Ptosis Repair Gallery

This patient in her 70s underwent bilateral upper blepharoplasty, bilateral ptosis repair, and Botulinum toxin @raleigheyeandface

*The after photo is a selfie from our patient.

Notice the distance from the corneal light reflection to the eyelashes. The right upper eyelid is low, which is called ptosis. The patient underwent right internal ptosis repair in which surgery is performed on the inside of the eyelid (no skin incision). After surgery, the eyelid is of a normal height and contour and the patient has an aesthetically pleasing appearance.

Notice the distance from the corneal light reflection to the eyelashes. The right upper eyelid is low, which is called ptosis. The patient underwent right internal ptosis repair in which surgery is performed on the inside of the eyelid (no skin incision). After surgery, the eyelid is of a normal height and contour and the patient has an aesthetically pleasing appearance.

Notice the distance from the corneal light reflection to the eyelashes. The right upper eyelid is low, which is called ptosis. The patient underwent right internal ptosis repair in which surgery is performed on the inside of the eyelid (no skin incision). After surgery, the eyelid is of a normal height and contour and the patient has an aesthetically pleasing appearance.

This patient presented with drooping of her upper eyelids. In addition to excess skin (dermatochalasis), the eyelids were low due to changes in the muscles that open the eyelid (ptosis). The patient underwent bilateral upper blepharoplasty and internal ptosis repair. Not only have the eyelids been raised and the excess skin removed, but the eyelid contour has also been improved.

This is another great example of how surgery can enhance appearance in a way that looks natural. Puffiness of the under eyes or eye bags are a common condition we treat at Raleigh Eye and Face. The puffiness is caused by orbital fat shifting forward over time. In some cases, patients are born with visible fat in the lower eyelids. When puffiness is present, patients are often mistaken as being tired. Lower blepharoplasty can be performed to contour the fat and create a smooth and youthful transition between the eyelids and the cheeks. The incisions are made on the inside of the eyelids. This patient also had relative left microptosis or a mild eyelid droop. In the ‘before’ photo, the right upper eyelid looks pseudo retracted or too high when in reality the issue is that the left upper eyelid was a touch too low. This patient also underwent a left microptosis repair which was also performed on the inside of the eyelid. There are no visible scars or signs of surgery, and the patient looks refreshed and natural. Here is a summary of what was done in the case.

Left micro ptosis repair surgery: the left upper eyelid was raised to a normal height.

Lower blepharoplasty surgery: orbital fat that shifted forward over time was sculpted to create a smooth transition between the lower eyelids and cheeks.

This patient presented with drooping of her upper eyelids. In addition to excess skin (dermatochalasis), the eyelids were low due to changes in the muscles that open the eyelid (ptosis). The patient underwent bilateral upper blepharoplasty and internal ptosis repair. Not only have the eyelids been raised and the excess skin removed, but the eyelid contour has also been improved.

This was an interesting case that highlights how combining treatments can lead to the best results. This patient in her 60s had volume loss in her upper lids and temples which was accentuated by her prominent cheekbones. This volume loss along with ptosis and a compensatory brow hike resulted in an aged appearance with hollow upper eyelids. Additionally, her skin quality had diminished over time. She underwent multiple treatments to address the various contributing factors. This is a great example of how surgery and non surgical procedures compliment each other to provide the best results. Surgery, botulinum toxin, filler and laser all play different roles in rejuvenation. Here is what was done in this case.

Ptosis repair surgery: the upper eyelids were raised to a normal height.

Lower blepharoplasty surgery: orbital fat that shifted forward over time was sculpted to create a smooth transition between the lower eyelids and cheeks.

Upper blepharoplasty surgery: excess upper eyelid skin was removed.

Botulinum toxin was strategically placed to treat forehead and other facial wrinkles and relax the facial muscles.

Filler was placed in the temples to address age related volume loss. This improved facial contours by treating a relative depression above this patient’s high and prominent cheekbones.

