Hello!                                                                                                                                Ptosis can be mild, moderate or severe as shown in these photographs. In your case, the ptosis is 'moderate'. Here is useful information that is specifically applicable to 'moderate' ptosis by birth.

What is the cause of moderate ptosis?                                                                         Moderate ptosis is most commonly caused by a birth defect. The muscle that lifts the eyelid does not develop well, leading to a droopy eyelid. It is like a string of a curtain that can lift only 50%. In children less than 10 years old, moderate ptosis may affect vision if it covers the pupil. In adults, it is mostly a cosmetic issue. 

Surgery for moderate ptosis                                                                                                          For moderate ptosis, there are two surgical options:
a) Tighten the existing eyelid muscle (levator resection): This is the most commonly performed surgery for moderate ptosis. Through a hidden incision in the upper eyelid fold, the natural eyelid muscle is tightened without any marks on the brow.

b) Connect eyelid muscle to the brow muscles (Sling surgery): This involves passing a thread/silicone string to connect the weak eyelid muscle to the normal eyebrow muscle.
The right option is chosen by a complete evaluation. Both procedures take 30 minutes to an hour and get done in a single day as an out-patient procedure. Hospital admission is not required.                                      

Preparation for your surgery                                                                                                     During consultation, we measure the eyelid aperture, and muscle function (levator function), which decides the severity of the ptosis. A few blood tests are mandatory for anesthesia fitness. All this can be done in a day or two, prior to surgery. If sling surgery is being planned, we will discuss various options of sling material.

Charges                                                                                                                                        To give an exact estimate, I first need to measure your eye findings. The extent of surgery (and therefore its cost) is dependent on measurements. However,  a rough range of costing would range from  30,000 INR to 1,00,000 INR, depending upon type of surgery, type of anaesthesia, and the service package chosen. The differences in the packages will be explained to you by the counselor after your check-up. You can also request the differences between packages via email if you wish. 

General anesthesia (required for children and apprehensive patients) and hospital room charges will be additional, nominal, and charged separately if applicable.


How many visits will you need?                                                                                               Ptosis surgery is not a one-day process, and follow-up visits are important. The typical visit schedule is as follows:                                                                                                                Pre-Surgery check-up: Thursday                                                                                                Surgery day: Friday                                                                                                                              Post-op check-1:  Saturday morning 7.30 am.                                                                                  Post-op Check-2: At 1 or 2 weeks (Thursday)                                                                              Post-op Check-3: At 6-8 weeks (Friday) 

Recovery                                                                                                                                         We understand, that it is important to know how soon can you get back to work, or how soon can you look normal? Here is a short outline of the expected recovery:                                          Week 1: Your eyelids will have swelling, bruising, and minimal pain. There will be watering, but you can perform visual tasks and indoor activities. Gym and jogging to be avoided.                      Week 2: Pain will be gone, and swelling would have reduced by 60-80%. You can get back to outdoor activities and routine work along with gym or jogging.                                              Week 3-6: You would see swelling only in the morning hours, and the rest of the day would be fine.                                                                                                                                                      Week 12: Complete healing, with no swelling. if any stitch adjustment is to be done, it is ideally done at this time.

Drawbacks and complications                                                                                                   When the drooping is moderate (as is in your case), surgery will lead to incomplete closure of the eye, including a visible gap between the two eyelids during sleep. When looking straight, the symmetry will be nearly perfect (90%), but when you look down, the eyelid will not relax normally, creating an asymmetry in downgaze. If sling surgery is performed, it may not last your lifetime, and may need revision surgeries in future. It is important for you to understand, that one surgery won't last a lifetime.

In 1% of cases, the eye may not be able to tolerate the incomplete closure, and a reversal of the surgery may be needed to avoid a permanent scar on the cornea. The eyelid position can be too high or too low  in 5% of cases and can be improved by stitch readjustment.

Stitch readjustment                                                                                                                 Ptosis surgery is not an exact science. Despite our best efforts, sometimes the lid position does not appear perfect due to individual differences in healing. In 5% of cases, you may have over/under-correction. This is corrected by stitch adjustment at the 6-week visit (Or later as per your convenience).

Stitch adjustment is done in the operation theater but is not a re-surgery. We simply adjust the internal stitch to correct the asymmetry. In most cases, a single stitch adjustment may suffice. Rarely, more than 1 may be required. Complete healing and return to normalcy may take up to 6-12 weeks.

Visiting Hyderabad                                                                                                                       Your travel and stay will be organized by you. If you are an out-station patient, click here for useful tips to plan your visit to Hyderabad.

Before and After photos explaining what to expect in 'moderate' ptosis