Q: What causes drooped upper eyelids?
A: “Eyelid ptosis” is commonly caused by a slippage of the upper eyelid muscles that normally raise the eyelids. Dr. Kopelman compares eyelid anatomy to the structure of a house – a drooped eyelid or “ptosis” is like a weak foundation of a house- while excess loose redundant upper eyelid skin is akin to loose shingles falling down. The disinsertion of muscle attachments which lead to ptosis occurs most commonly as a age related change but can also occur at birth and in middle aged patients who have worn hard contact lens for long periods of time. Like an overhanging awning this downward droop leads to an obstruction of a patient’s superior field of vision.
Q: Will ptosis be considered a covered expense by my insurance company?
A: Because the drooped eyelids impairs your vision and can impede your daily activities it is “viewed” as a functional impairment. Your insurance carrier may cover the procedure. However, eyelid ptosis must be differentiated from excessive laxity of upper eyelid skin.
An eyelid droop must be differentiated from a laxity of the upper eyelid skin that can hang down and impinge on your field of vision. When skin hangs down and fat bulges appear then an upper eyelid blepharoplasty, a cosmetic procedure, is necessary to remove excess skin and protruding fat. At the time of your visit, Dr. Kopelman will perform a comprehensive evaluation of your drooped eyelids. He will determine if ptosis (drooped upper lid) is present alone or whether it exists concurrently with lax upper eyelid skin and bulging fat. If both eyelid muscle and skin laxity exist together then a ptosis repair and cosmetic procedure can be performed at the same time in order to achieve an optimal rejuvenated appearance. Unfortunately, the cosmetic component is not covered by your medical insurance.
Q: How is the surgical repair of ptosis performed?
A: Ptosis is easily corrected by tightening internal eyelid muscles which open the eyelids. There are two internal muscle groups, the levator and Mueller’s muscles, that raise the eyelid. Most mild to moderate degrees of eyelid ptosis (droop) can be corrected by tightening the posterior Mueller’s muscle. When a greater degree of ptosis is present then tightening the anterior levator muscle is preferred.The surgery is typically performed under intravenous sedation with local anesthesia. If the posterior Mueller’s muscle is tightened the patient can be in a “twilight” sleep. No cooperation is necessary. However, if the patient has a greater degree of ptosis then levator muscle surgery requires the patient to open and close their eyelids during the procedure. In order to precisely titrate the degree of eyelid elevation and restore the contour of the eyelid the patient must be able to raise their eyelids during the procedure. Because the patient takes an active role during the surgery, only light sedation with local anesthesia is performed.
Swelling and minor bruising is expected following eyelid ptosis repair. Initially this swelling can be minimized by the frequent application of ice compresses (using zip-lock bags). After two days of ice compresses Dr. Kopelman suggests that you switch to warm compresses which will help to accelerate the resolution of bruises. Minimal discomfort is typically experienced which is commonly controlled with plain Tylenol. Sutures are removed from 5-7 days following surgery.
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