Ptosis Surgery Cost and Procedure Guide

Why have ptosis surgery?

Overall, ptosis can cause a number of issues and can be difficult to live with. A low eyelid may reduce the visual field. In addition, it can make everyday tasks such as reading increasingly difficult. This can cause the eyebrows to become painful and make the eyes tired. Although these are functional issues, ptosis can also make some people unhappy with their appearance. As a result, they may want ptosis surgery for cosmetic reasons.

Patients may want to consider ptosis surgery if:

• Drooping of the eyelid is affecting vision
• The ptosis is causing discomfort and headaches
• There is a desire to change the appearance of the eyelid
• There is a desire to improve the symmetry of the face

What is ptosis?

Ptosis is usually caused by the weakening of the upper eyelid muscles or the nerves that supply them. These muscles, known as levators, hold the eyelid in place and help to keep the eyelid open.

Weak eyelid muscles will cause the eyelid to sag. This can lead to a number of problems, including problems with vision, discomfort and headaches.

Ptosis can develop in a patient for a number of reasons, including:

• Ageing
• Trauma
• Complication from another eye surgery
• Congenital disabilities (from birth)
• Medical problems such as myasthenia gravis or muscular dystrophy

Ptosis can be treated using a number of different surgical techniques and is normally performed under local anaesthetic. Several factors influence the choice of technique used. This includes the cause of ptosis, whether individuals were born with it or it developed in later life, and the degree of eyelid drooping. The surgical procedures work by shortening the muscles and tendons that raise the eyelid. This helps to hold the eyelid up and prevents it from drooping. The surgeon will discuss the different treatment options during the consultation.

What ptosis surgery will not resolve

Ptosis correction surgery can give many long-lasting benefits. However, there are specific issues that it will not resolve. It is important that patients discuss their symptoms in detail with the surgeon. In some cases, they may recommend alternative treatments that are more suitable for the patient’s needs. In summary, ptosis surgery will not correct:

Blurred vision

Ptosis can limit the area that the eyes can see (visual fields) or the amount of light that is let into the eye if the eyelid covers part of the patient’s eye. This means that patients may not be able to see the upper part of the peripheral vision, or their vision may be dimmer. However, ptosis is unlikely to make vision blurry or hard to focus. Instead, patients may need to have glasses or surgery to correct a problem with the eye itself. Once this is corrected, it may resolve issues such as headaches caused by eye strain.

Eyebrow position

Some people feel that their eyebrows may be too close to their eyes, or that their forehead is too big. As a result, they may benefit from brow-lift surgery rather than ptosis correction. As ptosis surgery involves shortening the eyelid muscles, it will not typically change the position of the eyebrows.

Wrinkles around the eyes

Some people develop wrinkles around the eyes as part of the ageing process. These wrinkles, also known as “crows feet”, can make people feel as though they look old or tired. Crows feet can easily be treated with surgical and non-surgical options. The surgeon can discuss these in more detail if it is appropriate.

During the consultation, the surgeon will talk in detail about the benefits and limitations of ptosis surgery. This will help the surgeon to decide which procedure is most suitable for the patient's needs.

How much does ptosis surgery cost?

There is no fixed price for Ptosis Surgery because every procedure is individually tailored to a patient’s personal needs. Book an initial consultation with a surgeon to discover more about the price of Ptosis Surgery.

There are a number of factors that may affect the final price; they include:

• Surgeon experience and anaesthetist experience
• The complexity of the individual procedure
• Surgical techniques or combination surgeries
• Which hospital or clinic is chosen for the procedure
• The time required in surgery for each patient’s case

During the initial consultation with a surgeon, a patient has the opportunity to state what they are hoping to achieve from the procedure. The surgeon will then make suggestions on how best to achieve these goals. Only after the consultation and after these decisions have been made will a final price be determined.

The final price will have no extra costs or hidden fees. It will cover:

• Surgeon and anaesthetist costs
• Highly rated CQC hospital costs
• Overnight stays (if required)
• Aftercare and follow-up appointments

Who are the ideal ptosis surgery candidates?

