A 35-year-old gentleman is very self-conscious about his eyes. He has large and drooping eyelids and deep creases. He wants to know the procedures to correct his eyes.
Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon and specializes in cosmetic surgery of the eyes, face and body. He is a fellow certified by the American Society of Oculofacial Plastic Surgery and has been in practice for over 20 years.
Dr. Prasad explains that this gentleman’s condition is referred to as ptosis or drooping of the eyelid. To know the cause of this, patients have to determine if this was a recent onset, or if the eyes were already relatively low to begin with. If this was a sudden onset, they would need a neurologic workup to look for possible neurologic causes. They also have to look at old photos in cases where congenital ptosis has gotten worse.
In addition, there is also acquired ptosis that's related to a tendon called levator aponeurosis that gets thinner over time. In a 35-year-old, acquired ptosis is mostly associated with contact lens wear. People who wear contact lenses, especially those who wear hard lenses, can have thinning of that aponeurosis or tendon.
Somebody can have a very high eyelid crease and a large lid, which is referred to as involutional ptosis. This is usually more age-related or in people in their late 50s and older.
After the patient had the neurologic workup and are cleared, Dr. Prasad would do levator advancement surgery. This procedure moves the levator muscle or the muscle that lifts the eyelid forward and corrects its position. Sometimes it’s thin, slipped back, or combination of both. During this surgery, the patient is awake for this very important part because the muscle is very sensitive. He lets the patient open their eyes and let them sit up to make sure that the eyelid height, shape and contour are symmetric. It’s remarkably complex and there are a lot of small factors that have to be balanced in order to get a nice shape. Ptosis correction surgery is the domain of oculofacial or oculoplastic surgeons.
Dr. Prasad recommends meeting with a neurologist, an ophthalmologist or a neuroophthalmologist to have the neurologic issues worked out. Also, he must look back at his photos and bring the photos with him when he meets doctors so that they can look at what they looked like. He needs a more detailed examination to really determine what kind of ptosis he has. Dr. Prasad explains that his eyelids are much too low and he should meet with a doctor to evaluate what his diagnosis is and then move forward with the appropriate medical or surgical procedure.
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