How to Tell If Slightly Uneven, Drooping Eyelids are Actually Ptosis and Require Surgery

Author: Amiya Prasad, M.D.

What surgery would be performed for upper eyelid bilateral ptosis of the right eye? I have been told by several doctors on here following a picture I posted- saying I have upper eyelid ptosis of right eye and also that it's bilateral. My question is what surgery would be performed for this? What are the outcomes? I don't want to rush into anything to hasty especially concerning important parts like my eyes. Thanks Thank you for your question! You submitted a photo and you write in your question that you have ptosis in the right eye and doctors have also taught you that you have ptosis in both eyes. You want to know what's involved in the surgery and that you don't want to make a hasty decision. Well, certainly you certain made a good decision by first analyzing whether or not this is the right choice for you to pursue.

Whenever I see a patient with ptosis, my first question is of course is how long has the ptosis been like that. Had they noticed? Is this something new, is this something that has been happening overtime? Essentially, a thorough history is critically important. If it has been mentioned to you that you have ptosis, there was an incidental statement that you were never aware of, then it's meaning because you were never bothered by it. Ptosis in itself is not a reason to do surgery unless you are concerned about the aesthetic appearance or if there is also a functional issue related to vision. In order to a proper ptosis examination and to evaluate whether you need one eye or both eyes done, you ultimately would need a proper ptosis evaluation. What I mean by that is the eyelid muscle called the levator muscle is a very sensitive muscle and there are certain things about that muscle that makes it more complicated to deal with. This is why 99.99% of board certified plastic surgeons don't do this type of surgery and this is the domain of the oculofacial plastic surgeon.

That being said, one of the things that is tricky about ptosis and why you are probably getting some confusion about whether it's one eye or both eyes is that there is a particular physiological call Hering's law that has to do with the amount of tone each eyelid receives as a function of that muscle. It's called muscle innervations or the amount of tension that muscle has. So it has been seen that if you lift one eyelid, in certain cases, the other eyelid would actually come down. And so that's why during a ptosis surgery, in the preoperative photos, a person can look like one eye is low and the other eye is high and that when you do just one side, then the first side can look high and normal and the other side can be low. So again, I can't stress enough the importance of an examination. But most importantly, you have to decide if you are bothered about the ptosis at all. Within the normal population, 1 or 2 millimeters difference between the eyes is usually accepted as normal and most people don't notice that.

When people notice ptosis, it has to do very often when other people tell them. You have a lazy eye but that's not a correct term but that's how patients describe it to me. Or is something going on with one eye, why is that one eye closing. So it sometimes takes several exact visits for me to make a decision before I decide to move forward with a ptosis operation. When a person comes in with a relative subtle amount of ptosis, I want to look at them at several parts of the day. Maybe at the end of the day, they can be more fatigued and the ptosis is more prominent. So I think that you're task now is to meet with qualified experienced oculofacial plastic surgeons who can guide you and you can get some opinions and look at their work and get a sense of what threshold is that would be right for you if this is even right for you.

How to Tell If Slightly Uneven, Drooping Eyelids are Actually Ptosis and Require Surgery

Again, you submitted one photo and it's clear that there's a slight difference between the two eyes but to me from that photo, it's only slight. So move forward and meet with doctors, get some opinions and understand the risks, benefits and options in doing this procedure and then take it from there. So I wish you the best of luck, I hope that was helpful and thank you for your question.

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