What is it?
Although colloquially, patients usually say that their eyelids have fallen when there is excess skin (what is known by the scientific name of dermatochalasia), actually drooping eyelids are those in which the edge of the eyelid and not the skin is the which is located below the height that is considered normal. This causes the eye to have a closed, winking appearance.
What treatment options are there?
In cases of drooping eyelids (eyelid ptosis) there is no other option other than surgery. In the eyelid there are two main muscles that lift it and, therefore, it is on them where we can act to lift it.
Who and when can operate on a drooping eyelid?
Almost everyone is a candidate for eyelid surgery when it is drooping (ptosic). In certain pathologies, surgery is performed seeking functional improvement, so that the patient can open the eye and see. For example, a paralysis of the nerve that activates the muscle that lifts the eyelid requires surgery that is vital for the patient to be able to manage.
Other patients undergo surgery because the asymmetry causes a social problem, either because they feel watched or because they do not like being asked about this defect. While other people simply seek to be and feel better about themselves.
What techniques are available?
Depending on the evaluation carried out in the consultation, two different approaches can be chosen:
- Through the skin: a scar is made taking advantage of the crease that we all have when we open our eyes in the upper eyelid. The levator palpebra muscle is accessed and repositioned on the tarsus (the fibrous skeleton of the eyelid) with some resorbable stitches that do not need to be removed. As there is almost always some skin left over, in that same surgical procedure it is usually used to perform a blepharoplasty (removing the excess skin that, if not removed, leaves the appearance of excess and wrinkled skin).
- Through the conjunctiva (inner layer of the eyelid): the eyelid is turned over and with local anesthesia the Müller muscle is cut and sutured in such a way that there is no type of scar on the skin. After a week, the only point given is removed. Sometimes we also perform a blepharoplasty to remove excess skin.
How do you decide which technique is appropriate?
Depending on the intensity of the eyelid drooping, we can improve it with one or another. If the fall is 2 mm and in consultation there is a positive response to a special test with eye drops, then the approach is attempted through the conjunctiva, since there is no visible scar (in addition to being a faster and more comfortable intervention). . If the drop is greater than 2 mm or the test is not positive, or if there is obvious excess skin (dermatochalasia) or there are fat lumps on the eyelids, an anterior approach is made through the skin and is used to resolve all the problems that may exist in the eyelids.
How long does the operation usually last?
It will depend on the amount of tissues that have to be rehabilitated, normally between half an hour and an hour.
What is the postoperative period like?
In both cases, moderate inflammation occurs in the first week. After a week the points are removed in consultation. Postoperative treatment consists of the use of local cold and anti-inflammatory and antibiotic ointment.
What are the possible complications like?
The most common is inflammation of the eyelid skin, which can take from a week to 2 months to improve. Hematomas occur as a consequence of the rupture of small blood vessels, and except for the discomfort when the patient sees himself in the mirror, they have no further impact on the prognosis of the operation. In a non-negligible percentage, hypo- or hyper-corrections occur, that is, the eyelid does not rise enough or is raised too much. In these cases, touch-ups can be made to properly position the height of the eyelid.