With the advancing period of puberty, physiological changes come in various areas of the body and face, with which each and every one of us has to deal with to one degree or another. Facial skin aging is an integral part of this and we are all familiar with the changes that occur in our faces, or those of people older than us. One of those changes that can be easily identified is drooping upper eyelids, which, in addition to giving a tired and older appearance, is a phenomenon that may also interfere with vision and functionality.
Upper eyelid ptosis is a condition in which the upper eyelid is positioned low in relation to the visual axis or in relation to the second eyelid.
Upper eyelid ptosis is defined as a low position of the upper eyelid in relation to the center of the pupil. This is a common phenomenon in adulthood, but can also be congenital or acquired. Prolonged use of contact lenses, eye surgery, repeated eye infections, prolonged use of eye drops and injuries can all cause upper eyelid ptosis. Various neurological diseases can manifest or be characterized by eyelid ptosis. In cases where the ptosis is acute, it is recommended to consult an ophthalmologist. Upper eyelid ptosis causes an aesthetic disturbance in the appearance of the face, but in many cases also a functional disturbance due to partial obscuration of the visual axis. In children, eyelid ptosis may cause the development of a lazy eye.
Eyelid drooping occurs due to gradual weakness of the muscle, and can be a manifestation of a congenital disorder, especially in cases of eyelid drooping in children or adolescents, secondary to other causes that Prof. Ben Simon can assess during an examination in the clinic.
מבחינה אסתטית לעיתים נראה מנח נמוך של עפעף עליון אחד ביחס לעפעף השני ולעיתים שני העפעפיים העליונים “צונחים” ביחס לממוצע המקובל לאותו גיל באוכלוסייה.
במקרים רבים הצורך בניתוח תיקון נעשה בהתוויה רפואית בשל הסתרה לציר הראייה, מה שהופך את הטיפול האסתטי לטיפול פונקציונלי בעל חשיבות תפקודית שחיונית לאיכות חייו של המטופל.
הדבר משמעותי יותר בילדים כאשר הפרעה כזו יכולה לגרום להתפתחות עין עצלה ומחייבת טיפול בשלב מוקדם, ומעקב גם על ידי רופא עיניים ילדים.
There are different degrees of drooping eyelids, but most often when we look at a man or woman who suffers from drooping of one or both eyelids, we can recognize a tired appearance that resembles a person with half-closed eyes and a tired and elderly appearance. Sometimes when it is a case of drooping of only one eyelid, we can notice asymmetry between the eyelids and sometimes also bags that form under the eyes.
When a person suffers from ptosis, they will feel it themselves, especially if the eyelid blocks part of their upper field of vision. In addition, they may feel the difficulty in opening their eyes wide due to the weakness of the muscle attachment to the eyelid.
Eyelid surgery is a surgical procedure designed to improve the appearance of the upper eyelids, when the eyelids droop downwards. As the human body ages, the skin loses its moisture and elasticity, which creates excess skin and a “drooping” effect of the upper eyelid above the eye, which makes the eye look tired and older, but can also interfere with the field of vision, and actually hide part of the eye, creating a problem that is not only aesthetic.
In recent years, more and more men and women who are reaching old age are deciding to undergo eyelid surgery to improve the appearance of their facial skin, and to restore the fresh, youthful appearance they once had. Today, eyelid surgery is an extremely popular procedure, and is considered quick and safe.
During the surgery, the surgeon removes excess muscle, fat, and skin from the eyelid area. The surgery is performed under local anesthesia with sedation or general anesthesia in children, so that at the end of the surgery, several hours of recovery and return to normal life will be required. At the end of the surgery, there may be some discomfort in the eye area and slight swelling, but these will pass within a few days to two weeks, and can be alleviated according to the doctor’s instructions.
The surgery does not take long and is not particularly complex, so it is a relatively easy and quick surgery. Of course, there are several techniques for performing the surgery, with the development of advanced technology and medical aesthetic techniques that are constantly being upgraded and renewed. The surgeon will choose the correct and most appropriate surgical method for the patient’s medical circumstances.
