What is ptosis and how is it treated?
Blepharoptosis — drooping of the upper eyelid — is not the same as heavy eyelid skin. In true ptosis it is the eyelid margin that sits too low: the mechanism that lifts the eyelid has failed, stretched or detached. Treating this with simple skin removal (blepharoplasty) will not solve the underlying problem.
The most common form in adults is involutional aponeurotic ptosis, where the levator aponeurosis (the tendon that transmits the lifting force of the levator muscle to the eyelid) stretches, thins or detaches. This happens gradually with age but is also associated with prolonged contact lens wear, prior eye surgery and eyelid trauma.
The standard repair involves reattaching and tightening the levator aponeurosis through an incision along the natural upper eyelid crease. Crucially, this is performed under local anaesthesia with the patient awake, so Dr. Issa can assess eyelid height during surgery — asking the patient to open and close their eyes to confirm the level before closing. This intraoperative adjustment makes ptosis repair a more demanding procedure than standard blepharoplasty.
More serious underlying causes of ptosis — including third nerve palsy, Horner's syndrome and myasthenia gravis — must always be excluded at consultation before surgery is planned.
Not sure if your eyelid problem is ptosis or excess skin? Dr. Alia Issa can assess it.
Who is a candidate for ptosis repair?
Ptosis can affect patients of all ages. Dr. Issa assesses both functional and cosmetic cases with equal care. Candidates typically present with:
- Upper eyelid margin that covers more than 1–2 mm of the cornea on the affected side
- Upper visual field obstruction — often noticed as difficulty reading or driving
- A chin-up head posture adopted to see beneath a drooping eyelid
- Brow elevation used as a compensatory mechanism to lift the eyelid
- Eyelid asymmetry — one eyelid significantly lower than the other
- An elevated eyelid crease on the affected side (a classic sign of levator aponeurosis dehiscence)
- A history of long-term contact lens wear or prior eyelid or orbital surgery
Dr. Issa takes a detailed history and performs a comprehensive examination — including measurement of the marginal reflex distance, levator function and eyelid crease height — before any surgical plan is made, and will exclude neurological causes.
How the procedure works — before, during and after
Every case is individual. The following is a general outline of what patients can expect.
Ptosis evaluation is detailed. Dr. Issa measures palpebral aperture, marginal reflex distances, levator function and eyelid crease height on both sides. Visual field testing is arranged if functional obstruction is suspected. A precise surgical plan is created.
Surgery is performed under local anaesthesia with the patient awake and cooperative. An incision is made along the upper eyelid crease, the levator aponeurosis is advanced and sutured to the tarsus at the appropriate height, and the patient is asked to open and close their eyes so the height and contour can be adjusted before closing. Total procedure time is typically 60–90 minutes.
Mild bruising and swelling are expected and generally resolve within about 2 weeks. The eyelid may appear slightly higher or lower than ideal at first due to swelling. Sutures are usually removed at 7–10 days, and many patients return to work within that time.
Eyelid height generally stabilises at 4–8 weeks as swelling resolves. If fine-tuning is required, Dr. Issa reviews the result and discusses options. The aim is a symmetrical, natural eyelid position.
Why choose an oculoplastic surgeon for ptosis repair?
Ptosis repair depends on accurate diagnosis and intraoperative judgement of eyelid height — and on excluding neurological causes before surgery. An oculoplastic surgeon, trained in both ophthalmology and eyelid surgery, is well placed to make that distinction and to perform the levator repair with the patient awake.
Related reading in the Journal: what is an oculoplastic surgeon, and why it matters for eyelid surgery.
Frequently asked questions
What is the difference between ptosis and heavy eyelid skin?
Ptosis is a drooping of the eyelid margin, caused by weakness or stretching of the levator muscle mechanism. Heavy eyelid skin (dermatochalasis) is excess skin on the upper eyelid. They can look similar but require completely different corrections. Dr. Issa's assessment establishes the right diagnosis before any surgery is planned.
How is ptosis repaired?
The most common repair for adult ptosis involves reattaching or tightening the levator aponeurosis through an incision along the eyelid crease. It is performed under local anaesthesia so eyelid height can be assessed with the patient awake during surgery.
Is ptosis repair the same as blepharoplasty?
No. Ptosis repair corrects the muscular mechanism that lifts the eyelid; blepharoplasty removes excess skin. The two are often combined when ptosis and excess skin coexist, but they are separate operations addressing different problems.
Can ptosis affect vision?
Yes. In significant ptosis, the drooping eyelid margin can obstruct the pupil and reduce the superior visual field. This is documented with visual field testing. In functional cases, repair may be covered by insurance — your provider can confirm.
How long does recovery take?
Many patients return to daily activities within 7–10 days. Final eyelid height generally settles over 4–8 weeks as swelling resolves. Individual recovery varies.
What causes a droopy eyelid in adults?
The most common cause is involutional aponeurotic ptosis — age-related stretching or detachment of the levator aponeurosis. Long-term contact lens wear, prior eye surgery and trauma are also recognised causes. Neurological causes must be excluded at consultation.
Book your ptosis repair consultation in Dubai with Dr. Alia Issa.