Laser resurfacing was performed to rejuvenate the skin, improve skin quality, fine lines, wrinkles, and pigmentary changes.

This patient presented with drooping of her upper eyelids. In addition to excess skin (dermatochalasis), the eyelids were low due to changes in the muscles that open the eyelid (ptosis). The patient underwent bilateral upper blepharoplasty and internal ptosis repair. Not only have the eyelids been raised and the excess skin removed, but the eyelid contour has also been improved.

To enhance symmetry, this patient underwent:

Right upper blepharoplasty to remove heavy skin and reform the eyelid crease

Right internal ptosis repair to elevate the right upper eyelid

Right Botulinum toxin brow lift

Botulinum toxin treatment to lower the right lower eyelid

This patient also had general facial Botulinum toxin treatment to reduce wrinkles (notice the improvement in the forehead lines)

This patient presented with drooping of her upper eyelids. In addition to excess skin (dermatochalasis), the eyelids were low due to changes in the muscles that open the eyelid (ptosis). The patient underwent bilateral upper blepharoplasty and internal ptosis repair. Not only have the eyelids been raised and the excess skin removed, but the eyelid contour has also been improved. A youthful appearance has been restored.

This patient presented with drooping upper lids due to changes in the muscles that open the eyelids (ptosis). Notice the distance from the corneal light reflection to the eyelashes. While the right side is obviously drooping, the left upper eyelid is also low. The patient underwent internal ptosis repair in which surgery is performed on the inside of the eyelid (no skin incision). After surgery, the eyelids are of a normal height and contour, peripheral vision has improved, and the patient has an aesthetically pleasing appearance.

This patient presented with drooping of her upper eyelids. In addition to excess skin (dermatochalasis), the eyelids were low due to changes in the muscles that open the eyelid (ptosis). The patient underwent bilateral upper blepharoplasty and internal ptosis repair. Not only have the eyelids been raised and the excess skin removed, but the eyelid contour has also been improved. A youthful appearance has been restored.

This patient underwent bilateral upper blepharoplasty. During surgery, excess skin was removed and the eyelid was contoured to enhance the upper eyelid appearance.

The patient also had a lower blepharoplasty. Notice the puffiness of each lower eyelid. This is due to orbital fat protruding and is a common concern for many patients. While some patients are born with puffy lower eyelids, this is a problem that more commonly develops over time. This patient underwent transconjunctival lower blepharoplasty (scarless approach through the inside of the eyelid) to address the puffiness. After surgery, the puffy areas are no longer visible and the patient has a natural and aesthetically pleasing appearance.

The patient also underwent internal ptosis repair in which surgery is performed on the inside of the eyelid to improve the upper eyelid height.

Ptosis is a condition where the eyelid is partially closed. In some cases, ptosis is significant enough to the point where peripheral vision is affected. Imagine if the blinds to your window were partially closed. You would have a hard time seeing out of the window as part of the view would be obstructed. Similarly, an eyelid that is too low (ptosis) can obstruct vision.

This patient had the most challenging form of ptosis to address surgically. His eyelids are so droopy, that the light reflex from the camera flash cannot be seen. Additionally, his eyelid excursion (which is classically used as a measure of the function of the levator muscle) is poor. This is assessed by having the patient look up and measuring how far the eyelid moves.

In cases of severe ptosis with poor eyelid excursion, traditional teaching advises a ptosis surgery called a frontalis sling. A frontalis sling is an implant that tethers the eyelid to the forehead muscle, allowing the patient to open the eyelid when the patient uses a facial expression that raises the eyebrow. Risks of a frontalis sling include infection, exposure of the implant, dry eye, and the need for additional surgery. As such, when feasible, other approaches to ptosis surgery are preferred.

Conversely, traditional teaching advises that internal ptosis repair should be reserved for milder forms of ptosis as it is considered less effective at raising the eyelid significantly.

This case is a great example of a successful outcome after internal ptosis repair was used for severe ptosis. Of note, the patient is less than two weeks after surgery in the post op photo. His results will continue to improve over the course of months.