Ptosis (Levator Muscle) Correction Surgery

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.

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

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

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 2.is 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.