Ptosis (Levator Muscle) Correction Surgery
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Ptosis (Levator Muscle) Correction Surgery

Ptosis (Levator Muscle) Correction Surgery


       The levator palpebrae superioris (the "levator muscle") is the muscle in the orbit that elevates the upper eyelid. Ptosis is often accompanied by sunken and asymmetrical eyes, which can be corrected by levator muscle repair or levator aponeurosis plication surgery.
During the levator aponeurosis plication surgery, the thin layer of levator muscle has to be first identified, then the plication of the levator aponeurosis is made by 4 times of the difference of vertical palpebral fissure between two eyes. For example, if the difference of vertical palpebral fissure between two eyes is 0.1 cm, the plication of the levator aponeurosis should be made by 0.4 cm. The left and right eyelids should reach symmetrical balance 1-2 months after surgery.
       Ptosis is relatively common in the general population, which can be corrected surgically. People with ptosis may not be aware of it and just find themselves always look so tired. Ptosis correction surgery helps not only to relieve the symptoms but also to restore the aesthetic appearance. It should be noted that ptosis correction surgery is a highly specialized and delicate procedure and should be performed by experienced cosmetic surgeons.

Ptosis can be divided into two types, congenital and acquired.

Using suture placement for ptosis repair is an option but not the ideal treatment because it cannot correct levator muscle weakness. The effective treatment for correcting ptosis is levator muscle surgery.

Among the patients with ptosis, one third are caused by traumatic injuries, such as car accident or double eyelid surgery damaging the levator muscle; two third are caused by disease or levator muscle dystrophy, such as congenital levator muscle dystrophy, acquired levator muscle weakness, leading to different vertical palpebral fissures in two eyes, namely asymmetrical eyes. 


Acquired ptosis

Acquired ptosis occurs more commonly in old ages, also called senile ptosis, which is caused by levator muscle weakness.


Congenital ptosis

Congenital ptosis is present at birth, which is usually caused by poorly developed levator muscles, affecting one or both eyes.



Surgical Correction

 Ptosis requires surgical correction. There are different surgical procedures for repairing ptosis. The surgeon should perform the most suitable one to achieve the optimal result based on the patient's eye condition.

 4 types of surgical procedures are used to correct ptosis:


1. "Brow suspension" is used to correct ptosis when the levator function is very poor. A string of material is burrowed under the skin to attach the upper eyelid to the frontals muscle, which helps to lift the upper eyelid. The material can be either fascia tissue taken from the patient's leg or a synthetic one.

2. "Levator resection" is used to correct ptosis when the levator function ismoderate.

"Fasanella-Servat procedure/Müllerectomy" is used to correct ptosis when the levator function remains normal.。

"Levator aponeurosis plication" is performed to correct senile ptosis by tightening the aponeurosis tendon and repositioning the drooping upper eyelid back to normal height.







Ptosis correction surgery can also be used to adjust eye shapes. For example, repositioning the upper eyelid at lateral canthus higher can improve the sleepy eye look. In fact it is the same concept to reshape or enlarge the eye by surgically adjusting the levator muscle. Both goals can be achieved by a single surgical procedure with fine adjustment.

Ptosis can occur partially at medial, middle or lateral upper eyelid. Patients with partial ptosis have normal eyelid structure but may have aesthetic issues. Although with no functional impairment, patients with partial ptosis may develop appearance-related distress and compromised psychological well-being. Ptosis correction surgery can help them to dispel concerns and regain confidence.





Q 1.How to judge whether the short palpebral fissure is due to small eyes or levator muscle weakness?

Normally the upper eyelid covers about 1 mm of the iris. A droop of more than 2 mm gives a "sleepy eye" look. The patients may need to try to compensate by raising eyebrows. The symptom gets worse with time. A surgical procedure that strengthens the levator muscle is needed to improve the symptom. Simple double eyelid surgery can make only little improvement.


Q it necessary to combine the levator muscle surgery with double eyelid surgery to improve ptosis?

Ptosis is most commonly cause by impaired levator muscle function. Simple double eyelid surgery cannot make up for the deficiency of levator muscle function, therefore can achieve only little improvement. Levator muscle surgery is the core to strengthen the levator muscle and effectively improve the symptom. Combining levator muscle surgery with double eyelid surgery can intensify the big eye effect meanshile create natural-looking eyelid creases.


Q 3.can people with keloid scar experience undergo double eyelid surgery?

Keloids occur most commonly on shoulder, chest, back, neck and face, ear and earlobe and abdomen and limbs (in the order of susceptibility). The uncommon sites are mouth, eyes and genital mucosa. Theoretically people with keloid scar experience are prone to develop excessive scar tissues. But based on the author's clinical experience, keloid formation after eyelid surgery has never been seen or reported.


Q 4.Mild ptosis (levator muscle weakness) should be corrected with surgery or botox?

Ptosis (levator muscle weakness) cannot be treated by botox. Surgical correction is recommended.



  1. Do not drive or ride motorbike home after surgery involving intravenous general anesthesia or eye area.
  2. Avoid strenuous exercise or lifting heavy objects within two days after surgery to prevent broken capillaries and swellings.
  3. Do not remove bandages or dressing without doctor indications.
  4. Apply ice compress on the first 2 days (48 hours) after surgery, then change to warm compress since the third day till the swelling fully subsides. But please be cautious that excessive heat or cold can lead to burns.
  5. Take medications as directed, after 3 meals and once before bedtime daily. If needed, painkillers can be given every 3 hours to reduce or control pain.
  6. Wound care: Twice daily (morning and evening) clean the wound with swab soaked in normal saline, and then dry the wound, followed by applying prescribed ointment.
  7. Avoid getting water on the wound within the first two days after surgery to prevent irritation. The wound can be cleaned with water since the third day and with soap or cleanser since the seventh day.
  8. Avoid smoking, alcohol and stimulating food such as tee, coffee and chili that affect wound healing within one week after surgery.
  9. Avoid seafood (except fresh fish) to prevent allergy.
  10. Avoid wearing contact lens, facedown position or any movement that may stretch face muscle or increase blood pressure.






Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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