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.” Â
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.Â
Ptosis can have a range of causes:Â
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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.Â
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.Â
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.
The ptosis surgery photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.
Surgery to tighten the levator muscle is the only way to correct ptosis for the long term.Â
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.Â
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%.
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.Â
Here’s what you can expect when you arrive:Â
Depending on the cause of your ptosis, your surgeon will then use one of these surgical techniques.
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.
Whether you'll be awake for a portion of your procedure depends on your treatment plan and your surgeon’s preferences.Â
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.
Ptosis surgery recovery typically involves two weeks of downtime, and full healing can take up to six months.Â
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:
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:Â
Ptosis repair results are long-lasting but not necessarily permanent.Â
“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.”
Updated October 12, 2023