Skip to main content

Ptosis Surgery

Surgery to lift a drooping upper eyelid when it blocks vision, causes strain, or creates a bothersome lid-height difference.

3 min read

Ptosis surgery raises a drooping upper eyelid. The goal may be functional, such as improving the upper visual field for reading, driving, or seeing overhead objects. Appearance may also matter because lid height affects facial symmetry. The technique depends on why the lid droops and how well the lifting muscle still works.

Key Takeaways

  • Raises the upper eyelid to improve vision, symmetry, or both
  • Technique depends on levator muscle function
  • Usually outpatient surgery
  • Often done with local anesthesia and sedation in adults
  • Small adjustments or revisions are sometimes needed; lid position is measured in millimeters, and millimeters count

When Surgery Is Done

  • The eyelid blocks the superior visual field
  • The patient lifts the brow constantly to see
  • Lid asymmetry is bothersome after a stable cause is confirmed
  • The underlying condition has been treated or is stable
  • Surgery is usually delayed when myasthenia gravis, thyroid eye disease, or a nerve palsy is actively changing

Types of Surgery

Levator Advancement/Resection

Used when the levator muscle still has decent strength. The surgeon tightens or advances the muscle through an eyelid-crease incision. This is the workhorse approach for many adult ptosis cases.

Müller's Muscle Resection

Often used for mild ptosis when the eyelid responds well to in-office testing with special drops. The incision is inside the eyelid, so there is no visible skin scar.

Frontalis Sling

Used when the levator is too weak to do the job. A sling connects the eyelid to the forehead muscle so brow movement helps lift the lid. This can be important in severe congenital ptosis, CPEO, or other poor-levator situations.

What to Expect

Before Surgery

  • Eyelid height, crease position, levator function, and brow position are measured
  • Photos may be taken for planning and insurance documentation
  • Visual field testing may be needed if insurance coverage is based on visual obstruction
  • Blood thinners are adjusted only if your prescribing clinician says it is safe
  • Adults often have local anesthesia with sedation

During Surgery

  • You may be asked to open your eyes during the procedure so the surgeon can check lid height
  • This helps the surgeon assess symmetry during the procedure
  • Most cases take 30-60 minutes per eye

After Surgery

  • Bruising and swelling are expected
  • Ice packs and head elevation help in the first days
  • Antibiotic ointment may blur vision temporarily
  • Follow-up is usually within 1-2 weeks
  • Final lid height and scar settling take 2-3 months, sometimes longer

Possible Complications

  • Under- or over-correction, sometimes requiring revision
  • Asymmetry between the lids
  • Dry eye or exposure symptoms, especially if the lid is lifted aggressively
  • Difficulty closing the eye fully
  • Infection or bleeding, uncommon

Results

Most patients are satisfied, especially when the pre-op measurements are stable and expectations are realistic. About 10-15% may need some adjustment or revision. Improvement can be both functional and cosmetic, though ptosis can recur in certain muscle or nerve conditions.

Was this article helpful?