Question 1

What is ptosis surgery?

Accepted Answer

Ptosis repair surgery corrects the drooping of the upper eyelid known as ptosis (pronounced “toe-sis,” short for blepharoptosis) by repositioning the underlying muscles to lift the upper eyelid.The droop may be barely noticeable or the eyelid can sag to such an extent that it covers your pupil, the black dot in your eye. Ptosis surgery is most often performed by oculoplastic surgeons and ophthalmologists who specialize in eyelid surgery.

Ptosis repair may be done on its own, or at the same time as an upper eyelid blepharoplasty, which involves removing excess skin and fat, according to Dr. Katherine Zamecki, a board-certified oculoplastic surgeon in Danbury, Connecticut. “Ptosis repair surgery can involve an incision in the skin in the crease of the upper eyelid, or it can sometimes be done from the underside of the eyelid,” Dr. Zamecki explains. “Your surgeon will discuss with you which is the preferred technique in your particular case.”

Upper eyelid ptosis is most common in older adults, who may notice over time that they’re losing peripheral vision or looking through their eyelashes. “Looking down, as is done during reading, can cause the eyelid to droop even more, causing further difficulty with the vision,” explains Dr. Zamecki.

Ptosis can have a range of causes:

The tendon (aponeurosis) belonging to the main muscle responsible for lifting the upper lid—the levator muscle—stretches and weakens with age. This causes the tissues within the eyelid to stretch, leading to a drooping eyelid. “This is the most common type of ptosis, commonly referred to as aponeurotic or acquired ptosis,” says Dr. Zamecki.
Some people are born with congenital ptosis, which can lead to amblyopia (the medical term for the permanent reduction in vision some people refer to as a “lazy eye”). The levator muscle typically does not work well in these cases, notes Dr. Zamecki.
Trauma can stretch the eyelid muscle and cause acquired ptosis. In fact, even devices used to hold the eye open during LASIK or cataract surgery can lead to this problem.
The condition can also result from underlying medical conditions that affect muscle functioning, such as myasthenia gravis or a tumor. Your doctor should investigate this possibility before surgery.

Question 2

What are the pros & cons of ptosis surgery?

Accepted Answer

Pros

Ptosis treatment can make you look younger and more awake.
This procedure can expand your peripheral vision and allow more light into the eye, which helps with contrast and improves your eyesight.
If you have just one droopy eyelid, surgery can make your eyelid height more symmetrical.
Ptosis surgery has high patient satisfaction, with a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating from reviewers on RealSelf who say it gave them better vision and a refreshed look, with a relatively short recovery.
If a drooping eyelid affects your field of vision, ptosis surgery is considered medically necessary and covered by health insurance. “A peripheral vision test can be done to determine if, and by how much, your peripheral vision is being compromised by the eyelid(s),” notes Dr. Zamecki.

Cons

You’ll need 10 to 14 days of initial downtime after your upper eyelid surgery and 3 to 6 months to fully heal.
Since ptosis treatment lifts the eyelid, it creates more exposure for the eye, which can make it prone to dryness. “The severity of dryness post-operatively will be influenced by how much dryness there was pre-operatively and how much more open your eyes are after surgery,” says Dr. Zamecki. “Your surgeon should examine you, assess your dry eye symptoms pre-operatively, and counsel you accordingly.”
In the initial few weeks after surgery, the eyelid(s) may not move completely normally, with incomplete blinking and/or closure can lead to more dryness. Unless the eyelid was lifted too high, this will improve with time, as scar tissue softens and swelling resolves.
Asymmetry can arise as a result of surgery. In fact, of the reviewers who say this procedure is “Not Worth It,” their biggest complaints are asymmetry and eye irritation post-procedure.

Question 3

How much is ptosis surgery?

Accepted Answer

Your ptosis surgery cost will depend on the details of your treatment plan (for example, whether it’s for one or both eyes), what kind of anesthesia you have, who administers it, where your procedure is performed, and your provider’s credentials and level of experience.

In most cases, ptosis surgery is considered medically necessary and is covered by health insurance plans, including Blue Cross Blue Shield and Medicare.

