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Droopy eyelids

Ptosis is the medical term for droopy lids, which can occur in one or both lids. Dr. Zoumalan specializes in eyelid surgery, and ptosis surgery is one of the most common surgeries he performs. Dr. Zoumalan has written numerous book chapters and medical journal publications in the latest techniques in ptosis and eyelid surgery. He also continues to teach the latest ptosis techniques to young doctors at the Keck School of Medicine at USC as an instructor. Dr. Zoumalan has performed thousands of ptosis surgeries, often in combination with cosmetic upper and lower eyelid surgery.

Causes of Ptosis:

Ptosis can occur in adults and in children. Adults usually get ptosis as a result of aging and stretching of the eyelid muscles, prior eye surgery which can stretch the eyelid muscles, or even long term contact lens use. Children with ptosis are often born with it and their eyelid muscle is born weak.

There are various different ways to repair a droopy lid and it depends on the type of ptosis and Dr. Zoumalan’s recommendations after a complete oculoplastic exam. Dr. Zoumalan will evaluate you during your consultation and determine what the best type of procedure will be for you. He takes into consideration many factors such as: your eyelid appearance, how droopy your lid is, the amount of extra skin you have draping over your droopy lid, the strength of your eyelid, and whether you have dry eyes or not. Prior photographs are also very helpful to determine what position your lids were prior to them being droopy.

Correcting Ptosis:

Dr. Zoumalan uses a minimally invasive, advanced ptosis technique in many of his patients. Ptosis surgery can often have some residual asymmetries after surgery where one eyelid may still be slightly higher than the other eyelid; Dr. Zoumalan uses this advanced technique to adjust the lid one week out after surgery. Patients often enjoy this added level of measure to help correct for any residual asymmetries. Dr. Zoumalan uses recovery techniques to allow his patients to return to work and their daily activities usually within several days to a week after surgery.

Ptosis surgery can often be combined with other eyelid surgeries such as cosmetic upper and lower lid eyelid surgery or even lower eyelid reconstructive surgery.

Where is the incision made in the upper lids for an upper eyelid ptosis repair?

Dr. Zoumalan will determine if you will require excess skin to be removed from your upper lids in addition to having your lids lifted. If you only require your lids to be lifted and not require any skin to be removed, then Dr. Zoumalan performs a minimally invasive technique to tighten the muscle from inside the upper lid so that no direct incisions are made on your eyelid. If you do require some excess skin to be removed at the same time, Dr. Zoumalan will identify your natural crease carefully, and make a hairline incision over the natural crease. The hairline incision heals well within the natural crease. Dr. Zoumalan pays careful attention to the wound closure using very fine sutures which are removed in 5-6 days.

Why Patients Choose Dr. Zoumalan

Dr. Zoumalan is board-certified by the American Board of Ophthalmology and a member of the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS). His practice is tailored to cosmetic and reconstructive oculoplastic surgery.

Dr. Zoumalan will evaluate ptosis through various examination findings and measurements. Dr. Zoumalan will examine not just the eyelids but also the eyebrow position, upper eyelid position, lower eyelid position, the eyes themselves, and the midface (cheekbone area). All these factors are vital in optimizing the surgical outcome. The function of the upper lid muscle (the levator muscle complex) is important when it comes to deciding the type of ptosis surgery to perform.

Children who are born with ptosis, for example, usually have a weakened levator muscle complex and will require a different type of surgery than adults who have acquired ptosis through their adult years. Adults with acquired ptosis usually get it from age related changes to the lid, but Dr. Zoumalan will have to perform a detailed examination to rule out other particular causes.

Other important things to consider include a history of dry eyes and prior eyelid surgery, both of which need to be looked at carefully in those particular patients. Dr. Zoumalan does not operate on patients with active dry eye symptoms; dry eye symptoms should be managed and optimized by their eye doctors prior to surgery. Dry eyes symptoms can certainly worsen after ptosis surgery or any eyelid surgery and Dr. Zoumalan carefully monitors for this before and after surgery.

Patients with prior eyelid surgery are also at risk for dry eyes and difficulty closing their eyelids after surgery. Although these risks are minimized with Dr. Zoumalan’s use of minimally invasive surgery and advanced techniques in wound closure, Dr. Zoumalan is very cautious and will monitor the function of the eyelids before and during surgery very carefully.

In cases of low set brows that are worsening the ptosis, patients may need to have a combined brow lift in addition to upper eyelid ptosis repair. There are several types of brow lifting procedures that Dr. Zoumalan performs, and each one is specific to the patient’s desired results, examination findings, age, and gender.

The incisions for the brow lift can either incorporate the existing blepharoplasty incisons (such as brow pexy) or well-hidden small in incisions in the hair-baring scalp areas (such as in temporal brow lift or endoscopic brow lift surgeries). The benefit of combining a brow lift with blepharoplasty is that the brows can be repositioned to a more natural and youthful position. By doing so, less skin is required to be removed in the upper eyelids.

