Upper Eyelid

Dr. Walrath performs the following upper eyelid surgeries for patients who have discomfort, difficulty seeing, or compromise to the surface of their eyes:

• Ptosis repair: fixing the droop of the eyelid
• Blepharoplasty: removing the excess skin of the eyelid that interferes with vision.  A typical postoperative course can be viewed here.
• Entropion repair: fixing the inturned upper eyelid to prevent further damage to the cornea
• Retraction repair: lowering the upper eyelid, often retracted due to sequelae of thyroid eye disease or prior surgery, and improving appearance and ocular health
• Lid weight implantation: placing gold weights or other materials in the upper eyelid to assist with eyelid closure in patients with paralysis of the facial muscles, often due to Bell’s palsy

Ptosis repair

Ptosis of the eyelid refers to a loss of function of the main lefting muscle / tendon of the eyelid, and is different from simply having excess skin hanging over the eyelid.Ptosis is usually due to one of two processes: the tendon that connects the muscle to the substance of the eyelid becomes thinned, weakened, or detached; or the muscle that lifts the eyelid degenerates or is otherwise abnormally replaced with fat or fibrosis.Surgery is generally divided into three groups:

1. External incision eyelid surgery (levator advancement, levator resection)
2. Internal incision eyelid surgery (conjunctivomullerectomy)
3. Eyelid and forehead surgery, for severe cases (frontalis suspension)

Levator surgery

This external surgery involves making an eyelid incision for the length of the eyelid (when both lids are involved, so that excess skin will also be removed), then locating the levator muscle and tightening it up, then re-securing it to the substance of the eyelid. The success rate (in terms of acceptable lid height and shape) in cases where both eyes are done at the same time is usually reported to be about 90%.  A review of Dr. Walrath’s surgical series from 2015 (approximately 200 levator surgeries) found a reoperation rate of 4%.

This patient (postoperative) underwent external eyelid surgery to correct drooping that was present on both sides — you can see her preop photo in the photo gallery.  Swelling and bruising are usually minimal after ptosis surgery.

You can see what a reasonable expectation would be for the degree of swelling and bruising one week after surgery here and here.

Conjunctivomullerectomy

Internal eyelid surgery involves numbing up the inner aspect of the eyelid as well, then flipping the eyelid and removing a measured amount of the inner eyelid muscle. The surgery is rapid and has a high success rate, with no external incision required. The success rate is similar to the external surgery.

Frontalis suspension

When the eyelid muscle has very poor function, eyelid surgery itself will not be able to fix the problem. In these cases, the solution is to help the patient use their forehead to improve the eyelid lift. These patients often use their foreheads quite a bit anyways, so this is a natural solution for them. This technique is required most often in those who have had droopy eyelids for their whole lives and occasionally in those who have degenerative muscle or neuromuscular conditions.

This child (postoperative) recently had the right eyelid lifted with by frontalis suspension. The small forehead incisions are 1 week old, but these usually heal without a visible scar. Preoperative photos of a similar patient can be viewed in the photo gallery.