Documentation of the severity of your ptosis will be made by physical exam, photos and peripheral vision testing (visual field). “The necessary documentation will be submitted to your insurance prior to surgery in order to secure approval, if applicable,” Dr. Zamecki explains.

If the drooping is so mild that it’s not impairing your vision or ability to perform daily activities, it may be considered cosmetic and will not be covered by insurance. Ask your surgeon if they offer monthly payment plans or accept third-party financing options, such as CareCredit.

See our complete guide to ptosis surgery costs

Question 4

Ptosis surgery before and after pictures

Accepted Answer

The ptosis surgery photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 5

Can you fix ptosis without surgery?

Accepted Answer

Surgery to tighten the levator muscle is the only way to correct ptosis for the long term.

However, Upneeq can create a temporary improvement that lasts 6–8 hours. These FDA-approved prescription eye drops work by contracting a smaller muscle in the eyelid (Mueller’s muscle) that elevates the eyelid, allowing it to open a noticeable 1–2 millimeters (mm) wider.

If your eyelid droopiness is caused by a heavy brow, a “chemical brow lift” with Botox can sometimes elevate the brow position by 2–3 mm and, in turn, improve droopy eyelids.

RealSelf Tip: In aesthetic medicine, ptosis is almost exclusively related to the inadvertent injection of Botox, often by inexperienced injectors, into an unwanted area, such as the forehead or area between the eyebrows, leading to muscle weakness and a resultant droop. According to a 2016 study, choosing an experienced injector to treat glabellar lines (between the eyebrows) decreases the chances of any resulting eyelid ptosis from 5% to 1%.

Question 6

How does ptosis surgery work?

Accepted Answer

Ptosis surgery takes 45 to 90 minutes, depending on the technique and whether the operation involves both of your eyelids. When it’s done in an ambulatory surgery setting, plan on being there for an additional 2 hours.

Here’s what you can expect when you arrive:

You’ll be re-examined immediately prior to surgery.
Eyelid markings will be made while you’re sitting up, so the correct position of your brows can be determined and compensated for as needed. If relevant, the surgeon may also mark how much excess skin can be safely removed.
Your natural skin crease will be marked.
You’ll be given local anesthesia with sedation or general anesthesia, to ensure you’re comfortable during the procedure.

Depending on the cause of your ptosis, your surgeon will then use one of these surgical techniques.

Levator advancement: In this external approach, the surgeon makes an incision in the skin of the eyelid—typically in the eyelid crease, to conceal the scar—to access the levator muscle. They reposition the levator tendon and secure it to the connective tissue in the eyelid (also known as the tarsus) to tighten it, and the skin is stitched back up. This is done under local anesthesia with sedation so that you can be awake to make eye movements, when asked, to help determine the eyelid placement.
Internal: For this internal approach, the surgeon turns your eyelid inside out to shorten either the levator muscle or the smaller Mueller’s muscle from the inside. This may be done with local anesthesia and sedation or under general anesthesia.
Frontalis Sling: With this procedure, the surgeon passes thin silicone tubing underneath the skin of the eyelid to attach the levator muscle to the frontalis muscle of the forehead and brows, enabling the stronger forehead muscle to hold the eyelid up. Performed under general anesthesia, the sling technique is usually done for people who have congenital ptosis or neuromuscular causes for their ptosis, leading to weaker eyelid muscle function.

RealSelf Tip: Stop taking any blood thinners prior to your surgery, and discuss which other medications should be held (and for how long) with your surgeon and your primary care physician.

Question 7

Are you awake during ptosis surgery?

Accepted Answer

Whether you'll be awake for a portion of your procedure depends on your treatment plan and your surgeon’s preferences.

For the external approach, you may need just local anesthesia with sedation. This combination still allows you to sit up and open your eyes as directed by your surgeon, so the lid height and contour can be evaluated during the procedure.
For the internal approach and frontalis sling, you may be under sedation with local anesthesia, or under general anesthesia (fully asleep).

Question 8

Is ptosis surgery painful?

Accepted Answer

The procedure itself is not painful because you'll either be given local anesthesia (in the area where the incisions will be made) and sedation, or put under general anesthesia.

