Primary goal: Elevation of a drooping (not baggy) upper eyelid
Secondary goals: (May be performed in conjunction with blepharoplasty)
Anatomy: The levator muscle begins in back of the eye and turns into a tendon as it enters the eyelid. Most cases of adult-onset ptosis are the result of thinning of the levator aponeurosis. Less commonly, rare muscle diseases such as myasthenia gravis may cause the muscle itself to become paralyzed (requiring operations different from those discussed below.)
Anesthesia: Local anesthesia with minimal sedation is mandatory to allow for patient cooperation during surgery
Operation: Through an upper eyelid crease skin incision, the blepharoplasty is carried out as described previously to the point through and including the removal of fat. Once exposed, the levator aponeurosis can be inspected by the surgeon. The aponeurosis is "tucked" using non-dissolving sutures. The surgeon must be careful not only to create a smooth lift for the droopy lid, but also to match the one upper eyelid to the other upper eyelid and to restore the normal curve to the lid margin.
Variations: Less commonly and at the option of the surgeon, ptosis may also be repaired by several different operations performed from the back side of the eyelid ("Müller's muscle-conjunctival resection" and "Fasanella-Servat procedure") in conjunction with blepharoplasty from the normal skin approach.
Advantages: If a patient suffers from a combination of both baggy eyelids and drooping eyelids (ptosis) yet only the bagginess is addressed, the final result will be disappointing.
Care and recovery: The upper eyelid may not fully "express" the lift until most of the swelling has disappeared. In some cases, it may take as long as six weeks for the full effect of the ptosis repair to become apparent.
Risks and complications: Ptosis repair may be complicated by overcorrection and undercorrection, irregularities of lid shape, and asymmetry between the two sides.
