There are many ways to repair ptosis of the eyelid. Many patients to have ptosis are unaware that there’re many options in order to fix their ptosis. As an Oculoplastic surgeon for island specialist we utilize many different approaches to ptosis repair. This article goes over all the different techniques that we use as well as what the indications are to use them. Hopefully patients will be able to evaluate which procedure may or may not be the best technique for them. That being said ultimately, your surgeon Will have the vans examining you and knowing which procedure is the best fit for you.
External Levator Resection
The external leavator resection is one of the most common techniques for lifting an eyelid. There is a muscle in the eyelid known as the levator muscle which allows for the eyelid to open and close. Additionally, the eyelid can change position when looking up-and-down. Believe it or section is best done in patients who have a good levator function. Levator function is determining the excursion of the eyelid from down to upgaze. Normal elevation of the eyelid is 14 mm.
The surgery is completed by an incision in the skin usually in the eyelid crease. During this procedure the patient is given sleepy medicine in the eyelid is numbed. The muscle is tightened with a suture. The patient is awoken and sat up and the surgeon checks the eyelid height. If the eyelid height is correct, the patient is layed back down the sutures are permanently closed and the skin is closed. If the eyelid is not symmetrical the surgeon adjusts the sutures until they are.
Mueller Muscle Conjunctival Resection (MMCR/Putterman)
In this surgery, the surgeon uses an algorithm to remove tissue on the inside of the eyelid. There is a formula that is used which correlates the amount of tissue removed with the desired elevation of the eyelid.
This surgery has the benefit of having a reduced risk of contour abnormalities and increased chance of success. A drop test in the office determines if this surgery can be completed as not every patient is a candidate. Different than the levator surgery, there is no cooperation that is needed for this surgery.
This is a great procedure for Horner’s syndrome ptosis.
Tarsal Resection (Fasanella Servat)
In this procedure, a different part of the inside of the eyelid is removed to elevate the eyelid. This is often less desired that the MMCR procedure because the tarsus is often needed to rub against the eye and oculoplastic surgeons are resistant to remove any of it.
Full Eyelid Resection
This surgery is rarely done and involves removing a full thickness block of the eyelid.
This surgery is the most common for congenital ptosis but also for any eyelid ptosis where there is poor function of the levator muscle. This surgery involves placing a material (silicone, thigh fascia, suture) in the eyelid and connecting it to the brow so when the patient raises the eyebrow the eyelid elevates.
There are several indications or diseases where the sling is often used:
Poor functioning ptosis
Third Nerve Palsy
There is no cooperation needed for this procedure in the operating room. There is more guesswork for this procedure as one doesn’t know exactly how high the eyelid will rise or how much eyebrow the patient will use when awake. It can’t be checked in the operating room as the eyebrow muscle is paralyzed from the numbing medicine necessary for this procedure.
As can be seen there are different techniques to raise the eyelid. Often the best procedure is selected based on
Function of the muscle
What eyelid procedures the patient has had before
If the eyedrop raises the eyelid
How well the patient can cooperate in the operating room if needed.
What are the risks to the eye and cornea for each procedure.
I hope this helps patients who are interested in ptosis repair and looking at their options.
My preferences are to use MMCR in adult cases and Sling in pediatric cases but each case is different and has to be assessed on an individual basis.
If you are a ptosis patient in Denver and interested in a consultation call our office for an appointment 303 468 8844.