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    Preoperative Diagnosis: Bilateral upper lid ptosis, upper and lower lid dermatochalasia (excess skin) and fat prolapse.

    Procedure performed:Bilateral upper lid ptosis repair, upper and lower lid blepharoplasty, lower lid chemical peel (TCA 30%).

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    Preoperative Diagnosis: Bilateral upper lid ptosis, upper and lower lid dermatochalasia (excess skin) and fat prolapse.

    Procedure performed: Bilateral upper lid ptosis repair, upper and lower lid blepharoplasty, lower lid chemical peel (TCA 30%).

  • side_profile_eyelid_surgery_blepharoplasty_chemical_peel

    Preoperative Diagnosis: Bilateral upper lid ptosis, upper and lower lid dermatochalasia (excess skin) and fat prolapse.

    Procedure performed: Bilateral upper lid ptosis repair, upper and lower lid blepharoplasty, lower lid chemical peel (TCA 30%).

  • image

    Preoperative Diagnosis: Bilateral upper lid ptosis.

    Procedure performed: Bilateral upper lid ptosis repair.

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    Preoperative Diagnosis: Bilateral upper lid ptosis and brow ptosis

    Procedure performed: Bilateral upper lid ptosis repair (blepharoplasty) and external browpexy

  • image

    Preoperative Diagnosis: Bilateral upper lid ptosis and brow ptosis

    Procedure performed: Bilateral upper lid ptosis repair (blepharoplasty) and external browpexy

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    Preoperative diagnosis: Bilateral upper lid ptosis and brow ptosis, lower lid excess fat pockets

    Procedure performed: Bilateral upper lid ptosis repair (blepharoplasty) and external browpexy, lower lid blepharoplasty

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    Preoperative diagnosis: Bilateral upper and lower lid excess skin, lower lid aging changes with excess fat pockets.

    Procedure performed: Bilateral upper lid ptosis repair (blepharoplasty), lower lid blepharoplasty with fat repositioning, chemical peel to lower lids

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    Preoperative diagnosis: Bilateral upper and lower lid aging changes

    Procedure performed: Bilateral upper and lower lid blepharoplasty, chemical peel to lower lids.

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    Preoperative diagnosis: Bilateral upper lid ptosis, lower lid retraction, lower lid excess fat pockets.

    Procedure performed: Bilateral upper lid ptosis repair, revisional lower lid retraction repair using Alloderm graft and canthoplasty, and lower lid blepharoplasty.

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    Preoperative diagnosis: Bilateral upper lid ptosis, lower lid infraorbital hollowing

    Procedure performed: Bilateral upper lid blepharoplasty, hyaluronic acid fillers to her lower lid infraorbital area using Restylane.

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    Preoperative diagnosis: Right upper lid ptosis.

    Procedure performed: Right upper lid ptosis repair using a posterior approach (no skin incision).

  • image

    Preoperative diagnosis: Bilateral upper lid ptosis.

    Procedure performed: Bilateral upper lid ptosis repair.

  • image

    Preoperative diagnosis: Bilateral upper lid ptosis and excess skin

    Procedure performed: Bilateral upper lid ptosis repair, upper lid blepharoplasty

  • image

    Preoperative diagnosis: Bilateral upper lid ptosis.

    Procedure performed: Bilateral upper lid ptosis repair.

  • image

    Preoperative diagnosis: Bilateral upper lid ptosis and brow ptosis, lower lid excess fat pockets

    Procedure performed: Bilateral upper lid ptosis repair, upper and lower lid blepharoplasty with fat repositioning to lower lids, and left external brow pexy

  • image

    Preoperative diagnosis: Bilateral upper lid ptosis and excess skin

    Procedure performed: Bilateral upper lid ptosis repair, upper lid blepharoplasty

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    Preoperative Diagnosis:Left upper eyelid ptosis.

    Procedure performed: Left upper eyelid frontalis fixation ptosis surgery

  • pre-brow-lift-face-lift-blepharoplasty

    Preoperative Diagnosis: Upper and lower lid dermatochalasia, upper lid mild ptosis, mild upper lid ptosis, facial aging, and lower lid fat prolapse.

    Procedure performed: Upper and lower lid blepharoplasty and periorbital fat grafting, mild ptosis repair. Deep plane face lift (facialplasty), brow lift, and periorbital fat and facial fat grafting performed by Dr. Richard Zoumalan.

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    Preoperative Diagnosis: Left upper lid ptosis

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    Preoperative Diagnosis Above: Upper lid ptosis and upper and lower lid dermatochalasia.

    Procedure performed: Upper lid ptosis repair, upper lid blepharoplasty and lower lid blepharoplasty using a lower lid orbicularis suspension flap (skin-muscle flap) technique. Note how well the scars have healed. They are virtually undetectable even four months out from surgery.

