One Side
From
£3800
Both Sides
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£5250
Ptosis means downward displacement of an organ or tissue. Ptosis in the field of ophthalmology usually refers to a drooping upper eyelid (a blepharoptosis) but it can also refer to a drooping of the eyebrow (brow ptosis) or the midface (midface ptosis). Ptosis may affect one or both eyelids and can be very asymmetrical depending on the underlying cause. The most common cause of ptosis is a loosening of the tendon (aponeurosis) of the muscle (the levator) that lifts the eyelid, often following years of hard contact lens wear. Blepharoptosis is often age-related. Ptosis can also affect children. It is important to see a specialist oculoplastic surgeon to determine the underlying cause of the blepharoptosis before proceeding with any surgery.
The treatment is usually surgery although there are a few very rare disorders that may be treated medically (e.g. myasthenia). During surgery for adults the levator tendon (the levator aponeurosis) is tightened, usually under local anaesthesia with intravenous sedation provided by an anaesthetist (“twilight anaesthesia”). This is referred to as a “levator aponeurosis advancement”. An alternative operation can very often be performed via an incision on the inside of the eyelid. This is referred to as a “Müller’s muscle resection” and this leaves no visible scar (scarless ptosis surgery).
A patient with a left ptosis
The patient following a scarless Müller’s muscle resection
A patient with a bilateral ptosis
The patient following a scarless Müller’s muscle resection on both sides
A patient with a left ptosis
The patient following a scarless Müller’s muscle resection and an upper lid blepharoplasty
A patient with a left ptosis
The patient following a scarless Müller’s muscle resection and an upper lid blepharoplasty
Very rarely, for patients who have poor movement of the eyelids (poor levator function) e.g. due to a congenital developmental abnormality the lids may be attached to the brow so that the forehead muscles do the lifting. This is referred to as a “brow or frontalis suspension procedure”. The eyelids may be suspended using synthetic material e.g. a nylon suture (polypropylene), a silicone band, or using tissue taken from the outer aspect of the thigh (fascia lata) through a small incision just above the knee.
Ptosis surgery is sometimes combined with an upper eyelid blepharoplasty if there is an overhang of loose skin in the upper eyelid. The procedure can be performed under local anaesthesia on a day case basis. Most patients, however, prefer “twilight anaesthesia”.
You will visit the clinic to have a preoperative consultation. This usually lasts for 40 minutes. You will be asked to complete a healthcare questionnaire, providing information about:
You may have your blood pressure checked by the nurses at the clinic.
It is very helpful if you have old photographs which you can bring along to the consultation. If you are happy to email digital photographs of your current appearance in advance of the consultation with details of your concerns, this is also enormously helpful and saves time. Your photographs will be kept confidential and will form part of your clinical record.
The nurses are also happy to answer any further questions and to show you the facilities at Face & Eye, including the operating theatre if it is not in use.
If you are unsure of the names of any medications, bring them with you.
You will be told whether or not to stop any medications at this preoperative clinic visit. For example, if you are taking aspirin-containing medicines or anticoagulants, they may need to be temporarily withdrawn or reduced in dose for two weeks before the procedure as long as these are not medically essential. You might need to check this with your GP. Any anti-inflammatory medicines e.g. Ibuprofen, Nurofen should be discontinued at least 2 weeks before surgery. These medicines predispose you to excessive bleeding. You will be given a leaflet advising you on what medications, foods, and vitamin supplements to avoid prior to surgery. It is important that your blood pressure should also be under good control if you take medications for hypertension. This is very important.
If you can, try to stop smoking at least six to eight weeks prior to surgery. Smoking has an adverse effect on healing and damages your eyelid skin and supporting tissues and your eyes (it can result in premature cataract formation and age related macular degeneration with a loss of central vision).
Photographs of your face and eyelids will be taken before surgery so that the results of surgery can be compared with your original appearance. The photographs are confidential and can only be used for any purpose other than your own records with your specific written permission.
