Eyelid ptosis refers to a “droopy upper eyelid.” Eyelid ptosis can occur on one side or both sides and creates a sleepy appearance. Ptosis can also cause difficulty with peripheral vision. The most common cause of ptosis is due to weakness of the levator muscle which assists in opening the eyelid. Ptosis may present from birth (congenital ptosis), or caused by neurologic disorders, muscle problems, surgery or trauma. Surgical approaches include tightening or shortening the muscles that open the lid and can be performed from a hidden incision underneath the lid or through the natural eyelid crease. An upper lid blepharoplasty can often be combined with this procedure to address any excess skin.
Congenital and gravitational settling of the brows (brow ptosis) causes forehead lines, low or asymmetric brows, and redundancy in the upper lids, particularly laterally (temporal hooding). Botulinum toxin and fillers can be useful in helping manage mild brow ptosis and forehead wrinkling. However, with time, this becomes less effective and surgical options must be considered. Browpexy through an upper eyelid incision, direct brow lifting, and endoscopic brow and forehead elevation are the three most common approaches used in our practice.
Browpexy is typically used to stabilize the brow, with little effect on the forehead. This technique uses a suture or device to attach the deep brow tissues to the skull bone through an upper lid incision. Upper lid skin is usually excised as well.
Endoscopic Brow Lift
The most elegant brow and forehead elevation technique is the endoscopic brow and forehead lift. This is done through small incisions behind the hairline (can also be done on bald men). The scalp is freed from the bone using endoscopic instruments and elevated to a more desirable position. Various techniques are used, including absorbable Endotines or sutures, to fix the scalp and brows in position. For patients with high hairlines, a trichophytic forehead lift may be done with an incision along the hairline in an effort to shorten the forehead.
Direct Brow Lift
This direct approach removes tissue above the eyebrow and thus can stabilize or raise brows, as well as somewhat decrease forehead wrinkles. The scar is concealed in the upper brow hairs.
A brow lift may be combined with liposuction, rhytidectomy (face lift), ptosis repair, and upper and lower blepharoplasty.
Loss of facial volume can be restored using fat from other areas of your body. Areas including upper eyelid hollows, sunken lower lids, and deflated cheeks can be corrected with expert surgical technique to enhance volume and create a more youthful contour.