[Duhan Plastic Surgery Eye Surgery] - [Ptosis Revision Surgery]

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Ptosis

Ptosis of the upper eyelids

If you have ptosis that makes your eyes look sleepy,

a double eyelid is created while correcting the sleepy-looking eye shape.

http://www.doublefold.co.kr

Ptosis (sleepy-looking eyes)

Ptosis is when the eyes do not open fully and always look sleepy.

It is broadly divided into congenital ptosis and acquired ptosis.

It is also divided into true ptosis, in which the function of the levator palpebrae superioris muscle, which lifts the eyelid, is reduced, and

pseudo-ptosis, which only appears to be simple ptosis.

The purpose of correcting ptosis (sleepy-looking eyes) is to restore a large, bright eye shape,

and ptosis correction surgery requires an appropriate method according to the severity of the condition, as well as the surgeon’s skilled know-how and technique.

Examples of ptosis

Types of ptosis (sleepy-looking eyes)

1. Congenital true ptosis

This occurs because the levator palpebrae superioris muscle, which lifts the eyelid, has reduced function. It can occur in both eyes or in one eye.

In cases of congenital ptosis, it is better to correct it early before the function of the levator palpebrae superioris muscle deteriorates further.

In true ptosis, even if double eyelid surgery is performed, there is almost no effect of enlarging the pupil, and ptosis correction must be additionally performed to increase the vertical size of the pupil.

2. Congenital pseudo-ptosis

There are cases where the eyes look sleepy even though the levator palpebrae superioris muscle function is not reduced.

This happens because, in eyes without double eyelids, drooping eyelid skin covers the pupil.

It is sometimes mistaken for ptosis, and even plastic surgeons can occasionally misjudge it as true ptosis, so caution is needed.

Congenital pseudo-ptosis can make the eyes appear larger with double eyelid surgery alone, so separate ptosis correction is not necessary.

In the case above, the patient wanted ptosis correction (eye correction) because the eyes looked sleepy, but when a temporary line was created with wire, the previously hidden pupil was revealed much more clearly, meaning there was no ptosis at all.

This is a typical case of pseudo-ptosis, where simple double eyelid surgery alone is sufficient.

Nevertheless, there are clinics that unnecessarily recommend ptosis correction (eye correction), so caution is needed.

3. Traumatic true ptosis

This occurs when the levator palpebrae superioris muscle, which lifts the eyelid, is damaged by incorrect surgery or trauma.

If the damaged levator palpebrae superioris muscle is only partially injured, reconstruction is not difficult. However, in the case of complete injury, if it is not restored quickly, the levator palpebrae superioris muscle may retract, making reconstruction difficult.

The damaged levator palpebrae superioris muscle is identified, restored, and corrected.

4. Traumatic pseudo-ptosis

This refers to a case in which the function of the levator palpebrae superioris muscle is normal, but external factors interfere with the muscle’s function so it cannot exert force properly.

It usually occurs when the double eyelid line is made too thick and scar adhesion develops.

It is corrected by fully incising to release the scar tissue adhesion beneath the double eyelid line and lowering the line.

5. Senile true ptosis

This occurs as the function of the levator palpebrae superioris muscle, which lifts the eyelid, gradually declines due to aging, weakening the force used to open the eyes.

It usually occurs after age 50, and in senile cases, as with congenital ptosis, the postoperative prognosis is often not good.

Surgery combines upper blepharoplasty, which removes skin, with ptosis correction.

6. Senile pseudo-ptosis

As people age and the eyelids sag due to the aging process, the pupil becomes covered, making it appear as though the eyes do not open fully, similar to ptosis.

In such cases, the eyelid skin should be temporarily lifted or a temporary double eyelid should be created to check the actual vertical width of the pupil.

A diagnosis of ptosis should not be made simply because the eyelid is covering the eye.

Upper blepharoplasty, which removes eyelid skin, can alone create the effect of larger eyes, so ptosis correction is not necessary.

Causes of acquired ptosis

1. When the double eyelid line is made too high

2. When the eyes are rubbed habitually, causing scar tissue inside the eyelid that interferes with levator palpebrae superioris muscle function

3. When levator palpebrae superioris muscle function decreases due to aging

4. When the levator palpebrae superioris muscle is damaged by trauma

Differences between ptosis and normal eyes

○ When the eyes are opened naturally and looking straight ahead, it is normal for the upper part of the black pupil to be slightly covered by about 1–2 mm.

