What Is Ptosis?
Ptosis is a drooping of the upper eyelid caused by a problem with the muscles that elevate the eyelid or the structures that support them. Unlike excess skin, which sits above the eyelid, ptosis affects the position of the eyelid margin itself. As a result, the affected eye may appear smaller, more closed, or asymmetric compared with the other eye.
Two muscles help elevate the upper eyelid. The levator muscle is the primary muscle responsible for lifting the eyelid, while Müller’s muscle is a smaller muscle that provides additional lift and helps maintain the eyelid’s resting position. Ptosis surgery may address the levator muscle, Müller’s muscle, or both, depending on the cause and severity of the drooping.
Ptosis can be present from birth, when it is typically related to how the levator muscle developed, or it can develop later in life. Acquired ptosis often occurs when the levator tendon stretches or separates from its normal attachment. Aging, long-term contact lens wear, trauma, and previous eye surgery can contribute to these changes. In some cases, ptosis is associated with an underlying neurological or muscular condition, which is one reason a proper evaluation matters.
When mild, ptosis may primarily affect appearance. When more significant, it can lower the eyelid enough to block part of the upper visual field. Some patients compensate by repeatedly raising their eyebrows or tilting their head back to see more clearly.
At Remagin, ptosis surgery is performed by Dr. Keshini Parbhu, a fellowship-trained oculoplastic surgeon whose clinical focus centers specifically on the eyelids and surrounding structures.
Why an Accurate Evaluation Matters
Ptosis is often confused with excess upper eyelid skin because both can make the eyes look smaller or more closed. However, they are different conditions and require different surgical approaches. Treating excess skin alone will not correct an eyelid margin that is sitting too low.
It is also important to identify which part of the eyelid-elevating system is contributing to the problem. The levator muscle provides most of the eyelid’s lifting power, while Müller’s muscle contributes a smaller but meaningful amount of elevation. Evaluating eyelid position, levator strength, and the potential contribution of Müller’s muscle helps determine which surgical technique is most appropriate.
In selected patients, medicated eye drops may be used during the examination to temporarily stimulate Müller’s muscle. The eyelid’s response can help Dr. Parbhu determine whether an internal Müller’s muscle procedure may be an appropriate option.
A careful evaluation also helps rule out other contributing factors. In a small number of patients, new, changing, or progressive ptosis can be an early sign of a broader neurological or muscular condition. For this reason, every evaluation includes a detailed history and examination—not simply a measurement of how far the eyelid droops.
What Ptosis Surgery Involves
There is no single operation used for every patient with ptosis. The appropriate procedure depends on the cause of the drooping, the degree of ptosis, the amount of levator muscle function, and how the eyelid responds during the examination.
One common approach is levator advancement or repair. This procedure tightens or reattaches the levator muscle and its tendon to improve the muscle’s ability to elevate the eyelid. It is commonly performed through an incision in the natural upper eyelid crease.
Another option for selected patients is Müller’s muscle-conjunctival resection, often abbreviated as MMCR. This procedure is performed from the inside of the eyelid and shortens or advances the tissues associated with Müller’s muscle to raise the eyelid. Because the procedure is approached from behind the eyelid, it does not require an external skin incision specifically for the ptosis repair. MMCR is generally best suited to patients with good levator function and examination findings indicating that Müller’s muscle can contribute to improved eyelid height.
When very little levator muscle function remains, a frontalis sling may be considered. This technique connects the eyelid to the forehead muscle, allowing the brow to help elevate the eyelid.
Recovery typically involves swelling and bruising during the first one to two weeks. Eyelid height and contour continue to settle as healing progresses, and the final degree of symmetry may take additional time to become apparent.
When Ptosis Surgery Is Combined With Other Procedures
Excess upper eyelid skin and ptosis frequently occur together, particularly in older patients. When both conditions are present, upper eyelid blepharoplasty and ptosis repair may be performed during the same surgery.
Blepharoplasty removes excess skin, while ptosis surgery raises the position of the eyelid margin by addressing the levator muscle, Müller’s muscle, or related supporting tissues. Addressing only one condition when both are contributing may leave the eyelid looking or functioning differently than intended.
