When to perform eyelid ptosis procedure

When a patient comes in for double eyelid surgery evaluation, ptosis is often diagnosed. Patients without a double eyelid fold or a small natural fold, in essence, has not been utilizing their eyelid elevating muscles vs. people with a natural double eyelid fold. Once a ptosis is diagnosed, the question is when to perform the ptosis correction. Should the patient wait until later years or should the patient have the ptosis procedure at the same time as the double eyelid procedure? The answer is definitely at the same time.

We should consider what would happen if one delays the ptosis procedure. The patient’s eyelid elevating muscle (levator muscle) will continue to weaken from lack of use. In addition, the patient’s brow will descend. In older patients with ptosis, their brow position will have descended more than patients without ptosis. This is because patients with eyelid ptosis raise their forehead to help raise their eyelid. So with constant brow/forehead elevation and descent (with relaxation of their brow/forehead), the brow will descend faster from constant stretching. The ligamentous connection weakens like all ligamentous connections when it is subjected to over-use and stretch.

The effect of brow descent is that the upper eyelid will appear more puffy and thicker. In addition, as mentioned, the levator muscle will further weaken at a quicker rate from inadequate use. Therefore, ptosis correction is critical in maintaining optimal eye elevating muscle function and preventing early aging around the eyes.