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I was born with congenital ptosis. Ptosis, meaning “drooping eyelids,” impaired my vision; cosmetically, I looked sleepy all the time, but visually, I was only able to see things that fell below my lids since my eyelids couldn’t open completely. To see anything higher meant tilting my head upwards, as the muscles responsible for lifting my lids were weak.
When I was three years old, I had ptosis remedy surgery to improve my vision. It helped me see the world in a whole new light — literally. (I still remember seeing my mom for the first time, after the patches I wore for a few weeks were removed.) But as I got older, I was desperate to find information about how to take care of my condition and if additional medical attention would be needed. My left eyelid has always been a touch heavier than my right, but it seems heavier than ever — 30 years after my remedy surgery.
Ptosis is more common than you might expect, especially as a result of aging. I spoke to experts about what options are out there, when surgery is necessary, and if noninvasive treatments help.
What causes ptosis?
There are two categories of ptosis: congenital (present at birth, like mine) and onset, which is acquired with age. Congenital ptosis is a result of a weakened levator muscle or a problem with the specific nerve pathway that controls the eyelid muscles. “Congenital ptosis most often occurs when the muscle elevating the eyelid no longer functions, is damaged, or that muscle can even be missing almost entirely,” says aesthetic orbital and oculoplastic surgeon Raymond Douglas. Congenital ptosis is not necessarily a result of an underlying disease and can be genetic.
Under the “acquired ptosis” category, there are five types, including aponeurotic or involutional ptosis, which is the most common. “In this condition, the muscle has been stretched out, usually through the aging process, but can also occur from excess rubbing or pulling down the eyelid. Long-term contact-lens use has also been associated with this type of ptosis,” says oculoplastic surgeon Christopher Zoumalan.
How is ptosis treated?
Zoumalan explains that ptosis doesn’t necessarily need to be remedied unless it has the potential to impair your vision. Issues like amblyopia — a form of “lazy eye” — as well as astigmatism can be a result of ptosis that isn’t treated. Misaligned or “crossed” eyes can also become an issue.
If your doctor determines the ptosis is detrimental enough to your vision that you need surgery, there are a few options. Zoumalan corrects mild ptosis through a minimally invasive procedure in which the weakened muscle is tightened through an incision that is on the backside, which leaves no visible scar. It can also be attached to other muscles to aid in lifting the eyelid.
“More severe cases may require an incision that is placed along the outside eyelid skin itself, much like the incision used in a cosmetic blepharoplasty surgery, but the ptosis muscle is tightened through that approach,” says Zoumalan. “When there is complete weakness of the levator muscle, which can be seen in severe congenital ptosis cases, other procedures that utilize the nearby forehead muscle, such as a frontalis sling fixation technique, can be used to elevate the eyelid.” Frontalis slings attach sutures to the forehead and the eyelid itself to raise it; the sling can be created with silicone or with fascia from your body, typically found in the thigh. It’s all invisible to the naked eye as it’s created behind the eyelid tissue.
Because the weak muscle will never regain its strength, there are a few things to consider if you get the remedy surgery. There isn’t required maintenance, but Douglas advises that an additional surgery may be required later in life for congenital ptosis if the sling helping to lift the eyelid starts to give away over time. It varies patient to patient and is something he recommends keeping tabs on.
Muscle exercises may assist as well, if they still have function. “You can work eyelid muscles by raising your eyebrows, placing a finger underneath and holding them up for several seconds at a time while trying to close them against the pressure of the hold,” Douglas says.
Can Botox or fillers be used to treat ptosis?
If you’re looking for aesthetic solutions, neuromodulators like Botox as well as filler can furnish symmetry. “Botox may be used in some cases to weaken some surrounding muscles of the eyelid to allow the eyelid to open up a little bit,” says Zoumalan. “However, Botox to improve the eyelid height is unpredictable and variable in results.” Therefore, he says, it is not a standard of care for managing ptosis.
According to Douglas, filler, fat transfer, and other autologous options can improve the eye area. He suggests Sculptra, an FDA-approved injectable, which can build your own collagen and elastin in the eye area, giving the appearance of a better-positioned eye, less drooping, and a more youthful look; but again, it isn’t a remedy for ptosis should it impair your vision. Techniques like radiofrequency and ultrasonic skin-tightening can also benefit the appearance.
Blepharoplasties, as previously mentioned by Zoumalan, are plastic-surgery procedures often associated with ptosis, but their purpose is different from that of remedy surgery for weakened muscles. “Blepharoplasty is the surgical procedure that I perform to remove excess upper eyelid skin,” explains Zoumalan. “This is in contrast to ptosis surgery, where the droopy muscle is tightened to improve the lid height. They are both different procedures for different reasons.” He acknowledges, however, he can do both procedures at the same time on the patient, given many of his patients have both ptosis and excess skin on their upper lid.
Remedy surgeries for ptosis can often be covered by insurance if the patient’s vision is impaired; for cosmetic symmetry, it’s not. If you’re experiencing ptosis, the first step would be to consult an oculoplastic surgeon to discover if it’s severe enough to warrant surgery.
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