This depends on many factors, including the degree of ptosis, cause of ptosis and when it developed. In addition, ideal candidates for ptosis correction surgery will have good general health and be mentally prepared for the procedure. Ideal ptosis surgery candidates may also be:

• Wanting to improve their confidence
• Looking to restore their field of vision
• Aiming to relieve headaches and eye tiredness
• Well informed about the risks and benefits of the procedure

Who is not suitable for ptosis surgery?

Ptosis surgery is typically straightforward with few complications. However, some patients may not be suitable for certain treatments. Patients should let the surgeon know if they:

• Are pregnant
• Have a bleeding disorder
• Have any infection or inflammation around the eye

Patients will be able to discuss these issues during the consultation.

What to expect from the ptosis surgery

There are several different methods available for ptosis surgery. The surgery shortens the muscles that attach to the eyelid. Shortening the muscles pulls the eyelid upwards, correcting the ptosis. Several factors influence which method is used. These include the degree of ptosis and how long the patient has had it. The surgeon will discuss the different possible methods in detail during the consultation. This ptosis surgery procedure page provides a general overview of what to expect.

Consent

First, patients will meet with the surgeon to discuss procedure options and the details of the planned operation. They will also be able to answer any questions that patients may have. It is important that patients have a full understanding of the procedure and its risks. That way, they can be sure they are making the right choice to go ahead with the surgery. If patients have any concerns, make sure to ask the surgeon. They will be happy to address any questions the patient may have.

After this discussion, if the patient would like to go ahead with the surgery, they will be asked to sign a consent form detailing that they understand the reason for the surgery, the intended benefits and possible risks.

Anaesthesia

Patients normally have this treatment under local anaesthetic. Sometimes a small amount of sedation may be used for the procedure alongside the local anaesthetic, or rarely a general anaesthetic is used. Before having the surgery, the patient will meet an anaesthetist. This specialist doctor focuses on pain relief, comfort and safety during surgery.

The Procedure

Surgeons use several different methods to correct ptosis. Which method used depends on how much the eyelid has drooped and for how long. The main methods used are discussed below. All of them work to pull the upper eyelid up and correct the drooping. The surgery takes 45-60 minutes per eye and is normally completed as a day case, meaning the patient will not need to stay in hospital overnight after the procedure.

The possible procedures commonly used are outlined below:

Levator Aponeurosis Advancement

The surgeon makes an incision in the natural crease of the upper eyelid. The levator muscles are identified and reattached or raised. Sutures hold the muscle in place. During the procedure, patients may be asked to sit up so the surgeon can assess that the eyelids are symmetrical. Excess skin from the eyelid may be removed if necessary.

Levator resection is a similar procedure. In this procedure, the surgeon removes a piece of muscle to shorten the levator.

Muller's muscle resection

In this method, incisions are made inside the eyelid. A layer of muscle called Muller's muscle is located, shortened and tightened using stitches. These are removed up to three weeks later.

The fasanella-Servat procedure works in a similar way, although it is mainly used for mild ptosis.

Brow suspension

Brow suspension corrects congenital ptosis or ptosis associated with muscular dystrophies. In these conditions, the levator muscle is typically weak. As a result, brow suspension uses the forehead muscle to help lift the eyelid. The surgeon makes small incisions around the eyelid. Afterwards, they attach a piece of material under the skin, connecting the forehead muscle to the eyelid. The material used can either be a natural material, such as a tendon, or a synthetic material, such as a silicone cord.

After the procedure

Once patients have had the surgery, they will return to the ward to recover. Patients may find that their eye area is slightly numb. The sensation will return as the anaesthetic wears off. They may also notice some blurring of the vision. This will also get better with time. Overall, most patients go home the same day. If patients have had a general anaesthetic, the recovery time may take longer. They will be under supervision from the medical team during this time. Although patients should be able to go home the same day, they will not be able to drive. Therefore, they may need to ask a friend or family to take them home.

What to expect from the ptosis surgery consultation

Before having surgery, patients will need to meet the surgeon for a consultation. The ptosis surgery consultation will typically last up to 1 hour. During this time, there are a number of things that the surgeon will want to discuss. This will include:

What to expect from the ptosis surgery consultation

Before having surgery, patients will need to meet the surgeon for a consultation. The ptosis surgery consultation will typically last up to one hour. During this time, there are a number of things that the surgeon will want to discuss. This will include:

• Past medical history
• Any previous surgeries
• Current medications
• Any allergies

In addition, they will want to talk to the patient about what they hope to achieve from having the operation. It is important that patients are honest about their expectations; that way, the surgeon can ensure patients get the right surgery to help them meet their goals.