Afterward, your eye will just feel tender and sore. Any discomfort should be manageable with over-the-counter pain medication, and the soreness will gradually subside over the first several days after your procedure.

Question 9

How long does it take to recover from ptosis surgery?

Accepted Answer

Ptosis surgery recovery typically involves two weeks of downtime, and full healing can take up to six months.

How much time you take off after surgery will depend on your level of activity at work. There is no heavy lifting or bending allowed during the first postoperative week.

Here’s what you can expect during your recovery:

“You are likely to be swollen and tender and have blurred vision for five to seven days following surgery,” says Dr. James R. Gordon, a board-certified oculoplastic surgeon in New York.
Bruising of the eyelid skin is also common and lasts two weeks, with both bruising and swelling peaking three to five post-op.
Your doctor will recommend a schedule for icing for the first 48 hours.
“It is common to use Vaseline or an ophthalmic antibiotic ointment on any sutures,” notes Dr. Zamecki. If you can’t completely close your eye, your doctor will give you eye drops to help keep the eye lubricated to prevent infection, irritation, and dry eye.
If your surgeon didn’t use absorbable sutures (which don’t require removal), your sutures will be removed at a follow-up appointment about a week after surgery.
You’ll be advised not to wear contact lenses or rub your eyes for up to two weeks post-op.
Wearing eye make-up can be resumed after two weeks.
Most of the swelling should have resolved within four to six weeks after surgery.
You'll be significantly healed by month three, though “most patients are fully healed by 6 months,” according to Dr. Zamecki.

Question 10

Is ptosis surgery safe?

Accepted Answer

Ptosis repair surgery is widely considered to be safe, when it’s performed by an experienced, board-certified plastic surgeon or oculoplastic surgeon.

Potential side effects and complications of ptosis surgery include:

Infection.
Hematoma, a pooling of blood under the skin.
Asymmetry
Overcorrection, which leaves the eyelid position too high, or undercorrection, which leaves the eyelid position too low. “This requires further surgery but can sometimes be addressed in the office in the early postoperative period, thus avoiding a trip back to the operating room,” explains Dr. Zamecki.
Dry eye is quite common. According to a recent study, ptosis surgery can lead to dry eye of varying severity that may persist for up to 6 months.
Scarring. “Although the eyelid skin is very thin and heals beautifully, you can expect a very thin white line in your eyelid crease where the incision was made,” says Dr. Zamecki.
Inability to fully close the eyelid. This usually resolves on its own within a couple of months, as the swelling resolves.
Retrobulbar hemorrhage, bleeding deep within the orbit that can lead to vision loss. “This is exceedingly rare,” Dr. Zamecki notes.

Question 11

How long does ptosis repair last?

Accepted Answer

Ptosis repair results are long-lasting but not necessarily permanent.

“Ptosis surgery is not like taking out an appendix,” says Dr. Kenneth Steinsapir, a board-certified oculoplastic surgeon in Beverly Hills, California. “The longevity of the surgery very much depends on the quality of your eyelid tissues, which may stretch and weaken again, as well as other factors, including how vigorously you tend to rub your eyelids,” he explains. “Ptosis surgery frequently needs to be revised; conversely, for some, the repair can last a lifetime. Your mileage may vary.”

Question 12

Sources & studies

Accepted Answer

Kwitko, G., Patel, Bhupendra. “Blepharoplasty Ptosis Surgery.” StatPearls. April 2023.

Ceylan, N. and Yeniad, B. Effects of Upper Eyelid Surgery on the Ocular Surface and Corneal Topography. Turkish Journal of Ophthalmology. February 2022.

Cleveland Clinic, “Ptosis (Droopy Eyelid).”

NYU Langone Health, “Ptosis Surgery.”

PTOSIS SURGERY

Dr. Katherine Zamecki

Mari Malcolm

Dr. Katherine Zamecki

Mari Malcolm

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Dr. Katherine Zamecki

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PTOSIS SURGERY QUESTIONS

Female, mid 30's. Possible Ptosis? (Photo)

Asymmetrical eyes - what procedure would lift, round and make them more even? (Photo)

28, male, sleepy eyes - Am i a good candidate for ptosis surgery? (Photos)

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