Eyelid Ptosis

Eyelid Ptosis Surgery is a procedure that corrects drooping of the upper eyelid, known as ptosis. Upper eyelid ptosis occurs when the eyelid sits lower than normal and may partially cover the pupil, making the eye appear smaller, uneven, or tired. In some patients, ptosis can also affect the visual field.

Unlike Upper Blepharoplasty, which primarily removes excess upper-eyelid skin and fat, Ptosis Surgery addresses the eyelid-lifting mechanism itself. Depending on the cause and severity of ptosis, the levator muscle or its tendon may be repaired, tightened, or repositioned to improve upper-eyelid height and function.

During consultation, I assess eyelid position, levator muscle function, degree of ptosis, eye symmetry, upper-eyelid skin and fat, and brow position. The goal is to restore appropriate eyelid height and symmetry while maintaining natural eyelid movement and appearance.

Eyelid Ptosis Surgery may be appropriate for patients with a drooping upper eyelid caused by weakness, stretching, or abnormal position of the eyelid-lifting mechanism. Ideal candidates may include patients with:

• One or both upper eyelids sitting lower than normal
• Upper eyelid ptosis that partially covers the pupil or affects the visual field
• Noticeable asymmetry between the upper eyelids
• A tired or uneven appearance caused by a low upper eyelid
• Compensatory eyebrow elevation or forehead muscle use to keep the eyes open
• Congenital or acquired eyelid ptosis that has remained stable

During consultation, I assess eyelid height, levator muscle function, eye movements, eyelid symmetry, brow position, and upper-eyelid skin and fat. This helps determine the severity and likely cause of ptosis and whether Ptosis Surgery, Upper Blepharoplasty, or a combination of procedures is appropriate.

Patients should have realistic expectations and understand that the goal of ptosis surgery is to improve eyelid position, symmetry, and function while maintaining natural eyelid movement and appearance.

Before Surgery:
During consultation, I assess the degree of upper eyelid ptosis, levator muscle function, eyelid height and symmetry, brow position, and overall eye function. These findings help determine whether a frontalis sling procedure is appropriate. When levator muscle function is significantly reduced, a silicone rod can be used to connect the upper eyelid to the forehead muscle, allowing the frontalis muscle to assist in elevating the eyelid.

Anesthesia:
Frontalis sling surgery may be performed under local anesthesia with sedation or general anesthesia, depending on the patient's age, medical condition, cooperation, and extent of surgery. The choice of anesthesia is individualized to provide appropriate comfort and safety.

Procedure:
For moderate to severe types of eyelid ptosis, my preferred technique is a Frontalis Sling Surgery.  Several small incisions are made along the upper eyelid and forehead. A silicone rod implant is passed beneath the skin to connect the upper eyelid to the frontalis muscle of the forehead. The silicone sling transfers the lifting action of the forehead muscle to the upper eyelid, allowing the eyelid to be elevated when the patient raises the eyebrows.

The sling is carefully adjusted to achieve appropriate eyelid height, contour, and symmetry while avoiding excessive elevation or difficulty closing the eye. The silicone rod is secured beneath the skin, and the small incisions are closed carefully. The final eyelid position may continue to change as swelling decreases and the tissues adapt to the sling.

• Post-op Medications: I usually prescribe oral antibiotics and pain relievers after Frontalis Sling Surgery. Cold compresses and keeping the head elevated can help reduce swelling and bruising during the early recovery period.
• Suture Removal: Sutures are usually removed after 6–7 days, depending on the healing of the eyelid and forehead incisions.
• Downtime: Mild discomfort, swelling, bruising, and tightness around the upper eyelid and forehead are expected after surgery. Temporary difficulty fully closing the eye may occur as the eyelid adapts to the sling. Many patients can return to work within approximately 7–14 days, depending on swelling, bruising, and the nature of their work.
• Scarring: The small incisions on the upper eyelid and forehead may initially appear pink or noticeable but gradually soften and fade over 6–12 months as the scars mature.
• Results: The eyelid may initially appear higher or slightly uneven because of swelling and adjustment of the silicone sling. As healing progresses, the eyelid position and contour gradually settle. Mild tightness or asymmetry may persist during the early months, with continued refinement as the tissues adapt to the sling and mature over time.

The cost of Eyelid Ptosis Surgery in the Philippines varies depending on the severity and cause of ptosis, surgical technique, anesthesia, surgical setting, and what is included in the surgical and hospital fees. For patients considering Eyelid Ptosis Surgery in Manila, the total cost also depends on whether one or both eyes require correction and whether additional eyelid procedures are needed.

Cost of Eyelid Ptosis Surgery for uncomplicated cases

Eyelid Ptosis Surgery: ₱75,000 per eye*

*For uncomplicated eyelid ptosis surgery using a Frontalis Sling with a silicone rod under local anesthesia. Postoperative medications and additional medical expenses are not included.

If both eyes require surgery, the estimated surgical fee would be ₱150,000 for both eyes in an uncomplicated case. Additional fees may apply when ptosis surgery is combined with procedures such as Upper Blepharoplasty or Double Eyelid Surgery, or when more complex eyelid reconstruction is required.

The final cost may vary depending on the patient's individual anatomy, severity of ptosis, surgical plan, anesthesia, and facilities or services required. A final quotation is provided after consultation and treatment planning.

Eyelid Ptosis Surgery, using a Frontalis Sling Technique is generally safe when appropriately planned and performed. However, as with any surgery, complications can occur. Some are temporary and improve during healing, while others may require additional treatment or revision surgery.

Possible complications include:

• Bleeding or hematoma, which may require additional treatment.
• Infection, including infection involving the silicone sling, which may require antibiotics or removal of the sling.
• Eyelid asymmetry, including differences in eyelid height or contour.
• Overcorrection or undercorrection, resulting in the eyelid being positioned too high or too low.
• Difficulty fully closing the eye (lagophthalmos), particularly during the early healing period, which may cause eye dryness or irritation.
• Exposure keratopathy or corneal irritation if the eye cannot adequately close and protect the cornea.
• Recurrence or inadequate correction of ptosis, which may occur as tissues heal or the sling loosens or stretches.
• Silicone rod visibility, extrusion, migration, or granuloma, although these complications are uncommon.

Careful assessment of levator muscle function, eyelid position, brow function, ocular surface, and degree of ptosis is important in determining whether a Frontalis Sling with a silicone rod is appropriate and in minimizing potential complications.