Non-Incisional Ptosis Correction

Overview

Adults commonly have surgery to correct upper eyelid ptosis as an outpatient procedure under local anesthetic. The decision to have an anesthesiologist present to provide intravenous sedation and provide supervised care is frequently made by the patient or surgeon. As little sedation as possible must be used since it will help the surgeon determine how much to elevate the eyelids.

Eyebrow elevation surgery is frequently performed before eyelid ptosis correction and/or blepharoplasty surgery if it is necessary. After the local anesthetic is administered, the upper eyelid crease (if present) is cut, and the levator muscle is found, stretched, and reinserted into the tarsal plate (the firm supporting structure of the upper lid). First, temporary sutures are applied. Typically, the patient is positioned upright during surgery to check for eyelid symmetry and ensure that the droopy eyelid is sufficiently corrected. Only eyelid surgeons with extensive training in the specifics of ptosis correction should do eyelid ptosis surgery, which is a more technically difficult procedure than blepharoplasty surgery (removal of excess eyelid tissue).

What is Non-Incisional Ptosis Correction?

Non-Incisional Ptosis Correction is an operative treatment to correct Levator muscle ptosis. The classic incisional approach, which requires a lengthy operation and recuperation period, has been used to treat the majority of ptosis patients, which are characterized by muscle weakness that makes it difficult to raise the eyelids. Many plastic surgery facilities now execute the Non-Incisional Ptosis Correction to get over these drawbacks and give patients a non-invasive way to improve their appearance and function.

What is Ptosis?

A droopy upper eyelid is referred to medically as ptosis. It is measured from the upper edge of the cornea and more specifically describes the lowering of the upper eyelid margin over the iris of the eye. Depending on this assessment, it might be mild, moderate, or severe and affect either one or both eyes. The measuring of the upper eyelid margin based on the eye's light reflex (known as the Margin Reflex Distance 1 or MRD1) is another approach to categorizing the severity of ptosis.

Ptosis can cause obstructed upper visual fields, a worn-out appearance, and sleepiness. The muscles in the forehead can be somewhat stimulated to assist compensate as the pain worsens, but this can eventually result in headaches and forehead creases. The double eyelid crease can simultaneously loosen and fade. Ptosis can become so severe in some circumstances that people begin to run into low-hanging objects or lose their ability to drive safely.

Ptosis Causes

Involutional, or age-related, ptosis is the main contributor to the condition. This results from the muscles that elevate the eyelid margin being stretched. There are two muscles in control of this. The Levator muscle, along with the Mullers muscle, is the primary muscle responsible for lifting the upper eyelid. Both of these muscles are joined to the tarsal plate, a cartilage plate that is situated behind the skin and eyelashes.

Congenital, mechanical, myogenic (muscle disease), neurogenic (when the nerves responsible for lifting the muscle are affected), and excessive weight from a tumor or excess skin are additional reasons for ptosis. Botox injections to the brow and forehead are a frequent cause of the latter two. Some of the Botox seeps into the upper eyelid muscle, paralyzing the nerves and muscles that retract the eyelid. A droopy eyebrow can cause ptosis because the skin between the brow and eyelid drops, so the upper eyelid should be examined in continuity with the brow as well. When the upper visual fields are significantly limited, ptosis may be a medical problem. A formal visual field exam and the MRD1 are used to measure this. You can get advice on this from your plastic surgeon.

Non-Incisional Ptosis Correction Candidates

If done correctly, non-incisional ptosis correction should continue for years. However, it is important to keep in mind that the muscle being tightened is the secondary muscle, and for more severe cases of ptosis, an open approach is required to tighten the primary Levator muscle. Additionally, for secondary ptosis repair situations, the latter approach is preferable. As the tissue will weigh down on the small sutures and perhaps cause them to rupture, those with particularly thick upper eyelids, loose skin, or extra fat are less acceptable candidates for this operation. Larger sutures can irritate the eyes and cannot be utilized since they will be felt in the upper eyelid. To achieve the best results, the operation should eventually be tailored to the patient and based on a thorough evaluation by a qualified plastic surgeon.