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    Preoperative Diagnosis: Upper lid dermatochalasia (extra skin) resulting in lid hooding and ptosis.

    Procedure performed: Bilateral upper lid blepharoplasty.

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    Preoperative Diagnosis: Upper lid excess skin and lid ptosis (droopy lid) resulting in difficulty seeing well and a tired appearance, lower lid bags and excess skin.

    Procedure performed: Bilateral upper lid blepharoplasty, upper lid ptosis repair, and lower lid blepharoplasty.

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    Preoperative Diagnosis: Upper lid and brow ptosis resulting in difficulty seeing well and a tired appearance.

    Procedure performed: Bilateral upper lid blepharoplasty, upper lid ptosis repair, and upper lid external browpexy (brow ptosis repair).

  • image

    Preoperative Diagnosis: Upper lid and brow ptosis resulting in difficulty seeing well and a tired appearance.

    Procedure performed: Bilateral upper lid blepharoplasty, upper lid ptosis repair, and upper lid internal browpexy (upper lid brow ptosis repair done through an internal suture technique).

  • image

    Preoperative Diagnosis: Upper lid and brow ptosis resulting in difficulty seeing well and a tired appearance.

    Procedure performed: Bilateral upper lid blepharoplasty, upper lid ptosis repair, and upper lid external browpexy (upper lid brow ptosis repair).

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    Preoperative Diagnosis: Bilateral upper lid ptosis and dermatochalasia.

    Procedure performed:Bilateral upper eyelid ptosis repair and upper lid blepharoplasty (The eyelid position was lifted and excess skin was also removed). This photo was taken 3 months after undergoing the surgery.

  • asian_eyelid_surgery_post_op

    Procedure performed:Asian eyelid (double eyelid) surgery

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    Preoperative Diagnosis: Severe upper lid ptosis. The patient was born with mild congenital ptosis which got worse with age.

    Procedure performed:Bilateral upper lid ptosis repair. No skin was removed. The procedure was performed through a minimally invasive posterior approach.

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    Preoperative Diagnosis: Severe upper lid ptosis.

    Procedure performed:Bilateral upper lid ptosis repair. No skin was removed. The procedure was performed through a minimally invasive posterior approach.

  • image

    Preoperative Diagnosis: Severe upper lid ptosis. The patient was born with mild congenital ptosis which got worse with age.

    Procedure performed:Bilateral upper lid ptosis repair and blepharoplasty.

  • image

    Preoperative Diagnosis: Severe upper lid ptosis. The patient was born with mild congenital ptosis which got worse with age.

    Procedure performed:Bilateral upper lid ptosis repair. No skin was removed. The procedure was performed through a minimally invasive posterior approach.

  • image

    Preoperative Diagnosis: Right upper lid ptosis.

    Procedure performed:Right upper lid ptosis repair. No skin was removed. The procedure was performed through a minimally invasive posterior approach.

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    Preoperative Diagnosis: Significant upper lid ptosis.

    Procedure performed:Bilateral upper lid ptosis repair. Excess nasal skin and protruding fat pads were removed through small incisions near the medial (nasal side) of the lid crease.

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    Preoperative Diagnosis: Right upper lid ptosis and bilateral upper lid excess skin (dermatochalasia).

    Procedure performed:Right upper lid ptosis repair and bilateral upper lid blepharoplasty.

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    Preoperative Diagnosis: Right upper eyelid ptosis.

    Procedure performed:Right upper eyelid ptosis surgery.

Disclaimer:

*Individual results may vary

All before and after pictures displayed are real patients who have consented to having their pictures published on our site. Individual results will vary with each patient and Dr. Christopher Zoumalan does not guarantee any outcomes of procedures shown. All pictures are meant for reference and illustrative purposes only.

What are the symptoms of ptosis?
People with ptosis have droopy eyelids and often complain of seeing poorly in their superior part of their vision. This can affect driving, reading, and other normal daily activities. Patients with ptosis often see better once they manually raise their lids with their hands or by trying to raise their eyebrows and foreheads. Ptosis also results in a tired appearance as well.

Dr. Zoumalan uses a minimally invasive, advanced ptosis technique in many of his patients. Ptosis surgery can often have some residual asymmetries after surgery where one eyelid may still be slightly higher than the other eyelid; Dr. Zoumalan uses this advanced technique to adjust the lid one week out after surgery. Patients often enjoy this added level of measure to help correct for any residual asymmetries. Dr. Zoumalan uses rapid recovery techniques to allow his patients to return to work and their daily activities usually within several days to a week after surgery. Ptosis surgery can often be combined with other eyelid surgeries such as cosmetic upper and lower lid eyelid surgery or even lower eyelid reconstructive surgery.