Levator palpebrae superioris Aponeurotic Ptosis Surgery
Aponeurotic Ptosis is referred to as age-related ptosis (adult or senile onset ptosis). This may happen as a result of dehiscence, senescence, or disinsertion of the levator palpebrae superioris (LPS muscle – The muscle which elevates the eyelid) aponeurosis. Most of the times, post-operative causes are considered to be one of the major causes. Intraocular surgery or chronic inflammation may produce the same effect. Wearing contact lenses for a long amount of time is said to produce a strong effect on this condition.
There are a few eyelid surgeries that are performed in order to treat aponeurotic Ptosis.
- Muller’s Muscle Resection:
T Muller’s Muscle Resection is perfor,ed only in cases with mild ptosis, with very good leavtor muscle action. This operation is carried out by giving/making an incision on the inside of the eyelid (conjunctival side) from within. 3 stitches are made use of for tightening the Muller’s muscle. These stitches are removed within 3 weeks post surgery. This operation is usually performed on only those patients who have shown a favourable reaction to an eye drop test (phenylephrine test) carried out in the clinic – In this test, a drop of phenylephrine drug is put into the eye and the eyelid evaluated for a correction of the ptosis.
Levator Aponeurosis Advancement:
The operation is carried out by making an incision in the natural skin crease of the eyelid (eyelid crease). Stitches are given to tighten the levator aponeurosis tendon (Levator plication) and then the wound is closed. The results of surgery are better when performed under local anaesthesia, since when you are awake during the operation you can open your eyes when asked, to let the oculoplastic surgeon judge the best position for your eyelids. Generally all the stitches are absorbable and will drop out on their own after a few weeks.
Aims of aponeurotic ptosis surgery:
The surgery points to elevate the eyelid enough to terminate the ptosis causing problems with vision.
The perfect result is obtained when:
- The eyelid is at a normal level.
- The level of one eyelid corresponds with and is similar to that of the other lid.
- The eye closes fully and is comfortable.
- The lid has a natural curve, contour and a well defined symmetrical lid crease, which corresponds to the other lid.
Procedure of surgery:
For advancement of aponeurosis an incision is made in the skin crease of the lid and the levator tendon is located. The tendon is tightened with stitches. The tightening of the tendon is performed, depending on the levator muscle function as well as the amount of ptosis to be corrected. Then the lights are dimmed and patient is asked to open their eyes to know whether the stitches are in the appropriate position and if needed they are adjusted. Once the stitches are appropriately positioned, the skin is closed using dissolving stitches. The wound ends up in the natural skin crease of the lid, which forms when the eye opens, so that the incision for the surgery does not show once it has healed. A pad is then put on the operated eye.
For Muller’s muscle resection an incision is made on the inside of the upper lid and the levator palpebrae superioris muscle is shortened using non dissolving stitches which rest on the natural skin crease of the lid.
The surgery takes about an hour for each eye. If both the eyes have drooping, it is usually best to operate on both sides at the same time in order to obtain most accurate results.
Advantages of surgery:
- Refinement in the quality of vision, where a part of the eye was initially encrusted by the drooping upper lid
- An enhancement in the upper part of your field of vision
- Improving symmetry with the other eyelid
- Restoring the eyelid and the eye appearance back to normal
Complications of surgery:
- Wound infection – There is a small risk of infection after surgery, which necessitates treatment with antibiotic tablets.
- Bruised and swollen eyelids – The lid may feel sore and look bruised and remain swollen for up to a few weeks.
- Overcorrection – The eyelid is raised too much after the operation and the eye may then become dry and sore. Drops and ointment can help to provide relief and comfort. Massage and traction on the lid may treat a little amount of overcorrection. Rarely, a further surgery to lower the eyelid is needed soon after the initial one.
- Under correction – The eyelid is still low even after the surgery.
- Poor contour – The shape/curve of the upper lid is not proper.
- Incomplete lid closure- The lids may not close completely with the eye somewhat open at night. The danger involved is that the front surface of the eye may become uncomfortable and dry. Drops and ointment may help to treat this but rarely further surgery is necessitated.
- Reoperation – Further surgery is needed in about 4% of cases.
Ptosis eyelid surgery is amongst the toughest of all plastic surgeries. As you look at the world, the world looks at your eyes and hence, even a mm’s difference in the two eyelid heights will be noticed by all. Therefore, ptosis surgery should be performed only by the most well trained, best oculoplastic surgeons.
To watch a video of a lady treated for senile, aponeurotic ptosis, by Dr. Debraj Shome:
Best Droopy Eyelid Ptosis Surgery in Mumbai, India by Cosmetic Oculoplasty Surgeon- Dr. Debraj Shome
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To read more on Ptosis surgery, click on the link below from Dr. Debraj Shome’s blog:
Ptosis Surgery (Eyelid Surgery) in Mumbai, India by Best Oculoplastic Surgeon – Dr. Debraj Shome.
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Aponeurotic Ptosis Surgery
Aponeuroses are flat and broad tendons that join muscles with each other or to other parts of the body. The levator aponeurosis is the lower portion of the levator muscle and it assists in lifting the upper eyelid upwards. Drooping or falling of the upper eyelid is known as Ptosis, which is one of the most common eye muscle malfunction. This condition is corrected through Aponeurotic Ptosis surgery, which involves tightening of muscles and tendons to improve functionality. Only trained Oculoplastic surgeons can perform Aponeurotic Ptosis surgery for lasting results.
Before exploring various aponeurotic treatment options, it is important to understand what types of Ptosis conditions exist which can be surgically corrected. Ptosis may be caused due to a trauma, a medical disorder or due to advancing age. It can affect one or both eyes and can either be congenital or can be acquired. Given that every patient may have very different causes and manifestation of Ptosis, the aponeurotic surgery also varies from patient to patient.
The procedure for aponeurotic surgery is performed under local anaesthesia. The procedure is also known as levator muscle resection or a levator muscle plication can also be performed. To begin with, differential diagnosis for the underlying cause and the extent of Ptosis is performed. The eye drop test or Phenylpherine test is a preferred way of determining the extent of Ptosis.
During the surgical procedure, an incision is made in the natural skin crease of the eyelid and the levator tendon is located under the eyelid. The tendon is then surgically tightened and the incision is stitched up with dissolvable stitches. As the oculoplastic surgeon tightens the levator tendon, the patient is advised to move the eyelids and assess the aponeurotic tightening thus performed. The two eyelid heights are compared to ensure symmetry.
Aponeurotic surgery can bring both the eyelids at the same level and enable full closure of the eyelids. In addition to ensuring optimal eyelid functionality, aponeurotic ptosis surgery also restores a natural curve, contour and symmetry to the eyelids. If correctly performed, aponeurotic Ptosis surgery helps in –
- Restoration of eyelid movement and function
- Improving eyelid symmetry in case of unilateral Ptosis (single drooping eyelid)
- Enhancement of quality of vision
However, there can be some inherent risks and complications to the aponeurotic Ptosis surgery. In addition to wound infection, bruising and swelling, the surgery can also result in over or under corrections. Poor contouring after the surgery can also result in incomplete lid closure. That is why, it is imperative to get an aponeurotic corrective procedure performed by only trained oculoplastic surgeons. Dr. Debraj Shome specialized in Aponeurotic Ptosis surgery, offering customized surgical solutions for different conditions of Ptosis, in Mumbai, India, at The Esthetic Clinics.