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Facial plastic surgery
My own aura decide my first impression

Blepharoptosis

Ptosis is defined as drooping of the upper lid, partly covering the pupil.

Ptosis causes a tired, sleepy appearance and reduces vision.
The most important thing is analyzing if it is real ptosis or just sagged eyelid.
Forehead and brow lift is very important when brows are sagged. In that time eyelid surgery can be done at the same
time. But if ptosis correction is done separately, it can make very strong and unnatural impression.
The cause of Blepharoptosis
Diagnosis of ptosis It is very important to analyze real cause of ptosis. Sagged brows can be look like ptosis as well. In that case forehead and brow lift need to be performed. But if ptosis correction is done instead of brow lift, appearance of eyes will be unnatural and strong.

Patient without ptosis (before)

Patient without ptosis (after)

Click to watch forehead and brow lift >
Different causes of ptosis
There are two types. One hereditary, another acquired. Generally there is more acquired ptosis in Plastic surgery clinic. There are pthosis developed with age, complication of eye surgery, and contact lens
01.Cause of involutional ptosis is separation of levator plapebra and tarsal plate
02.Ptosis by eyelid surgery complication happens with separation of levator plapebra and tarsal plate or muscle damage
03.Ptosis tends to develops with contact lens user. This type of correction is hard to
predict the surgical result. It is complicated operation.
Symptom of ptosis
Ptosis is defined as drooping of the upper lid.Partly covering the pupil.
Ptosis causes a tired, sleepy appearance and reduces vision
01.Pupil is partly corverd
02.Due to droopy eyes, eye folds are high
03.Eyelid gets thinner as patient trying to raise brows
04.Wrinkles on forehead get deeper as patients
try to compensate droopy eyes for raising brows.
05.Eyes are become shorter since eyelid elevator muscle is weak
06.Eyes get tired in order to patient
trying to open eyes wide.

Check up
01.Involutional ptosis can be easily checked with patient’s photos when young
02.Checking function of eyelid elevator muscle. It can be checked by asking patient to look up
without moving brows.
03.Patient with genetic ptosis can not open eyes wide enough (genetic pthosis – photo 1), Sometimes it is different on each side of eyes,
it makes asymmetrical eyes (photo 2). When patient looking down, ptosis side has less movement since their elevator muscle is not flexible
04.Hering's law of equal innervation
Hering's law of equal innervation is used to explain the conjugacy of saccadic eye movement. The law proposes that conjugacy of saccades is due to innate connections in which the eye muscles responsible for each eye's movements are innervated equally. (photo – Hering’s Law)
  • Eyelid elevator muscle A

  • Eyelid elevator muscle Function B

  • Photo1) Congenital Ptosis

  • Photo2) Congenital Ptosis

  • Photo3) Congenital Ptosis

  • Hering’s Law

Surgical method
There are 4 surgical methods. If eyelid elevator muscle can lift up 14mm it is normal. But if it is under 4mm method with maximum effect need to be performed. Between 4 to 12mm, surgical method is up to surgeon and surgeon’s experience

Surgical method by eyelid elevator muscle

01.If elevator muscle is slightly weak ( over 8mm )
: ligament of mueller’s muscle and elevator muscle is dissected then stitched
02.If eye elevator is weak (5~7 mm)
: Stitch eye elevator to tarsal plate.(photo B)
03.When eye elevator muscle is severely weak(under 4 mm)
: connect tarsal plate to forehead muscle. Then eyelids are lifted when forehead is raised.(photo c)

Involutional ptosis and postoperational ptosis

In these cased brow elevators are functioning well,
it can be corrected with connect elevator to tarsal plate.
The surgical result is highly effective

  • Photo A

  • Photo B

Photo C

watch this video

After care
01.It is better not to lift any heavy object or bend over during 1st week after operation
02.It is helpful to have ice pack for 2 to 3 days
03.Used antibiotic and steroid eye drop for 4 times a day.
04.Stitch will be off within 5 to 7 days after operation
05.Swell and bruise will disappear within 10 ~ 14 days
Chick here for reference >

Surgical result

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