Ptosis surgery

Ptosis surgery

What anaesthetic is used?

Usually it is preferable to carry out ptosis surgery under local anaesthetic as it more precise in setting the eyelid height. A mild sedative tablet can be taken preoperatively to help with anxiety.

What does surgery involve?

The surgery can be performed in a number of ways. For larger degrees of eyelid lifting, the incision is made on the front of the eyelid through the skin crease so that it will not be visible. If only 2-3 mm of eyelid lift is required, then the procedure can also be performed through an incision on the underside of the eyelid. 

If there is also excess skin on the upper lid, this can also be reduced by combining the ptosis repair with a blepharoplasty. By taking away some of the excess skin at the same time, using the same incision, there can be a better cosmetic outcome. Indeed the loss of superior visual field can be due to both a droopy lid and excess skin so this combined procedure may be necessary to achieve the desired improvement in visual field.

The operation takes around one hour per eye and often both eyes are operated together. The operating table is adjustable so there is usually a way to get comfortable and remain in position. The local anaesthetic injection is the only uncomfortable part and usually comes as a short sting.

After the ptosis operation is complete, the eyes are padded shut. If both eyes are operated together, this means both eyes are taped shut. In this case, it will be necessary to arrange for someone to take you home and look after you until you take the pad off the following day.

Do I need to stop or change any medication before having surgery?

Prior to surgery, it is important to discuss regular medication with your surgeon. Blood thinning medications, including aspirin, warfarin, clopidogrel, rivaroxaban, apixaban, edoxaban and dabigatran all increase the bleeding during and after surgery. It is important to know why these are being taken and if it is safe to stop them. Your GP may be able to advise you on this matter in conjunction with your surgeon. 

What are the risks of ptosis surgery?

There are risks associated with every operation and it is important to understand these to make an informed decision. Mr Modi will go through these with you at your appointment.

With any operation there is some bleeding, bruising and swelling. The eyelids are very vascular so it is normal to have some bruising and swelling after surgery in this area. There is a low risk of infection and an antibiotic ointment is supplied after surgery to apply to the eyelids twice a day for 7-10 days.

With eyelid surgery, there is some risk to the eye but if the proper precautions and care are taken, this is extremely unlikely.

The most important risk with ptosis surgery is that there may not be enough of a lift and this can result in an unsatisfactory result or asymmetry. Conversely there can be an overcorrection after surgery. It is not an entirely precise science as once the anaesthetic is applied, this can affect the function of the orbicularis (eyelid closing muscle) or the levator (eyelid lifting muscle). Once the anaesthetic wears off, these can start working again to give a final lid position that is slightly higher or lower than expected. To treat this, a further adjustment can be required.

Instructions after ptosis surgery

Day 1-2 – On the first day, the eye pad can be taken off. You will have been prescribed some antibiotic eye ointment and this is to apply twice a day for 7-10 days.

Ideally, you must keep the eyes dry. It will be possible to bathe or shower whilst keeping the eyes from getting wet. A small amount of splashing is unlikely to cause a problem.

A gentle wipe of any crusts with cotton pads and cooled boiled water is helpful for comfort however care must be taken to avoid rubbing.

It is helpful to sleep with an extra pillow as this will prop up the head, which will help reduce swelling postoperatively.

Day 2-4 – Postoperative review will be arranged at this stage to check for eyelid position. Stitches are not usually removed until after one week.

It is helpful to start applying ice packs to the upper lids as this can also help with eyelid swelling.

Day 3-7 – The eyes can be gently washed with soap and water. It is important to dab but not to rub the eyes. The crusts will come away when ready.

Day 7-10 – Review will usually be arranged again at around this stage and sutures may be removed if necessary.

Day 14 – Makeup can be used again. Swelling and bruising will be barely noticeable to most people.

6 weeks - Final review is usually arranged around 6 weeks as by this stage, most of the swelling will have settled.