Is it necessary to make an incision on the upper eye lid for ptosis surgery?

Question

I have a failed ptosis surgery 10 years ago. I would like to correct it but don't want to have another cut on the upper eyelid, at least not from the outside. Is it possible?

Randal Haworth, MD, FACS · Answer

I'm sorry to hear about your unsuccessful ptosis surgery. The approach to addressing the issue would depend on the specific cause of the failure and the extent of the correction needed. However, in general, it may be possible to correct ptosis without making another incision on the upper eyelid. Here are a few options to consider:

Internal approach: In some cases, the ptosis can be corrected through an internal approach, which involves making an incision on the inside of the eyelid. This method can be effective for mild to moderate ptosis, and it leaves no external scarring.
Non-surgical options: Depending on the severity of your ptosis, non-surgical options such as Botox or filler injections may be able to help improve the appearance of your eyelids. These treatments work by relaxing the muscles that cause the drooping, lifting the eyelid, and improving symmetry.
Revision surgery with a different technique: If an internal approach or non-surgical options are not suitable or effective, you may need a revision surgery with a different technique. In some cases, a new incision may need to be made, but a skilled surgeon may be able to minimize scarring and achieve a more successful outcome.
It's essential to consult with a board-certified oculoplastic surgeon who specializes in ptosis correction to determine the best approach for your individual situation. They can evaluate your eyelids, discuss your goals and concerns, and recommend the most appropriate treatment options.

Best of luck !

Terence Goh, MBBS, MRCS(Ed), FAMS (Plast Surg) · Answer

Dear jymjym,
Thanks for your question on the possibility of non-incision ptosis surgery.
Depending on the severity of the ptosis there are options for either non-incision ptosis surgery or incisions on the underside of the eyelid. However, having said this, it would usually be most effective and most precise to correct the ptosis with an incision on the external eyelid skin. Techniques that utilise sutures to alter the eye opening can improve the ptotic eyelid and can also change the eyelid crease but there is a limitation on how much it can do. If there is much asymmetry then an open incision would usually be better. Similarly for procedures done on the underside of the eyelid, the crease cannot be altered so these are only to correct symmetrical problems or in situation when the asymmetry is small.
The eyelid scar for ptosis surgery is placed in an ideal eyelid crease and it usually heals well and it is not usually noticeable except when u close your eyes. After a few months,that scar also usually becomes very faint and appears like a natural crease.
Hope this helps to answer your question.
All the best!

John J. Martin, Jr., MD · Answer

we often will correct a ptosis from the underside of the lid so that you have no external incisions.  In the office we put a drop in your eyes to evaluate the internal Mueller's muscle.  The amount of lift you get with the drop then helps us to determine how much correction you will need.  The lid is flipped over in the OR and some of this muscle is removed.  Quick recovery for most patients.

Is it necessary to make an incision on the upper eye lid for ptosis surgery?

Answers (3)

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