Ptosis Surgery

PTOSIS SURGERY

What Is Ptosis?

Ptosis is a condition characterized by the drooping of the upper eyelid below its normal position. It is not only an aesthetic concern but, in advanced cases, can also restrict the visual field. Ptosis may be congenital or acquired due to aging, muscle weakness, trauma, or previous surgeries.

The position of the upper eyelid is primarily determined by the levator palpebrae superioris muscle and its supporting structures. Weakness of this muscle or loosening of its aponeurosis is the most common cause of ptosis.

Phenylephrine Test: A Key Diagnostic Tool

One of the most important steps in surgical planning is the phenylephrine test.

During this test:

• 2.5% or 10% phenylephrine drops are applied
• Müller's muscle is stimulated
• Temporary elevation of the upper eyelid is observed

👉 A significant elevation indicates that Müller’s muscle is functional, suggesting that the patient may be a good candidate for müllerectomy (Müller muscle resection).

How Is Ptosis Surgery Performed?

Ptosis surgery is tailored according to the severity of the condition and muscle function:

🔹 Levator Resection / Aponeurosis Repair

• The most commonly performed technique
• Strengthens or repositions the levator muscle
• Ideal for patients with moderate to good muscle function

🔹 Müllerectomy (Müller Muscle Resection)

• Suitable for patients with a positive phenylephrine test
• Minimally invasive
• Performed internally, leaving no visible scar

🔹 Frontal Sling (Advanced Cases)

• Used when levator function is very poor
• The eyelid is elevated using the forehead muscle

What Is Hering’s Law and Why Is It Important?

An essential concept in ptosis surgery is Hering’s Law.

It states:
👉 Both eyelids receive equal and simultaneous neural input from the brain.

Therefore:

• If one eyelid is drooping, the other may compensate
• After correcting one eyelid, the opposite eyelid may appear to droop

📌 For this reason, even in unilateral ptosis, bilateral surgery may be recommended to achieve better symmetry.

The Need for Upper Blepharoplasty

In many ptosis patients, the issue is not only muscular but also involves excess skin (dermatochalasis).

In such cases:

• Ptosis surgery alone may not be sufficient
• Upper blepharoplasty should be performed to remove excess skin

👉 A combined approach provides a more youthful, open, and natural appearance.

Who Is a Good Candidate?

Ptosis surgery is suitable for patients who have:

• Drooping upper eyelids
• Restricted visual field
• Eyelid asymmetry
• A tired or aged appearance

Recovery Process

• First 3–5 days: swelling and mild bruising
• 7–10 days: significant improvement
• 2–3 weeks: return to social life
• 1–2 months: final results settle

Risks and Considerations

As with any surgery, potential risks include:

• Temporary asymmetry
• Undercorrection or overcorrection
• Dry eye symptoms

👉 These risks are minimized when performed by an experienced oculoplastic surgeon.

Cost

The cost of ptosis surgery varies depending on whether one or both eyes are treated, the surgical technique used, and whether the patient has had previous procedures.

• One eye: €2,000 – €3,000
• Both eyes: €3,500 – €5,000

RovithoMed Evaluation

Ptosis surgery significantly improves both the aesthetic appearance and functional quality of life. The success of the procedure depends on proper evaluation of phenylephrine response, levator function, and Hering’s law.

When necessary, combining the procedure with upper blepharoplasty enhances both aesthetic and long-term results.

At RovithoMed, all evaluations are performed with precision by highly experienced and distinguished specialists. Each year, we connect hundreds of patients with expert surgeons and would be pleased to assist you with the most suitable treatment plan.