The procedure | Correction of eyelid ptosis

Ptosis, or drooping of the upper eyelids, occurs when the muscle that opens the eyelid looses strength. This can be due to aging or due to the weight of skin excess in the upper eyelid, but also due to for instance the wearing of hard contact lenses for a prolonged period of time. Typically the eyelid lowers itself over the course of the day, as the muscle becomes progressively tired. The aim of the procedure is to reposition or tighten the muscles responsible for lifting of the upper eyelids, so that the rim of the eyelid is relocated to just below the upper border of the iris. The procedure can be combined with an upper eyelid blepharoplasty or a brow lift.

Where will I be operated?

The operation will be performed in the fully equipped operating theatre at the Radetzky villa.

What can I expect of the operation?

The operation will be performed under local anaesthetic and will take approximately 45 minutes. Your surgeon will always see you before the operation and will talk you through the steps. Pictures will be taken for documentation. The procedure will start with prepping and draping of your face. Markings will be made on your eyelids and you are advised to keep your eyes closed. You will be warned when the local anaesthetic is going to be injected and you will experience a swelling of your eyelids. While you will not feel any pain during the procedure, you will be able to experience movements, pressure or changes in temperature. Your surgeon will use a precise electric devise to stop any bleeding that may occur. At one stage during the procedure you will be asked to blink or to look straight ahead a couple of times, to judge the natural tension in your eyelid. When the muscle is tightened you will notice a reduced range of motion in your upper eyelid.

What are the risks?

The most common complication is an increase (either subjective or objective) in frequency of dryness of the eyes. It is therefore essential to use both the eyedrops and the ointment (before sleeping) that will be prescribed by your surgeon. Postoperative bleeding occurs in less then 1 in 100 cases. If this occurs behind the eyeball it may compromise vision. Even though this is extremely rare (only 1:40.000), you are advised to contact your surgeon if you experience impaired vision in the days after surgery.

What can I expect after the operation?

When the anaesthetic wears off you may experience some slight discomfort, which however typically disappears after the first few hours. In the first few days healing will include some swelling and (variably) some bruising. Regularly cooling your eyelids in the first 24 hours will help in keeping this swelling to a minimum. Prevention of bending down or lifting heavy goods in the first few days also helps. You may find it more comfortable to sleep with an extra pillow to elevate your head in this period. Because of the elevation of the eyelids it will be difficult to close your eyes completely for a while, which might last as along as a few weeks. It is essential that you prevent your eyes from drying out by using eye-drops (or ointment during the night).

What will the scars be like?

The scar follows the curvature of the eyeball and should, over time, not be visible anymore when opening the eyes. At the side of the orbit the scar will be visible for a few millimetres, especially as it will be slightly red for the first few months. Eventually the colour will even out. Typically a scar will take one year to fully mature and in the majority of cases the scars, although present, should not be visible anymore by that time.

How long before I can resume my life?

Most people manage to return to light activities in the first few days after surgery. At one week after surgery a follow-up appointment will be made for you at the Radetzky villa, where the sutures will be removed. From then on it is possible to apply make-up again. At this stage the swelling and possible bruising normally is reduced to a level where social activities can be resumed. Occasionally however it takes longer for these side effects to disappear completely. We therefore advise you to postpone any important social activity until at least three weeks after the operation. We also recommend you to refrain from doing any strenuous activities in the first 2 weeks.

What is good to know about the long term?

The level at which the eyelids rest depends on the muscle that opens your eye. This level may be variable during the day, as the muscle tires as the day progresses. If you have a one sided ptosis this means that the asymmetry will significantly reduce, but will not completely disappear.
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