Therefore, eyelid surgery is an innovative solution that can help many people who are struggling with the phenomenon of eyelid drooping. When deciding to undergo surgery, it is very important to choose a specialist correctly and after weighing the various alternatives. When choosing a doctor, it is important to choose a doctor who specializes in ophthalmology with a focus on expertise in eyelid surgery.
Prof. Guy Ben Simon is a specialist in eyelid surgery, and among other things, he is also the director of the Institute for Orbital Plastic Surgery at Tel Hashomer Hospital. In his private clinic, you can find a courteous team that will be happy to assist with any questions or requests, while Prof. Ben Simon himself performs the medical procedures precisely and professionally, equipped with extensive experience.
The common cause is degenerative change in the muscle that lifts the upper eyelid (levator aponeurosis) with loosening of the connection between the muscle and the eyelid (levator dehiscence).
Eyelid drooping can be a manifestation of various neurological diseases, or other systemic diseases, and therefore a thorough evaluation and examination is necessary before surgery. Sudden eyelid drooping can indicate a significant medical event and requires immediate medical treatment.
Drooping eyelids after Botox injections may appear as a side effect after treatment and will usually be temporary and go away on its own. Drooping eyelids after Botox also occur naturally after the effects of Botox have worn off and are an indication that it is time for the next aesthetic treatment.
In cases of upper eyelid ptosis that appears at a relatively young age and is not congenital ptosis:
It is important to rule out secondary prolapse due to systemic disease or local disorders such as contact lens use, prolonged use of eye drops, eye infections (such as varenicline, with papules under the upper eyelid), or floppy eyelid syndrome.
When drooping eyelids are aesthetically disturbing, or cause partial disruption of the visual axis, surgery to correct drooping eyelids may be considered.
Depending on the cause of the drooping, the patient’s age, and the associated pathologies, in most cases, surgery will be performed to correct drooping eyelids.
Eyelid surgery is suitable for anyone who suffers from drooping eyelids with an associated aesthetic or functional disorder, such as a feeling of heaviness or visual field disturbance. In infants and children with drooping upper eyelids and visual axis disturbance, the surgery is performed as soon as possible to prevent the development of lazy eye, but not before the baby reaches one year of age and weighs 10 kg.
Surgery to correct upper eyelid ptosis is usually performed under local anesthesia with intravenous sedation, so you must come fasting for 8 hours from food. You can drink water up to 3 hours before the surgery (if you suffer from diabetes, you will only be required to fast for 6 hours). When taking blood thinning/anticoagulant medications, they should be discontinued several days before surgery as recommended by the surgeon and with the approval of the treating physician. You must bring a companion to the surgery, as you cannot drive or return alone by public transportation due to the effects of the anesthetics and the local swelling after surgery. In infants and children, the surgery is performed under general anesthesia.
It is important to rule out secondary prolapse due to systemic disease or local disorders such as contact lens use, prolonged use of eye drops, eye infections (such as varenicline, with papules under the upper eyelid), or floppy eyelid syndrome.
Depending on the cause of the drooping, the patient’s age, and the associated pathologies, in most cases surgery will be performed to correct ptosis in the eye.
To the question, what is ptosis? The answer is the reattachment of the muscle that lifts the eyelid to the eyelid tissue.
Eyelid surgery is designed to correct drooping eyelids by repairing the muscle responsible for holding them in place. Drooping eyelids at a young age are even more important, both for aesthetic and preventive reasons.
The approach can be through an incision in the eyelid crease, especially in cases where cosmetic blepharoplasty is combined or in cases of severe eyelid drooping.
In cases of upper eyelid drooping. Easy, surgery can be performed through a posterior approach without a skin incision (through the conjunctiva of the upper eyelid) in order to achieve a good aesthetic result.
In our study, we found that surgery to correct ptosis using a posterior approach (removal of the Muller muscle) gives a better aesthetic result and is accompanied by fewer complications.
Posterior approach surgery is appropriate for mild to moderate eyelid ptosis (MRD measurements of 1-2 mm) as well as in patients who have responded to an in-office aspirin drop test.
In this test, 10% epinephrine drops are applied, the eyelid is waited for about 10 minutes, and the eyelid position is checked. If the eyelid has reached the desired height, the surgery can be performed.