If more of the black pupil is covered than that, ptosis should be suspected.

○ When the eyes are opened naturally and looking straight ahead, the vertical width of the eye should be 8 mm or more for it to be normal.

If the vertical width is narrower than that, it is ptosis.

○ When shifting gaze from looking downward as much as possible to looking upward, the amount the eyelid moves should be about 14–16 mm.

If it is less than that, it can be judged as true ptosis.

Ptosis examination method

The method for examining ptosis is to check the vertical width of the pupil while looking straight ahead.

In normal people, the vertical width is between 8 and 9 mm,

and generally, cases of 8 mm or less are considered ptosis.

However, because eye shapes and sizes differ from person to person,

ptosis is not diagnosed based only on exact numbers.

It is judged based on whether the person has an objectively sleepy-looking impression,

and the diagnosis is made by comparing this with the measurements.

The function of the levator palpebrae superioris muscle is also measured and evaluated.

1. Palpebral fissure height (vertical eye width measurement)

2. Check whether the expression looks sleepy

3. Measure the function of the levator palpebrae superioris muscle (normal 14–16 mm)

Surgical methods for ptosis

1. Levator palpebrae superioris shortening

This is a method of suturing by overlapping about 4–8 mm to shorten the length of the eyelid-lifting muscle (levator palpebrae superioris), and is mainly applied in cases of mild ptosis.

Ptosis correction must be performed through incision, so a double eyelid line inevitably forms during the process; therefore, people without double eyelids have no choice but to create at least an inner double eyelid.

Levator palpebrae superioris shortening procedure

① Design is made and local anesthesia is performed.

② An incision is made along the design line.

③ After the incision, the orbital septum is opened to expose the levator palpebrae superioris muscle.

④ The levator palpebrae superioris muscle is exposed, marked as much as needed for shortening, and the marked part and the upper border of the tarsal plate are tied together with sutures.

⑤ Sutures are buried in three places to create the double eyelid line.

⑥ The outer skin is sutured.

Levator palpebrae superioris resection

This method removes about 5–10 mm of the levator palpebrae superioris muscle to shorten its length, then sutures the end of the resected levator palpebrae superioris muscle to the tarsal plate.

It is mainly applied in cases of moderate ptosis.

3. Frontalis suspension

This method is performed in cases of severe ptosis with levator palpebrae superioris function below 5 mm, and is used when functional recovery is difficult with levator palpebrae superioris shortening or resection.

The frontalis muscle of the forehead is advanced and tied to the tarsal plate of the eyelid so that the frontalis muscle can take over the function of the levator palpebrae superioris muscle.

General anesthesia is required, and severe vomiting-related complications may occur.

4. Müller’s muscle shortening

Instead of levator palpebrae superioris shortening, a shortening procedure using the Müller’s muscle beneath the levator palpebrae superioris muscle is sometimes used.

Müller’s muscle shortening has the advantage of minimizing vomiting-related complications, but it is difficult to measure postoperative prognosis, recurrence is common, and because surgery must be performed while damaging the levator palpebrae superioris muscle to access Müller’s muscle, it is not a procedure with any special advantages.

Also, anatomically, many people have little to no Müller’s muscle, or it is very thin, so in such cases Müller’s muscle shortening cannot be applied.

Before and after ptosis surgery

Postoperative care guidelines

1. Apply cold compresses using the cold pack provided by the clinic.

Do this for 2 hours a day for 3 days.

The 2 hours of cold compressing can be done continuously, or split into 20–30 minute sessions.

It is usually convenient to do it before sleeping.

2. Use the prescribed artificial tears and eye drops to prevent dry eye.

3. Follow-up visits after surgery are usually twice: the day after surgery and on the day of suture removal.

Sutures are removed on day 3 or 4.

4. Makeup and face washing are possible after suture removal.

Before suture removal, wash the face with a wet towel.

5. Since no bandage is applied to the surgical site, daily life is possible.

6. Postoperative swelling varies by individual, but it usually subsides to a considerable extent in about 7 days; however, the period for it to settle completely is about 1 to 3 months.

7. Incomplete eye closure, or lagophthalmos, varies depending on the degree of ptosis and the extent to which the levator palpebrae superioris muscle was shortened, but in many cases it can take from 15 days to as long as 6 months or more.

On average, it progresses for about 2 to 3 months and then the eyes close naturally.

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