As part of their assessment, the surgeon will also want to examine the affected eye and may arrange various tests. Furthermore, the surgeon will talk about the operation and what it involves. They will also discuss any risks and complications that can occur. This will help patients to make an informed decision about whether or not surgery is right or not.

Questions to ask during the ptosis surgery consultation

The consultation is a chance for patients to find out as much as they want about the operation. Therefore the surgeon will make sure there is plenty of time to answer any questions. It may be a good idea to write them down and take them to the consultation.

Some questions patients may like to ask include:

• Do you think what I want to achieve from surgery is realistic?
• How can I get the best results?
• Where will my scars be located?
• Can I see any before and after pictures of similar operations you have done?
• What other options are available for me?
• Are the results permanent?
• What will the recovery process involve?
• Will I need to stop any of my other medications before and/or after this procedure?

What are the main risks and complications?

When having surgery, it is important to be aware of any risks and complications that can occur. The surgeon will discuss these during the consultation. Below are the main risks of ptosis surgery, and although they are rare, it's important patients know all possible outcomes of the procedure.

Eyelid bruising and swelling

The eyelids can become sore, bruised or swollen. A degree of this is normal after an operation and will resolve over the following days and weeks.

Dry eyes

Following the surgery, the eyes can become dry and sore, and it can be difficult to close the eye fully. Patients may develop some blurring of their vision as a result. If patients are suffering from this, they can ask the surgeon to prescribe them some eye drops. These eye drops, known as artificial tears, help lubricate the eye and stop them from becoming dry. This normally resolves within one month.

Chemosis

The eyelid is lined by a thin layer known as the conjunctiva. After surgery, this layer can become swollen. The eyes may feel irritated, and it can be difficult to open the eyes fully. Generally, chemosis resolves within a few weeks.

Infection

Infection is a risk that can happen with any surgical procedure. In the unlikely case that the patient is affected, it will become apparent over the first two or three weeks when things are not settling down as expected. Antibiotics treat minor infections. Patients should contact their surgeon if they are concerned that they have an infection. Signs of infection include:

• Temperature over 38 degrees celsius
• Redness at the incision site that is spreading
• Yellow pus-like or foul-smelling fluid from the incision
• Increased pain or discomfort that is not relieved by painkillers

Haematoma

Sudden bleeding around the eyeball can push the eyeball forward, causing reduced vision and pain. Although this is very rare, it is serious and requires urgent treatment as it can lead to vision loss.

Overcorrection

Following surgery, patients may notice that the eyelid is too high. Massage and gentle traction can resolve this issue. However, in some cases, further surgery may be needed.

Loss of vision

Catastrophic loss of vision is a rare complication of ptosis surgery. It often occurs due to sudden bleeding around the eye, creating pressure on the back of the eye. This pressure can become severe enough to cut the blood supply to the eye itself. Symptoms include intense pain, double vision and a sudden bulging forward of the eye. Patients should seek immediate medical attention if they notice these symptoms.

Ptosis of the opposite eye

After surgery, patients may notice the eyelid of the non-operated eye beginning to droop. This can occur as the brain gets used to the new position of the corrected eyelid. Despite drooping being apparent in only one eye, both eyes can become affected.

Aesthetic

As with any procedure, there is always the risk that patients may not be happy with the aesthetic results. Therefore, it is advised that patients choose their surgeon carefully and make sure they are aware of all expectations.

General risks

During and after any anaesthetic and surgical procedure, there are general risks, including airway problems, blood loss, cardiac arrest, scarring, allergic reactions, and blood clots. Every effort will be taken to reduce these risks, and the likelihood of any of them happening will be discussed during the initial consultation.

How to prepare for ptosis surgery

Having surgery can be a daunting experience for anyone. As a result, it is recommended patients do what they can to help prepare for their procedure. This ptosis surgery preparation page highlights how patients can prepare for surgery. The surgeon will also discuss these preparations during the consultation.