Another advantage of Eyelid lift
surgery with a posterior approach, the surgery is relatively quick (about 10 minutes per side), and there is no need for intraoperative adjustment of the height and shape of the eyelid as with surgery using the external approach.
In children and in cases of ptosis in muscular dystrophy, the eyelid muscle sometimes does not function, so it is necessary to connect the eyelid to the muscle that raises the forehead and eyebrows (frontalis suspension) using synthetic or autologous materials (for example, a tendon from the leg).
It is accepted that surgery using autologous materials tends to last longer than synthetic materials.
In addition, synthetic materials may become contaminated, which requires their removal and sometimes even repeated eyelid lift surgery.
In many cases, the preferred treatment choice is a combination of Botox after eyelid surgery to refine the position of the eyebrows in relation to the eyelids.
The surgery is performed according to the function of the eyelid muscle and the degree of ptosis, with several possible techniques.
If there is excess skin, especially in older age, it is recommended to perform eyelid lift surgery or removal of excess skin in combination with eyelid ptosis correction surgery. The incision is made in the eyelid crease to avoid a prominent scar. During the surgery, the muscle that lifts the eyelid is advanced or shortened until a normal, symmetrical position is achieved between the eyes. In mild eyelid ptosis, the surgery can be performed through a posterior approach without an incision in the skin. In cases of eyelid ptosis with poor muscle function, the eyelid is connected to the muscle that lifts the brow – frontalis suspension or transfer.
In the first week after surgery, there is slight swelling of the eyelids, with subcutaneous hemorrhages. Vision is usually normal and there is no impediment to performing routine activities except for strenuous physical activity or swimming in a pool. It is common to apply antibiotic ointment to the surgical wound for a week, and to place cold compresses for the first two days after surgery, in order to reduce swelling.
After 7-14 days, the stitches are removed in the clinic. The final result of the surgery is observed approximately one to three months after the surgery, during which time there may be asymmetry in the degree of swelling, eyelid height, and asymmetry between the eyes.
In order to reduce the degree of swelling, it is recommended to use cold compresses for the first two days after surgery (using a damp towel and ice or frozen peas placed on the towel).
After this, a slow process of absorption of the bleeding occurs and the color of the eyelids becomes bluish/greenish. Most of the swelling goes away in the first week or two, at which point you can return to work.
Sometimes in the first few days, there may be a situation where the eyelids do not close completely (especially in cases of muscle shortening or attachment of the eyelid to the forehead muscle), and it is important to use eye drops and ointments to cover the eyelids. This lack of closure usually goes away in the first week or two after surgery.
It is important to choose an ophthalmologist with a specialization in eyelid surgery – oculoplastics, a unique field that focuses on upper eyelid surgery, lower eyelid surgery (sags under the eyes), forehead and eyebrow lifting, and eye socket and tear duct surgery.
As well as having experience in eyelid surgery, who will be able to diagnose and adjust the surgery or treatment required for you. It is recommended to see before and after surgery photos of other patients in order to adjust expectations, and sometimes it is even possible to consult with patients in order to understand the experience of treatment and recovery.
During the meeting, an initial introduction is made, the patient’s wishes are understood, and expectations are adjusted to the possible result. Prof. Ben Simon performs a thorough examination of the eye to assess diseases and associated conditions that will require adjustment of the surgery to the health of the eye. A comprehensive examination of the eyelids is also performed, including all aesthetic and functional disorders that can be improved.
After a discussion with the patients, an optimal treatment plan is developed. Most often, the solution is surgical, but in other cases, there are non-surgical treatments such as Botox injections, peeling, or fillers.
After the examination, patients go to the clinic manager to complete tests and receive the technical details of the surgery, including scheduling an appointment.
The clinic team includes Miri Sapir, who receives the patient, completes some of the preliminary tests, and serves as an aesthetic consultant, along with Anna Kasner, the clinic manager, who coordinates the surgeries and obtains full details about the nature of the process.
In many cases, excess skin must be removed (eyelid lift cosmetic surgery) because when an eyelid is lifted, the natural skin fold is emphasized.
In addition, the eyelid fold must be redefined and a dynamic fold must be created that will give the eyelid a natural appearance.
