Oculoplastic Surgery

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Blepharoplasty and Ptosis


Upper eyelid blepharoplasty

Sagging, droopy skin from the upper eyelid can often reduce one’s vision by weighing down the upper eyelid and hanging over the eyelashes. In an upper eyelid blepharoplasty, the extra skin from the upper eyelid is removed through an incision made in the eyelid crease. Fat in the eyelid may or may not be removed at the same time. The procedure can greatly increase peripheral vision and reduce feelings of heaviness and irritation of the eyelids, and for these reasons, insurance companies will often cover this procedure.

Upper eyelid blepharoplasty may also be done to improve one’s appearance. With age, the skin thins and begins to sag. The orbital septum also thins, and fat from around the eye may protrude as lumps or bumps in the eyelid. Reducing the amount of excess skin and sculpting the orbital fat can provide a more youthful and rejuvenated appearance to the eyes, an integral part of appearance.

Lower eyelid blepharoplasty

Lower eyelid blepharoplasty is performed to reduce bulges in the lower eyelid caused by the fat pockets underneath the eye. Extra sagging skin may also need to be removed. Depending on the amount of extra skin present in the lower eyelid, this procedure can be performed either from an incision behind the eyelid or in front of the eyelid (underneath the eyelashes). Insurance companies typically will not cover lower eyelid blepharoplasty.


Ptosis is an abnormally low position of the eyelid which may obstruct or limit vision from the upper part of the visual field. Ptosis results from an an abnormality or weakness in the two muscles that elevate or open the upper eyelid. Our oculoplastic surgeon can differentiate between true ptosis and excess overhanging skin (dermatochalasis) and determine the cause and type of ptosis.

The most common form of ptosis is referred to as involutional ptosis and is caused by loosening or slippage of the levator muscle in the eyelid. The muscle still functions normally but has “slipped” and needs to be tightened through surgery to restore a normal position to the eyelid. This is often done with an upper eyelid blepharoplasty (removal of excess eyelid skin). Frequently your insurance company will cover this procedure depending on its severity or if the vision is affected by the ptosis.

Other causes of ptosis include trauma, tumors, inflammatory disorders, neurologic disorders, and generalized muscle disorders. Some of these may be potentially lethal, and patients should seek urgent evaluation in cases of ptosis that are unilateral (only affecting one side), that developed quickly, or associated with other symptoms.

There are three main surgeries for the correction of ptosis. Depending on the severity and type of ptosis and the amount of extra skin on the upper eyelid, surgery can be performed through an incision in the upper eyelid crease or internally from an incision behind the eyelid, which typically leaves no scar. In cases of congenital ptosis, a frontalis sling procedure is often performed in which a silicone thread is passed from the eyebrow to the eyelid.

At your office visit, our oculoplastic surgeon will discuss the cause of the problem and the most appropriate surgery for you.