Ptosis Surgery

Your eye surgeon will:

1. Make a small incision (cut) into the eyelid’s natural folds/creases to find tiny muscles that raise the eyelids.
2. Remove the extra fat tissue and loose skin.
3. Tighten the eyelid muscles by stitching them and lifting the eyelids.
4. Further, close the cut in the skin of the eyelid with more stitches. 

The surgery takes around 45-90 minutes and depends on whether both upper eyelids require surgery.

There are three ways of correcting ptosis:

1. External approach: It is also called levator advancement and is performed on individuals who have strong functioning of the levator muscle. Your surgeon will make a cut in the eyelid skin and reposition it by attaching the levator muscle to the tarsus (connective tissue in the eyelid). This elevates the eyelid and helps you to see properly.
2. Internal approach: This surgery is advised for individuals with strong functioning of the levator muscle. Your doctor will turn the eyelid inside out and correct the muscles of the eyelid from the inside. Your doctor may either remove the Mueller’s muscle or levator muscle. Both the muscles are responsible for lifting the eyelid. The shortened muscles help you see better due to the lifted eyelid.
3. Frontalis sling surgery: This surgery is performed when you have ptosis and poor functioning of the eye muscle. Your doctor will attach the upper eyelid to the muscle above the eyebrow (frontalis muscle) with the help of a small silicone rod, which helps in elevating the eyelid.

Before the surgery, your eye surgeon will:

1. Determine the cause and severity of the ptosis
2. Do a comprehensive examination of your eyes, such as a visual acuity test (how well you can read the smallest letters on a standardised chart), perform a close physical examination of the eyelid, and ask about your family's health history
3. Will measure the marginal reflex distance-1, which is the distance between the corneal light reflex of the pupillary centre and the upper eyelid’s margin, to know the level of visual obstruction and amount of droop/sag.
4. Ask you about your goals for the surgery and will explain the complications of the surgery as well 
5. Will take your pre-operative photographs for comparison

A few days before the surgery, you will meet your anesthesiologist for the following:

1. Your medical history (including anaesthesia history) will be checked, and the results of the investigations recommended by your doctor will be reviewed.
2. For ptosis correction surgery, local anaesthesia is preferred.
3. Medical history and physical examination will be done to know if you are fit for anaesthesia.
4. You will be instructed whether you can take any oral medicine.
5. You will be advised not to eat and drink before the surgery.

On the day of the surgery, the healthcare staff will take you to the pre-operative room, where you can expect the following:

1. Consent formalities
2. The healthcare staff will note the following information:
   1. The time of your last meal and fluids
   2. Medical history, current symptoms and allergies
   3. Vital signs like body temperature, blood pressure and heart rate
3. The healthcare staff will trim the hair on the surgical site if needed.
4. They will place a soft, thin tube called an intravenous line into a vein in your hand or arm so that medicines can be given directly into your blood vessel.

You can expect the following during surgery:

1. Skin marking: Skin markings will be done on your upper eyelid in sitting posture and eyes in primary gaze to maintain symmetry in both eyes.
2. Position during surgery: For ptosis correction surgery, you will be kept in a supine position (lying horizontally facing up).
3. Cleaning and draping:
   1.  Draping and regular cleaning of the face will be done. 
   2. Both eyes will be kept exposed to check the eyelid position during the procedure.
4. Anaesthesia: The surgeon will inject local anaesthesia so that you do not feel any pain and you will be awake during the surgery.
5. Monitoring:
   1. The anesthesiologist will monitor your oxygen, blood pressure, heart function, and ventilation.
   2. The nurse will check your safe positioning while placing and moving you on the operating room table.
   3. Your eye surgeon/ophthalmologist will monitor the eye’s intraocular pressure and changes in operating condition during the progression of the surgery.

After the surgery, you will be moved from the operating room to the recovery room (also called the post-operative room), where: 

1. The healthcare staff will closely monitor your condition for a few hours.
2. You will receive painkillers and antibiotics for post-surgical pain and prevent any infection.

After completely recovering from anaesthesia:

1. You will be moved from the recovery room to your room or the intensive care unit as needed.
2. If you have had outpatient surgery, you will be sent home on the same day after you are stable on monitoring.

The recovery process in the hospital:

1. Your surgeon will cover your eyelids and eye with ointment and a bandage.
2. The care team will guide you to take over-the-counter pain medication.
3. Your surgeon will recommend lubrication eye drops or antibiotics to lower the itching and burning.

The recovery process after the hospital discharge:

1. You can place a cold pack wrapped in a towel over the area to lower bruising and swelling.
2. As much as possible, keep your head lifted for several days.
3. Avoid wearing contact lenses for at least two weeks.
4. Avoid strenuous activities for almost three weeks.
5. Avoid getting the eyelid wet.
6. Avoid swimming for four weeks.
7. Avoid drinking alcohol and wearing eye make-up for a few weeks.
8. Avoid going in the sun.

Your first follow up will be around seven to 10 days after the surgery, when your doctor will evaluate your recovery.

Possible side effects that can normally occur after the surgery are:

1. Bleeding
2. Pain
3. Allergic reaction to the material, medicine, or equipment

Complications/Risks of the surgery:

1. Cornea tear/abrasion
2. Cosmetic issue
3. Over-correction (eyelid raised too high)
4. Under-correction (eyelid not raised enough)
5. Bleeding in your eye socket
6. Contour defects in the eyelid
7. Conjunctival prolapse (extreme cut between the levator and conjunctiva that damages the suspensory ligament that holds the lens in its place).
8. Suture granuloma (small cluster of inflammatory cells formed at the site of surgery)
9. Infection of the surgical site.