Muscle shortening surgery can be performed through an external approach (skin incision) or an internal approach (from the side of the eyelid facing the eye) depending on the degree of drooping of the eyelids.
In these cases, the eyelid muscle usually does not function and it is necessary to reconnect the eyelid to the muscle that raises the forehead and eyebrows.
In these cases, an artificial material (such as a Gortex implant) can be used or a piece of tendon can be taken from the thigh.
The phenomenon you describe is indeed caused by a shared innervation of the eyelid by nerve 3 and nerve 5 (the nerve for sensation and the muscles of mastication).
The scientific name is Marcus Gunn Jaw Winking Phenomenon.
There are several types of surgery that can be offered at different stages of the disease, although in many cases surgery is not necessary.
Of course, depending on the type of surgery, so is the success, and I wouldn’t say that surgeries are generally not recommended.
The guiding principle is to perform the minimum analysis that will help solve the problem.
If eyelid drooping is significant and disruptive (functional or cosmetic), it can often be corrected by shortening the eyelid muscle.
If eyelid movement interferes, the eyelid muscle must be severed and an artificial connection created between the brow muscle and the eyelid muscle so that the movement during suctioning will stop and the position of the eyelid at first glance will be normal.
A complete eye examination, including refraction, should be performed to rule out the development of lazy eye, and eyelid muscle function should be examined. After that, a treatment policy can be decided.
It is certainly possible to make additional cosmetic corrections to the areas around the eye during eyelid lift surgery.
It should be remembered that surgery in another area involves anesthesia for that area, and the duration of the surgery is extended depending on the type of operation performed.
In many cases, we perform upper eyelid surgery, lower eyelid surgery, and eyelid ptosis correction in one surgery. Also, if there are benign lesions that interfere with cosmetic appearance, they can be removed.
Lateral retraction of the lower eyelids is a well-known problem, and may result from weakness of the tendon connecting the eyelid to the sides of the eye (chimney) and/or relative drooping of the central face.
Sometimes retraction appears after lower eyelid surgery performed with an external skin incision and/or excess skin removal.
In any case, the surgery must be planned according to the cause of the retraction.
Sometimes, a relatively short surgery can reconnect the eyelid to the socket in the lateral part (recreating the tendon or strengthening the existing tendon), but in other cases where there is a lack of tissue, slightly more complex surgeries are needed (central facelift through the conjunctiva).
According to your description, it appears that the tendon will need to be re-strengthened, but of course this cannot be determined until after a careful examination of the position of the eyelid, the degree of prominence of the eye, the position of the central face, and the degree of elasticity of the lower eyelid.
Drooping eyelids can occur at any age, from infancy through adulthood.
In childhood, the indications for eyelid lift surgery are:
We operate on children with drooping eyelids (ptosis) at any age, from a week to a month if there is a visual impairment and up to one year to 18 years of age for cosmetic reasons, so there is no age limit for eyelid lift surgery.
A complete eye exam, including visual acuity and eyelid muscle function, should be performed in order to plan the type of surgery required. There are several types of surgeries to correct ptosis – depending on the test findings.
Congenital eyelid ptosis is often due to weakness of the eyelid muscle with poor muscle function.
In these cases, surgery cannot be performed directly on the eyelid muscle (shortening and strengthening the muscle) and it is necessary to connect the eyelid muscle to the muscle that elevates the eyebrow.
This operation can be performed using synthetic materials such as silicone Gore-Tex or by taking a tendon from the thigh to connect the eyelid to the forehead muscle.
After the surgery, the eyes will be open and you will be able to look straight ahead, but there may be a problem closing the eyelids completely, especially at night.
It is usually necessary to use tear substitutes in the first few weeks after surgery.
Eye ptosis correction surgery is a common surgery and is considered safe and simple. The price of ptosis surgery is determined based on the individual case and the specific characteristics of the patient.
To schedule an appointment, call 050-2971663 or email clinicgbs@gmail.com and we will be happy to assist you.
MEDICA Medical Center, HaBarzel 28, 1st floor, Ramat HaHayal, Tel Aviv
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In some cases, maximal shortening of the eyelid muscle may also be considered.
Supra-maximal levator resection, or advancement of the frontalis transfer muscle.