Sleep

In the initial days after surgery, patients may find it easier to sleep with their head propped up. This helps to prevent pressure on the face and will be more comfortable. Try to rest and sleep in an inclined position during the first few days. Be sure to have plenty of pillows ready to help with this.

Food shopping

After having had the surgery, patients will want to relax and focus on recovery. It's a good idea to do a big food shop the day before the procedure. That way, patients won't have to be going to the shops when they should be resting. Patients may also want to prepare and freeze some meals before having the surgery. This will save time and effort afterwards.

Household chores

Patients may want to clean the house and do chores like washing or taking the bins out before the day of the procedure. This will help free up time in the days after the operation.

Young children and pets

Patients are likely to feel tired after the ptosis surgery procedure. Patients may therefore find it helpful to ask friends or family to help look after young children and pets for the first few days after the operation. This will help them focus on their recovery.

Glasses and contact lenses

After ptosis surgery, patients will not be able to wear contact lenses for a while. Be sure to arrange to have a pair of glasses on hand to wear after the procedure.

Eye protection

The eyes are likely to be swollen and sore following the surgical procedure. Therefore it is important to have a pair of sunglasses to protect the eyes from the wind, rain and sun. Sunglasses will also conveniently hide any swelling or bruising during the recovery.

Travel and driving

Patients will be unable to drive after having ptosis surgery. Patients should make arrangements with friends or family to help with travel during the recovery period.

Food and drink

Maintaining good general health is an important part of the recovery process. After surgery, eat high-protein, low-sodium foods, including fresh fruits and vegetables. Also, stay well hydrated with water and caffeine-free beverages. Patients should also try to avoid consuming high amounts of salt and sugar.

What to expect after ptosis surgery

It is useful to know what to expect after ptosis surgery. The surgeon will provide specific details regarding the aftercare. In addition, this ptosis surgery aftercare page gives general tips on the recovery process.

Directly after surgery

Once patients have had the procedure, they will wait on the ward to recover. During this time, the medical team monitors the patient and checks that they are comfortable. The eye area may feel numb if the patient has had a local anaesthetic. This is normal and wears off with time. If the patient has had a general anaesthetic, they may feel tired, drowsy or sick afterwards. This will also ease with time. If patients feel unwell at all, make sure to let the medical staff know. They are there to help make sure the recovery is as safe and easy as possible.

Returning home

Most patients return home on the day of their surgery. However, in some exceptional cases, an overnight stay is required. The surgeon will speak about this during the consultation. If patients are going home on the day of surgery, they will not be able to drive.

Returning to Work

After ptosis surgery, it is recommended that patients take at least a week off work. Most patients return to work within seven to ten days. However, it will vary depending on the job the patient has. If the job involves driving, it is important that patients do not drive until their vision has returned to normal. For most people, this will be the day after surgery.

Returning to exercise

During the recovery period, it is recommended that patients take things easy and relax. As a result, they should avoid strenuous activity and exercise for the first week. This can make the swelling and pain worse. Walking and other light activities are encouraged.

General tips

During the recovery time, it is likely that the eye will feel itchy and irritated. Therefore it may be tempting to rub the eye area. It is recommended that patients try not to this as it can affect the incisions and disturb the healing process. As patients progress through the recovery period, this discomfort will get better.

Final results

Although ptosis surgery is a short procedure, it can take a while before they will be able to fully appreciate the results. This may be up to six months in some cases. The scars will usually be pink and raised for the first few weeks. Eventually, they will fade to lighter lines on the skin in the following months. As the incisions are made in the natural folds of the eye, they are hidden as well as possible. However, it is important to keep any scars protected from strong and/or direct sunlight. Following the aftercare advice from the surgeon and keeping good general health will help the wounds heal fully. This will ensure that the cosmetic outcome is as good as possible and that scarring is minimal.

The Ptosis procedure can be covered by the NHS if the excess skin dropping on the eyelid is affecting your vision. The NHS, however, will not cover the surgery if it's solely for cosmetic reasons. Talk to your GP if you are unsure about your options.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.bopss.co.uk/public-information/common-conditions/ptosis-drooping-of-the-upper-eyelid/ British Occuloplastic surgery society

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.