Ptosis

What is Ptosis

Ptosis (眼瞼下垂, ganken kasui) is a condition in which the strength of the "levator palpebrae superioris" muscle that lifts the upper eyelid decreases, causing the eyelid to not open sufficiently. It is broadly divided into congenital and acquired types; most acquired cases are caused by loosening or separation of the levator aponeurosis due to aging. Prolonged contact lens use or the habit of rubbing the eyes can also cause the aponeurosis to stretch and thin, resulting in onset even at a relatively young age. Not only does the drooping eyelid create an impression of looking "sleepy" or "tired," but it is widely known that attempting to compensate using the forehead muscles results in chronic headaches, shoulder stiffness, and eye strain.

Surgical Types and Indications

Ptosis surgery selects the surgical method based on levator function (MRD value, MF value) and the amount of excess skin. The representative method is "levator aponeurosis advancement," which restores the opening of the eyelid by re-securing the loosened aponeurosis to the tarsal plate. When levator function is largely preserved, a transconjunctival approach (Müller's muscle tucking) is also an option. In cases of significant skin laxity, excess skin removal is performed simultaneously, and the double eyelid line is formed at the same time to achieve aesthetic results. A complication review published in Plastic Surgery International (2012) emphasizes that the accuracy of functional evaluation and preoperative design determine long-term outcomes.

Surgical Procedure

Preoperatively, the double eyelid line and target opening width are set in detail with the surgeon. Under local anesthesia, a few millimeters of incision is made along the double eyelid line, the orbicularis oculi muscle is dissected to expose the levator aponeurosis. The aponeurosis is drawn out and shortened, then sutured and fixed to the tarsal plate to restore eyelid opening power. A distinguishing feature is that the patient sits in an upright position and cooperates with opening the eyelid during surgery so that left-right symmetry balance can be confirmed in real time. Surgical time is approximately 60-90 minutes for both eyes, with same-day discharge being the standard.

Downtime and Recovery Progress

Post-operative swelling peaks during days 1-3. Cooling and rest are maintained while observing the progress. Suture removal is targeted for post-operative day 7, and makeup is possible from the day after suture removal. It takes 2-4 weeks for swelling to reduce to 70-80%, and final results (stabilization of appearance) occur after 3-6 months. In the early post-operative period, it may feel "too open," but as swelling subsides, the eyelid opening width settles to a natural level. Serious complications (infection, hematoma, scarring) are rare, but there are cases requiring minor adjustment of left-right differences, in which case revision surgery is considered 3 months or later post-operatively.

Functional Improvement and Aesthetic Effects

In addition to improved visibility from the expansion of the upper visual field, the compensation mechanism of attempting to open the eyes using the forehead muscle is eliminated, which alleviates tension in the frontalis muscle. As a result, many patients experience improvement in headaches, shoulder stiffness, and eye strain. Aesthetically, the eyes appear larger and brighter, with many patients reporting "I look rejuvenated" and "my expression is more expressive." When a double eyelid line is formed simultaneously, the desired double eyelid line can be created without difficulty.