Is Skin Removed During Ptosis Repair?

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.