only a problem if vision is being blocked?

Doctor Answers 11

Eyelid Ptosis correction at the time of upper blepharoplasty

it is fairly a simple and easy procedure to correct mild eyelid ptosis at the time of upper blepharoplasty. In some patients aging causes small separation of the levator muscle attachment from the upper eyelid tarsus. this can be repaired very easily at the time of upper eyelid surgery. I encourange you to have it repaired, since it can get worse with aging.


Beverly Hills Plastic Surgeon
4.5 out of 5 stars 34 reviews

Ptosis

Your description of how low the eyelids loom does not seem so "mild". If they are at or below the pupil, they probably are obstructing your vision and surgery would not be considered cosmetic. See an oculoplastic surgeon who can perform the necessary visual fiend testing to determine if your lids are truly blocking the vision. If they are, insurance will cover the cost of the procedure. Waiting and doing nothing is also fine. It will not make surgery more difficult in the future, 

When minor ptosis should be treated

Since there is minor ptosis it all depends on how much visual obstruction is due to the eyelids. This is not lymphatic, but dynamic so make sure you check this at different times of the day. The upper lid is not supposed to be cutting across the black pupil part of the eye. This will only get worse over time and should probably be addressed. Both eyelids need to be treated for a successful result. Look for a board certified oculoplastic surgeon who has performed thousands of ptosis repairs as there is a 10-20% revision rate with this type of surgery.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 67 reviews

Eyelid Surgery Option for Droopy Upper Lid

Hi 155151anon in Los Angeles, CA,

Minor sagging, drooping, or ptosis of the upper eyelid does not necessarily need improvement with plastic surgery. Yes, as other plastic surgeons have mentioned, droopy upper eyelids can block your visual fields and reduce vision. Eye strain could be a sign of significant eyelid ptosis. However, if you don't notice any visual problems, especially after comprehensive visual testing, then nothing further is necessary.

If you are considering cosmetic upper eyelid surgery (blepharoplasty) to improve the appearance of the "big" eyelids, then an eye lift in addition to a small of sagging skin removal may be the an option to consider. Lastly, asymmetry is very common, and largely considered essentially normal by plastic surgeons. While plastic surgery may improve eye symmetry, it may not completely correct it.

Only after a comprehensive evaluation can an eye plastic surgeon help determine appropriate options for you. Best of luck.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

Ptosis

An eye exam is scirtical to assess if anything at all would be necessary for you.  Mild ptosis that is asymmetric and does not bother you, does not have to be treated.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 19 reviews

Eyelid ptosis

From the measurements you have made, you have a slight to moderate amount of upper lid ptosis.  Unfortunately, as you age, you may find that the ptosis increases because your muscle that lifts the lid is weakened.  I would suggest a visual field exam to document your present field of gaze.  You may find that you would benefit at this time to repair it. However, if you do not feel the need to improve it now, you could wait an see what happens over time.  Keep in mind that you have a high likelihood of needing surgical repair in the future.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon
3.5 out of 5 stars 6 reviews

Minor Ptosis Best Left Alone

Impossible question to accurately respond to over the internet. You need an intensive eye examination by a boarded surgeon IN PERSON! There are many things that can not be diagnosed over the internet. The minor upper eyelid ptosis can be corrected but there are many measuremets needed to make a decision if you are a true candidate. 

Correction of Eyelid Ptosis

The upper eyelid normally rests just below the top of the iris (the colored area of the eye). It does not come even close to the pupil (the central black portion). You, therefore, have significant ptosis. It is hard to imagine that you do not have some symptoms from this. Symptoms can vary from “eye strain,” tilting the head up to see, to severe headaches from constantly using the forehead muscles. Usually, with as much droop as you have, surgery is indicated. “Big, double eyelids” may be worsening the problem, but are probably not the total cause. You need a consult with an Ophthalmic Plastic Surgeon with significant experience with cosmetic as well as ptosis repair.
 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

You have more than a tiny amount of ptosis

Normally the upper eyelid margin should rest between the edge of the pupil and where the colored part of the eye meets the white of the eye called the limbus. So the description of your eyelid position suggests that you have 2.5 mm of ptosis. That is significant but that does not mean that you need surgery. If your eyelids don't bother you, the best advice is to not worry about it.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 19 reviews

Ptosis of the eyelids

In answer to your question about ptosis:

I have what are considered "big" double eyelids, unfortunately I have ptosis in both eyes, a very small amount, about 0.5mm in right eye (covers A TINY portion of the black pupil) and about 1mm in left eye (covers also a tiny portion of the black pupil). I don't know whether to get this corrected or leave it alone; I don't think my vision is being blocked, but I think I might be straining my eyes at times..isn't ptosis only a problem if vision is being blocked?

This condition will not get better without surgery and is likely to only get worse.  Assuming you are healthy, my recommendation would be to proceed with repair.....rather than waiting until you are elderly at which time there might be contraindications to the surgery.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.