Dr. Parbhu evaluates the skin, eyelid margin, brow position, levator function, and Müller’s muscle response so the surgical plan reflects all of the factors contributing to the patient’s concerns.
How Dr. Parbhu Approaches Your Care
Evaluation begins with careful measurements of eyelid height, contour, symmetry, and levator muscle function. Dr. Parbhu also considers when the drooping began, whether it changes throughout the day, and whether previous contact lens wear, eye surgery, trauma, or medical conditions may be contributing.
When appropriate, specialized eye drops may be used to evaluate the potential response of Müller’s muscle. This information can help determine whether an internal Müller’s muscle-conjunctival procedure or an external levator-based procedure is likely to provide the most appropriate correction.
Dr. Parbhu also looks for signs that may point to an underlying cause beyond age-related stretching. Ruling out those conditions is an important part of a responsible ptosis evaluation.
The result is an individualized surgical plan based on the patient’s anatomy and remaining muscle function, with the goal of improving eyelid height, visual function, contour, and symmetry while maintaining a natural appearance.
Why Choose Remagin for Ptosis Surgery?
Board-Certified Ophthalmic Expertise:
Dr. Keshini Parbhu is a board-certified ophthalmologist with additional fellowship training focused specifically on the eyelids, brow, orbit, and surrounding structures.
A Diagnosis-First Approach:
Ptosis is evaluated separately from excess eyelid skin, with careful attention to eyelid position, levator function, Müller’s muscle response, brow position, and any findings that may warrant further evaluation.
Multiple Surgical Options:
Dr. Parbhu performs both external levator-based ptosis repair and internal Müller’s muscle-conjunctival procedures, allowing the technique to be matched to each patient’s anatomy and examination findings.
Treatment Matched to Muscle Function:
The surgical approach is selected based on the cause and severity of the ptosis and how much muscle function remains—not by applying the same procedure to every patient.
Frequently Asked Questions About Ptosis Surgery
The two conditions can look similar but affect different parts of the eyelid. Ptosis involves the position of the eyelid margin itself, while excess skin sits above the eyelid. Some patients have both. An evaluation with Dr. Parbhu can determine which factors are contributing.
Müller’s muscle is a small muscle inside the upper eyelid that provides additional lift and helps maintain the eyelid’s resting position. The levator muscle performs most of the work of raising the eyelid, but Müller’s muscle can be used as part of ptosis correction in appropriately selected patients.
Müller’s muscle-conjunctival resection, or MMCR, is an internal approach to ptosis repair. The procedure is performed from behind the eyelid and shortens or advances tissues associated with Müller’s muscle to raise the eyelid. It is typically considered for patients with good levator function and examination findings suggesting they are appropriate candidates.
It depends on the procedure. An external levator repair is generally performed through an incision placed within the natural upper eyelid crease. An MMCR is performed from inside the eyelid and does not require an external skin incision specifically for the ptosis correction. If blepharoplasty is performed at the same time, an upper eyelid crease incision will still be used to remove excess skin.
It can be, particularly when the drooping eyelid blocks part of the upper visual field or interferes with daily activities. Documentation of eyelid measurements, photographs, and visual field impairment may be required when insurance coverage is being considered.
The eyelid-supporting tissues can stretch again over time in some patients, although recurrence is not the typical outcome. Dr. Parbhu discusses expected durability based on the cause of the ptosis, the patient’s anatomy, and the surgical technique selected.
No. Ptosis may be present from birth, develop as the eyelid tissues stretch with age, or occur after contact lens wear, trauma, or eye surgery. In less common cases, it can be associated with an underlying neurological or muscular condition.
Yes. Ptosis and excess upper eyelid skin frequently occur together. Ptosis surgery raises the eyelid margin, while blepharoplasty removes excess skin. Addressing both during the same surgery may provide a more complete functional and aesthetic result when both conditions are present.
Schedule a Ptosis Surgery Consultation in West Orlando
Whether the concern is appearance, vision, or both, a thorough evaluation with Dr. Parbhu can identify why the eyelid is drooping and whether the levator muscle, Müller’s muscle, excess skin, brow position, or a combination of factors is contributing.
To learn more about ptosis surgery in West Orlando, call (407) 704-3937 or schedule a consultation (opens in a new tab) today.