Ptosis Repair
What happens to the eyelid and it drops?
The healthy upper eyelid is strong and it always sits above the whole pupil, which is the black circle in the center of our eyes.
To be precise, there is a strong muscle called levator muscle that lifts the eyelid via a hook. These hooks in medicine are called tendons.
The strength of the eyelid is usually due to the health of the muscle’s hook, called the levator aponeurosis.
Over time, these hooks deteriorate over the body, and thus the eyelid loses its youthful strength.
This results in the eyelid dropping, giving a sad and aged appearance. A simple way to imagine it, is like a hook that slowly slips and loses its grip.
This above is called aponeurotic ptosis and it is by far the most common form of ptosis.
How is ptosis corrected?
Ptosis is corrected with a procedure called levator advancement.
Levator advancement is a procedure that takes about 30-45 minutes and involves reattaching the levator aponeurosis ( the hook ) to its normal position.
Following our previous example, it's like gluing the hook to its normal position again, using the strength that remains in our eyelids in the best possible way.
Levator advancement does not leave a visible scar, and the stitches are removed in 7-10 days. These stitches are very small, and you might be surprised if you notice that there are stitches in the post-operative photo I have posted at the beginning of the text. Take another look to notice it.
The results of this procedure remove about 10 years from the patient's appearance and last an average of 10 years.
Is ptosis a clinical or an aesthetic entity?
Ptosis is always considered a clinical entity because raising the eyelid always results in improving the patient’s upper field of vision.
Once the eyelid covers the part of the pupil the amount of light entering the eye decreases, thus decreasing the patient’s field of vision.
Unfortunately, because these changes in vision occur gradually over time, they are not perceived by the patient until the ptosis is severe. The vast majority of patients describe improved appearance but also vision that "has opened up."
Finally, the majority of patients with ptosis use their forehead muscles to open their eyes as well as they can. This leads to headaches that typically improve after sleep, once the eyes have had a chance to remain closed.
Many patients also describe the need to lift their eyelids with their fingers during the day because they feel their eyes heavy.
Mr. Siskos is a strong advocate of early ptosis repair for the clinical improvement of patients' vision.
What is the anesthesia in ptosis repair?
The anesthesia in ptosis repair is only local and does not include sedatives, general anesthesia, or drowsiness. The procedure is entirely comfortable and painless.
Isn't the procedure only performed by plastic surgeons?
Do ophthalmologists perform plastic surgeries?
The answer to the first question is no. Previously, a general surgeon operated on everything: skin, face, abdomen, bones... And naturally, they would do something better and something not equally well, which is why over the years specialties and subspecialties have developed. One subspecialty of surgical medicine is oculoplastics.
The answer to the second question is also usually no. A general ophthalmologist typically does not receive training in eyelid plastic surgery.
Eyelid plastic surgery (oculoplastics) is a subspecialty of ophthalmology and not of general plastic surgery. The training is exclusively performed at major European or American centers and focuses on the repair of injuries, complex pathologies, and tumors of the eyelids. A trained eyelid plastic surgeon is always an ophthalmologist and not a general plastic surgeon as there is no official educational plan for eyelid surgery in plastic surgery.
In reality, eyelid plastic surgery is a highly specialized subspecialty, with few trained ophthalmologists worldwide compared to patient needs. With many more general plastic surgeons available, the majority of people never meet a trained eyelid plastic surgeon.
However, this reality does not mean that there are no general plastic surgeons who, over the years and with practical experience, can provide good results in simple cases of eyelid plastic surgery. Specialized eyelid plastic surgeons, on the other hand, are essential in more difficult cases such as injuries and periorbital tumors that require extensive removal and functional reconstruction of the area around the eye. These cases require complex knowledge that is not available without extensive and specialized training.
Dr. Siskos is the only trained eyelid plastic surgeon in Thessaly.
Myths about ptosis
I've heard that Botox fixes ptosis -> Myth
Botox may be able to lift the eyelid by maximum 1mm but it is not a reliable technique for this particular condition.
I've heard that ptosis is treated with removing skin -> Myth
This common misconception is also spread by doctors. Dermatochalasis is not ptosis although many people confuse the two different entities. Dermatochalasis, which is excess skin, is treated by removing skin. Ptosis is treated by repositioning the muscle.
Ptosis repair involves a lot of blood, many stitches, and is painful -> Myth
Ptosis repair, especially when performed by a trained eyelid surgeon, is a simple procedure that postoperatively requires only ice packs for 48 hours, with no need for any medication, pain relief, hemostatic, or antibiotic treatment. Only one continuous stitch is used on each eyelid.
Ptosis surgery can place my eyelid wherever I want it to be -> Myth
Postoperatively, the eyelid will heal and the symmetry between the two eyelids can not be pre-planned, as it depends on the healing process.
The goal of ptosis surgery is a completely open eyelid -> Myth
The goal of ptosis surgery is to improve the position of the eyelid while ensuring complete eyelid closure. Depending on the eyelid health smaller elevations might be advisable, to ensure safety while improving vision.
The result that Dr. Siskos considers ideal postoperatively is like in the photographs below. Natural, youthful, and beautiful.
Eye and Eyelid clinic
