The main muscle that lifts the eyelid is called the 'Levator' and their is a much smaller muscle under it called 'muller's". The levator muscle is flat, like a sheet and goes across your upper eyelid. Imagine a window shade with the eyelid edge being the bottom.... Sometimes the "shade" or muscle gets stretched causing it to hang lower, i.e. ptosis. Ptosis surgery corrects the sagging eyelid by tightening or removing some material to lift the shade/correct the ptosis. the goal is to have a nice smooth appearance. As with a shade, if you only work in the center you can get a look that is just as you would imagine with a hiked up appearance centrally. Make sure you actually need ptosis surgery.
Ptosis surgery helps suspends one of two muscles that operate to open your eyelids. Imagine having a roman shade (eyelid) over your window (eye). You can lift up on the shade to bring in more light to your window. As you get older or if there is an injury, sometimes the shade is stretched out or too long and it must be fixed and tightened. To lift from the front, the slack in the levator aponeurosis is tightened. If there is extra skin, the skin can be removed at the same time. You can also lift from the back and the mueller's muscle is shortened, but no extra skin can be removed through this technique. Only one muscle technique is chosen and used. Hope this helps!!
Johnson C. Lee, MD Plastic Surgery
Ptosis Surgery is Complex, Delicate and Precise
As I write this answer, no photo is provided so I cannot comment on your particular case. Ptosis Surgery is a complex, delicate and precise surgery that requires a highly trained expert to perform. Please seek out a Board Certified, Fellowship Trained Oculoplastic Surgeon who specializes in Ptosis surgery. Only with a thorough evaluation and careful study of your face can a surgeon determine what is best for you. Good luck in your search!
There are several different approaches to ptosis surgery. It is important to choose a surgeon who is skilled in more than one approach because each one treats different degrees of ptosis. The external approach targets the levator tensdon. This is shortened which give the muscle more leverage to open the eye. The internal approach targets muller's muscle. In this approach the muscle itself is shortened.
The most common type of ptosis repair advances or tightens the levator muscle to lift the eyelid margin. The surgery should provide a normal position and contour. Mueller's muscle is an accessory muscle beneath the levator. There are two approaches to ptosis surgery. The posterior approach (no skin incision) removes normal tissue that is not responsible for the ptosis (at least not in most patients) - this is not a good anatomic approach. The anterior (skin incision) approach allows tightening of the muscle responsible for the ptosis, fixation of the lid crease (so that the lashes project out and up), and removal of some skin to prevent the skin from folding down onto the lashes and pretarsal area. The best results are obtained from a skin incision approach by an experienced oculoplastic surgeon. Best wishes with your repair.
How is ptosis surgery done?
My approach is to make an external skin incision and tighten the tendon (aponeurosis) of the levator muscle. A section of the tendon is removed at the top of the tarsus then it is reattached to the tarsus with 3 sutures. The width of the removed section determines how much the lid goes up while the shape of the lid can be adjusted with the 3 sutures. Most of the time we try to maintain the existing curvature of the lid, i.e. not change the shape of the lid.
I have studied all of your posts including this one.
It is clear that you have early levator dehiscence. This is the tendon expansion of the main muscle that raises the upper eyelid, the levator palpebrae superioris muscle. The other muscle that has an effect on eyelid position is the Mueller's muscle. Ptosis surgery is commonly performed on either of these muscles. The conjunctival Muellerectomy resection is a procedure performed from behind the eyelid. This methods is preferred by surgeons because the anatomy is very straight forward. However, it often leads to mediocre results. It has the virtue of no skin incision. The other approach is though a crease incision and advances or repairs the leavtor muscle itself. It is a very powerful and flexible surgery. However it is very technique dependent and there is a world of difference between the results obtained by masters versus the average surgeon. There is no substitute for a personal consultation to carefully understand your personal concerns and goals and to carefully assess your eyelids. If you spend less than an hour with a potential surgeon in consultation, you are in the wrong office.