Dermatochalasis and Ptosis

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Drooping Eyelids and Obstructed Peripheral Vision

Dermatochalasis is a term used to describe the presence of loose and redundant eyelid skin. It is a common sign of periocular aging and is often seen in middle-aged and elderly people. Although more dramatically seen in the upper eyelids, dermatochalasis can also affect lower eyelids as well. 

Ptosis is the term used to describe falling eyelids due to muscle weakness or injury. The levator muscle is responsible for lifting the eyelid. As you age, that muscle can stretch and, as a result, cause the eyelid to fall.  

Ptosis can affect one or both eyes. It may be present at birth (congenital ptosis), or it may develop gradually over decades. Sometimes ptosis is an isolated problem that changes a person's appearance without affecting vision or health. In other cases, however, it can be a warning sign that a more serious condition is affecting the muscles, nerves, brain or eye socket. Ptosis that develops over a period of days or hours is more likely to signify a serious medical problem. 

Signs of ptosis can appear similar to dermatochalasis, although these are two separate conditions with different treatments. 

Signs and Symptoms:

• Difficulty blinking or closing the eyelids
• Limited eye movement
• Reduced visual field
• Tilting the head back to see beneath the eyelids
• Raising the eyebrows to lift eyelids up
• Aching or tiredness around the eyebrows and eye area
• Eye with ptosis has difficulty looking upwards
• Eye with ptosis appears smaller
• Higher eyelid crease on the affected side
• Dry or irritated eyes; related to poor eyelid function
• Decreased vision or impaired field of vision if eyelid blocks the pupil
• Eyelid appearance looks different when comparing recent photos to old photos 

The surgical treatment for excess upper eyelid skin is a procedure called a blepharoplasty.

Blepharoplasty: an ellipse of skin is removed from both upper eyelids to eliminate the excess skin. At the same time the puffiness in the inner corner of the upper eyelid (nasal fat pad) may be sculpted or repositioned to create a smooth contour of the upper eyelid. Care must be taken to ensure the upper eyelid is not over sculpted or “hollowed” which can result in an “over done” look.

Ptosis Repair:  The procedure repositions the underlying muscles to lift the upper eyelid, unlike blepharoplasty which removes excess skin and fat.  

It is important to have a detailed discussion on the risks associated with surgery as they can vary between the type of surgery performed.

In general the risks include but are not limited to the anesthesia risk, bleeding, infection, inflammation, scarring, changes in skin sensation, possible need for additional surgery.

It's important that you address all your questions directly with your surgeon.

In general, initial wound healing may take 7-10 days. Sutures will be removed when deemed appropriate by your surgeon.

Most patients return to work after 7-10 days.

At this point you may appear presentable; however, additional healing will continue over the course of several weeks as the swelling subsides, and incision lines continue to heal.

It may take several months for you to completely recover from surgery.

Following your physician's instructions is essential to the success of your surgery.