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Ptosis vs. Cosmetic Eyelid Surgery

Written by David Evans, PhD, MBA   Posted on September 8, 2016

In addition to Better Vision Guide, Ceatus Media Group publishes a number of educational websites across a range of health specialties, including dentistry, bariatric surgery and plastic surgery. While researching material on eyelid surgery for our facial rejuvenation site, one of our editors was surprised to learn that eyelid surgery is not necessarily always performed for cosmetic purposes, and that it does in fact have functional benefits for vision. The functional benefit he was speaking of relates to ptosis (toe-sis), a condition marked by abnormal drooping of the upper eyelid.

We don’t currently feature information about ptosis or eyelid surgery on Better Vision Guide, so I thought I’d spend a bit of time in this post discussing it.

It’s true that the vast majority of eyelid surgeries, called blepharoplasty or eye lift, are performed for cosmetic purposes. However, correction of a sagging or drooping eyelid can be more problematic than simply making you look a few years older. If the upper eyelid droops far enough, it can cover the pupil, impeding your ability to see (ptosis).

Ptosis can develop as a natural part of the aging process, but it can also be present at birth. Congenital ptosis poses additional risks because it can impair the visual development of children. For instance, lazy eye (amblyopia) is a common condition that children with ptosis are at risk of developing. Congenital ptosis may also be the sign of a larger issue such as muscular disease, eye-movement issues, neurological disorders or eyelid tumors. For this reason, it’s imperative that you have your child’s vision tested early to ensure that there are no warning signs for vision problems.

Upper eyelid drooping typically relates to weakness of the muscle in the eyelid, called the levator muscle. When ptosis presents at birth, it signals poor levator muscle development. Mild cases of congenital ptosis may not require treatment. Regular ophthalmic checkups will be needed to monitor eye health and make sure no other eye problems develop. A number of factors are used in making the determination whether or not congenital ptosis requires treatment. This includes things like the age of the child, how many eyelids are affected, the strength of the levator muscle, general eye health, etc. But if there is no direct risk to your children, treatment may not be recommended.

As for adults, ptosis occurs when then levator muscle breaks down, separates and/or stretches excessively during natural aging. Adult ptosis also can result from other things such as muscle or neurological diseases, cataract surgery, and ocular trauma.

For treatment, a relatively simple type of eye surgery can tighten the levator muscle, correcting the drooping. If the muscle is extremely weak, your surgeon may elect to bypass the muscle entirely, opting instead to connect the eyelid underneath the eyebrow.  In some cases, fatty tissue and excess skin is also removed from the eyelid.

What will eyelid surgery cost?

Eyelid surgery for correction of ptosis is virtually identical to that for facial rejuvenation, meaning the costs are essentially the same. The average cost of eyelid surgery ranges between $2,000 and $5,000 depending on the number of eyelids being treated and the exact type of treatment you receive. You will pay a fee for the surgeon and a fee for the facility where the procedure is conducted. You may also have a fee for anesthesia depending on the extent of the procedure. The difference is that the fees to correct ptosis, as a medical condition which impedes your vision, are reimbursed by insurance and Medicare, while the procedure for cosmetic eyelid surgery is paid out of pocket.

The long and the short of it is that eyelid surgery is primarily used as a cosmetic treatment that can offset the signs of aging and create a more useful appearance. But in certain circumstances, it can be the difference between healthy vision, and a lifetime of eye problems.