Some insurance companies request copies of preoperative photographs and some also require a visual field examination, to confirm that the eyelid problem is restricting your peripheral vision.
The risks and potential complications of surgery should be considered but these need to be kept in perspective. Complications in the hands of a trained and experienced oculoplastic surgeon are very rare and all precautions are taken to minimize any risks.
Most complications of eyelid surgery are amenable to successful treatment.
Complications from upper eyelid blepharoplasty surgery include:
After surgery, the eyes are treated with cool packs. Activity is restricted for 2 weeks to prevent bleeding. For some patients a postoperative eyepad is required and a stitch (Frost suture) is placed in the lower eyelid and taped to the forehead to ensure that the eye is closed and protected. This is usually removed the following day at the clinic.
You will be asked to clean the eyelids very gently using clean cotton wool and Normasol (sterile saline) or cooled boiled water and repeat the application of antibiotic ointment (usually Chloramphenicol or Soframycin) to the wounds 3 times a day for 2 weeks (unless you have had a scarless ptosis operation). The sutures used are dissolvable but are usually removed in clinic after 2 weeks. The sutures used in a scarless operation are removed after 4-7 days depending on postoperative progress. The skin around the eyes should be protected from direct sunlight, by avoidance if possible or by using protective sunglasses. Wearing make-up should be avoided for at least 2 weeks. After 2 weeks the use of mineral make-up is recommended. (The nurses at the clinic can demonstrate this to you). It is important to devote a lot of time to your aftercare for the first 2 weeks and some patients find this somewhat labour intensive.
A realistic period of recovery must be expected. Postoperative bruising usually takes at least 2-3 weeks to subside completely. Swelling takes much longer. Most of the swelling disappears after 3-4 weeks but this can vary considerably from patient to patient as does the extent of the swelling. The final result is not seen for at least 3-4 months. This should be taken into consideration when scheduling the operation. You should arrange this surgery after holiday periods or important professional or social events and not before so that you are available for postoperative review and just in case any surgical adjustments are required.
The upper lid scars gradually fade to fine white marks within a few months. The scars are hidden within the skin crease unless an additional skin incision is required to remove a “dog-ear” of excess skin just below the tail of the eyebrow.
You will need to use frequent artificial tears for the first 2-3 weeks following surgery. It is preferable to use preservative free drops, particularly if you have any allergies. These will be prescribed for you e.g. Xailin gel and Xailin Night ointment or Hylo Night ointment at bedtime. Alternative drops are Hylotear, Hylo-Care, Hylo-Dual, Hylo-Forte, Xailin gel, Xailin drops, Theoloz Duo, Hyabak, EvoTears, VisuEVO, Celluvisc, or Systane drops preservative free.
It is often recommended that you use ointment to the eyes 2 hourly for the first 48 hours after surgery following any upper lid surgery but note that this will cause blurring of vision. (You should not drive for the first few days after surgery). Click here to watch a short video showing you how to insert your ointment.
You are advised to sleep with the head raised approximately 30 degrees. It is preferable to raise the head of the bed if possible.
Contact lenses should not be worn for 2-3 weeks following this type of surgery.
Please note that although ptosis surgery can be performed under local anaesthesia alone, local anaesthesia with safe, conscious intravenous sedation given by a very experienced and skilled consultant anaesthetist (commonly referred to as “twilight anaesthesia”) is also available where requested. This form of anaesthesia is extremely popular with our patients and the effects are reversed very quickly. It enables local anaesthetic injections to be given painlessly with little recollection of the surgery, and helps to keep patients calm, relaxed and comfortable. It also helps to prevent rises in blood pressure thereby minimizing bleeding and postoperative bruising.
Any patients requiring general anaesthesia or who are unsuitable for surgery at our day case facility, the Face & Eye Clinic, will be treated by our surgeons in a local private hospital.