Non-Incisional Ptosis Correction Advantages

The advantages of non-incisional ptosis correction include the following:

• Since there is almost any swelling or scarring, recovery time is short.
• Correction of ptosis can be achieved without double eyelid surgery.
• It is possible to repair asymmetrical eyes by surgery.
• A patient's eyes may have a clear and distinct shape.
• Wrinkles on the forehead can be avoided.

How Ptosis Treated?

By injecting Botox into the muscles that lower the brow or close the eye, mild types of ptosis or ptosis secondary to brow droop may be corrected without surgery. These outcomes, though, are frequently transient and minor.

The majority of ptosis management techniques focus on reversing their underlying causes. The muscle that lifts the upper eyelid margin is typically tightened in these situations. Incisions can be made to visualize the Levator muscle and tighten it directly, or a non-incisional technique can be used in which sutures are inserted through the skin and Muller muscle using exact measurements to avoid cutting, leaving no scar. While the incisional method gives complete control over the tissues of the upper eyelids, it can leave obvious scars and is linked to more prolonged bruising and swelling. The muscles of the forehead may need to be used to assist in elevating the eyelid margin in extreme cases of ptosis where neither the Levator nor Mullers muscles are functional. These procedures not only help to correct ptosis but also aid in producing a lovely double eyelid.

Non-Incisional Ptosis Correction Preparation

Your surgeon must determine the most likely source of the ptosis and its severity before doing ptosis correction surgery. A thorough eye exam that includes a close physical examination of the eyelids, a visual acuity test, and the taking of family history will be necessary. To assess the degree of droop and degree of visual blockage, the marginal reflex distance-1 (MRD-1), the distance between the corneal light reflex of the pupillary center and the edge of the upper eyelid, will also be measured. To establish an improvement in peripheral vision following the elevation of the drooping eyelid, visual field tests may be used. These tests are important for demonstrating to your insurance provider that a benefit is medically justified.

Non-Incisional Ptosis Correction Procedure

Ptosis can be corrected without making an incision by shortening the Mullers muscle, which raises the upper eyelid margin while inserting needles and fine sutures through the upper eyelid's skin and cartilage. This muscle can automatically elevate the eyelid margin by contracting less. Similar techniques are employed in non-incisional double eyelid surgeries to place these sutures, which likewise results in the formation of a double eyelid crease.

This type of ptosis correction is quick in the clinic, generally taking considerably less than an hour to complete for both upper eyelids, leaves no scars, and can be done under local anesthesia. Compared to the incisional method of ptosis correction, it is associated with reduced edema and bruising. However, the level of ptosis correction is not as great as with Levator muscle surgery, and the risk of recurrence is higher, therefore it is typically only used for mild to moderate cases of ptosis, as well as situations when skin or fat do not need to be removed.

After Non-Incisional Ptosis Correction

Your eyelid will swell after surgery, and your vision will be hazy. To lessen swelling following surgery, it's crucial to elevate your head and use cold compresses as much as you can. The eyelid may droop once more if the edema is too severe and stretches the sutures.

The treated eyelid will be stiffer than usual after surgery. Your eyelid will often open somewhat as you fall asleep because of the relaxation of your facial muscles. In general, surgery will result in more stiffness the weaker the lifting muscle was before the procedure. To avoid dryness, it is important to use lubricating ointment and/or drops. Most patients will require these lubricants for a few weeks following surgery.

Some people are susceptible to severe eye dryness. People who already have dry eyes or ocular disease may experience severe dryness. Serious dryness can also affect persons who have trouble covering their eyes, such as those with weakened face muscles or uncoordinated eye movement. How to effectively lubricate your eye will be covered by your doctor. One week following surgery, you will visit the doctor to make sure your eye is properly lubricated. Until you can shut your eyelid properly, you will need to visit the doctor regularly.

Ptosis repair is unfortunately not a precise science. The tissue's ability to recover determines the eyelid's eventual position. Sometimes a subsequent correction is required. The wound is softly opened in the office and the eyelid height is corrected if the eyelid is too high or too low during the initial appointment.

In other cases, if the eyelid height is incorrect, the modification will be carried out several months following the operation. A second surgery is necessary to modify after the tissue has recovered.

