The difference between ptosis repair and blepharoplasty

During the office evaluation, there is often confusion about what a “lid lift” is, and it means different things to different patients.  I don’t favor that term, and instead I talk with patients about “ptosis repair” and/or “blepharoplasty”.

An analogy describing eyebrow position / eyelid skin / eyelid position can be downloaded here.

Blepharoplasty of the upper lids generally involves removing tissue.  This includes skin, muscle, and fat.  At the end of the surgery, the eyelids remain at the same height, but the “curtains” have been lifted above them.  This allows the patient to see more of the upper eyelid.

Ptosis repair involves actually changing the height of the eyelid, e.g. the position where it rests on the surface of the eye.  This is the part of the surgery that makes oculoplastic surgeons unique: most plastic surgeons can perform upper blepharoplasty safely and reliably, but very few of them can perform safe and reliable ptosis repair.  There are many reasons why oculoplastic surgeons generally perform ptosis repair more reliably, not the least of which is that the treatment plan for our patients starts in the office evaluation, where we rely on our training as ophthalmologists to assess the true nature of the ptosis and to determine the most safe and reliable surgical plan.

The patient below demonstrates the difference between extra skin on the right and true ptosis of the eyelid on the left.  The right side would do well with an upper blepharoplasty (removal of upper eyelid tissue).  The left side has true ptosis of the eyelid which should be repaired at the same time as the blepharoplasty.  One can see that the pupil is nearly covered by the lid on the left, while the entire pupil is visible on the right.

The postoperative photo below demonstrates her one week after right upper blepharoplasty and left upper lid ptosis repair with concomitant blepharoplasty. The same incision is utilized for both procedures: the eyelid crease incision.  This incision generally remains invisible afterwards.

(Full disclosure: I actually did a tiny ptosis repair on the right side as well, a decision that I made intraoperatively.)

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