What is Ptosis and How is it Different from Excess Skin?
The upper eyelid normally covers about 1–2 mm above the pupil. When the eyelid margin (not the skin) lowers and covers the pupil more, this is known as ptosis. Patients often raise their eyebrows to see better, tilt their heads back, and their eyes appear sad and small. This is different from excess skin covering the crease (treated with eyelid surgery) — cutting the skin does not elevate the eyelid margin.
Common Causes
Age-related muscle laxity (most common in adults): the levator muscle becomes stretched or detached from the eyelid cartilage, but muscle strength remains good. Congenital: underdeveloped levator muscle from a young age, resulting in weak muscle strength. After long-term contact lens wear or eye surgery: the muscle may be stretched. Pathological conditions (myasthenia gravis, third cranial nerve palsy, etc.): an ophthalmologist or neurologist should rule these out before cosmetic surgery. Therefore, if ptosis appears suddenly, changes throughout the day, or is accompanied by double vision or other muscle weakness, a medical evaluation is necessary.
Technique Selection Based on Muscle Strength
The doctor measures the function of the levator muscle (the range of motion of the eyelid from looking down to looking up). Good muscle strength: shortening or resecting the levator muscle through the eyelid crease — the most commonly used technique, which can be combined with crease creation and skin removal. Moderate muscle strength: more extensive shortening of the muscle. Very weak muscle strength: eyelid suspension to the forehead muscle using a strip of fascia or material — a specialized technique that requires careful consideration. The outcome depends on the initial muscle strength; weak muscle strength carries a risk of recurrence or the need for further adjustments.
Risks to Be Aware Of
Insufficient or excessive correction (eyelids not closing completely during sleep, dry eyes), asymmetry — sometimes the untreated side may show ptosis after the treated side has been elevated (Hering's phenomenon), uneven eyelid contour, scarring in the crease, swelling and bruising, recurrence in cases of weak muscle strength, hematoma, infection (rare). This is why a second adjustment may be necessary.
At BonBoz
The plastic surgeon assesses the function of the levator muscle, the distance between the eyelid margin and the pupil on both sides, checks for Hering's phenomenon, and rules out other necessary pathologies. The technique is chosen based on muscle strength, often combined with crease design for balance. The examining doctor is the one performing the surgery; the possibility of needing further adjustments, the risk of recurrence, and limitations with weak muscle strength are clearly communicated beforehand — no guarantees of results are made.