When your eyelids are properly closing and your eye is at ease, you can start wearing contact lenses again. About three to four weeks following surgery, the majority of patients start wearing lenses once more. Wearers of rigid contact lenses might first find difficulty in removing the lenses. Following surgery, a small percentage of people have trouble tolerating their lenses because their eyes may feel dryer. After surgery, you could in rare circumstances need to change your eyeglass lens. You shouldn't be checked for new eyeglasses until at least two months after surgery.

Non-Incisional Ptosis Correction Risks

Among the risks of ptosis correction surgery are:

• Infection. Though it happens infrequently, infections or inflammations of the stitches are possible. Antibiotics, both topical and oral, can quickly resolve this.
• Scarring. Scars are typically covered by the fold of the skin. Normally, stitches are noticeable for the first week before being removed, leaving a faint scar. For the first six to twelve weeks, the scar could appear thicker and redder, but beyond that time, it will progressively fade to almost invisibility. While not all scars heal equally well, silicone scar remodeling gel can lessen the appearance of a thicker or reddened scar. However, for the treatment to be effective, it must be used regularly for several months.
• Large bruise or hematoma. This is prevented by using ice packs regularly, avoiding strenuous activity for two weeks following surgery, and quitting aspirin and other anticoagulants (if safe to do so) two weeks before the surgery. If a hematoma develops, you might need to return to the operating room to have the blood clot evacuated and have your stitches redone. By doing this, the scar can get worse.
• Risk to vision. The risk for vision loss exists with any eyelid surgery due to the possibility of an undetected infection or bleeding damaging the optic nerve. Given how uncommon this is, your vision would be at far greater risk during a typical car journey.
• Asymmetry in the upper lid fold, height, shape, or fullness. Although it happens infrequently, Asymmetry frequently results from lid damage and goes away as the swelling goes down. In rare cases, revision surgery can be necessary. However, on occasion, pre-existing asymmetry of the face, brow, or eye position may be to blame. Your surgeon will go through this with you before the procedure.
• Blood-stained tears. Within the first 48 hours following surgery, blood-stained tears can develop; to treat them, apply gentle and firm pressure for 10-15 minutes to the closed eyelid.
• Ptosis recurrence. This can happen early after the operation (3 months) or late (after a few years), depending on whether the sutures dissolve early or the scar weakens or stretches. Re-operation will be required to solve this.
• Contralateral ptosis. Because the eyelids are a pair, it's common for the opposite eyelid to appear to be normal when one is droopy. However, the natural eyelid may droop right after surgery. This may require a ptosis correction or resolve on its own after a few weeks.
• The exposed stitches may cause a foreign body or prickling sensation. When this occurs, the problematic stitch must be taken out. Rarely, if the stitch is left in place, it may result in a corneal ulcer that requires aggressive topical antibiotic therapy.

What Should I Expect from Non-Incisional Ptosis Correction?

Non-incisional ptosis correction can be done in an office setting in under an hour. Except for a pinprick at the time of injection, the technique, which involves numbing eye drops and local anesthesia injection into the skin, is remarkably painless. You will close your eyes throughout the treatment. The tiny stitches and needles used during the operation are barely noticeable after the surgery. The recovery period is significantly shortened by the little amount of edema and bruising, and by two weeks following surgery, practically all of the swelling would have subsided. You won't need to remove any sutures, and you'll be given painkillers to manage any discomfort that might develop after the local anesthetic wears off in addition to antibiotics to lower the chance of infection after the treatment. These risks are, once more, quite low.

Conclusion

Droopy eyelids in adults, or ptosis, is a frequent disorder. Even though ptosis surgery is regularly performed, it is still one of the trickier eyelid operations carried out in an oculoplastic surgeon's office. It is impossible to overstate the diversity of eyelid positions brought on by adjusting a muscle in a thin, dynamic structure (the eyelid). When performed by skilled surgeons, surgical correction of droopy eyelids is very successful and often leads to a better field of vision as well as an improvement in the comfort and appearance of the eyelids. Satisfactory outcomes necessitate a high level of patient compliance and careful follow-up.