Is Skin Removed During Ptosis Repair?

Hi 155151anon in Los Angeles, CA,

Upper eyelid skin may or may not be removed with ptosis repair. Ptosis, or droopy upper eyelids, has several causes. More commonly, ptosis naturally occurs with aging and may affect visual field. Patients in this group generally benefit from upper eyelid skin excision or blepharoplasty, in conjunction with lifting the eyelid with ptosis repair. Patients who are young with ptosis don't have skin excess, so they may not have upper blepharoplasty with their ptosis repair. Only after a comprehensive evaluation can an plastic surgery specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki

Ptosis of the eyelid can arise from a number of reasons, and requires surgery to correct the problem. It generally results from a pulling away of the muscle attachments in the upper lid.  Often upper eyelid ptosis repair includes the removal of excess upper lid tissue. It is generally covered by insurance because of the potential for visual problems from the drooping lid.

Although skin removal is commonly performed in combination with a blepharoptosis repair, it is not an essential or required step of the proecedure and is more commonly treated with blepharochalasis, dermatochalasis or entropion.

Ptosis repair involves tightening or shortening the small muscle and tendon that open the upper lid.  Removal of excess upper lid skin may be done at the same time for cosmetic improvement, but is not an integral part of the ptosis repair

Every situation is different.  However, there is often a small degree of skin laxity on the eyelid platform and a degree of eyelash ptosis.  To correct these situations, it is helpful to make the lowest eyelid incision below the desired eyelid crease height and remove an appropriate amount of eyelid skin.  Fixation of the pretarsal skin to the levator aponeurosis is critical to tighten the eyelid platform skin and support the upper eyelid lashes so they don't drop.  This type of work can be done with both the anterior levator resection ptosis surgery and the posterior conjunctival Muellerectomy ptosis repair.

If skin excess (dermatochalasis) co-exists with a mechanical ptosis, then skin removal (upper eyelid Blepharoplasty) can be performed at the same time.  The most common form of ptosis is associated with aging, whereby the levator aponeurosis becomes stretched, attenuated, or suffers from fatty degeneration.  In these circumstances, a high percentage of patients have coincidental skin excess whihc impairs vision and/or is aesthetically bothersome.  For these patients, I generally perform an upper lid Blepharoplasty at the same time as the levator advancement.

Skin may or may not be removed during ptosis repair.  It ultimately depends on your symptoms.  Ptosis can exist in the absence of excess skin, and it can exist unilaterally.  Thus, only the levator mechanism would be repaired.  When excess skin is present, it may be excised along the repair of the levator mechanism.  You likely already know that excision of excess skin alone will not repair ptosis over the long term. 

The doctor may remove skin with ptosis repair especially if it is excessive. If the excess skin is contributing to your impaired visual field then yes it should be done.

There is a group of patients who have a droop of the upper eyelid because of the heavy skin excess weighting down the upper lids. Skin removal will help improve the lid position for those individuals. Of course, if the skin is not in excess, a lid hollow can be created if skin and fat are removed. In all cases, the eyelid muscle, the levator, must have the correct length and function for a proper repair.
Best of luck,
peterejohnsonmd

If a patient has excess s kin in the upper lip and wants it improved, then upper lid skin is removed during ptosis repair.