Eyelid Malposition Surgery
Eyelid Malposition: Ptosis, Entropion, and Ectropion
Normally functioning eyelids are firmly held against the eye. Tears lubricate the eyelid movements and the eyelids themselves function like the windshield wipers of the eyes. This is the result of a delicate balancing act between the eyelid position and tension of the eyelid ligaments. In the lower eyelid, the muscle that helps close the eyelids functions like a muscular hammock to hold the lower eyelid against the globe.
The general medical term to describe eyelids that are improperly situated against the eye is eyelid malposition, a condition that requires reconstructive surgery for correction and the restoration of proper function. In order to ensure a safe and successful reconstructive eyelid surgery, it is crucially important to select an experienced oculofacial surgeon with an incredibly high level of skill, meticulous surgical technique, and an in-depth knowledge of the delicate eye structures. You will find such a physician in Dr. Kenneth Steinsapir, a multi-fellowship-trained oculofacial plastic surgeon who specializes in customized Beverly Hills eyelid surgery procedures, and has a proven track record of producing beautifully natural reconstructive eyelid surgery results.
Eyelid Malposition Categories
Dr. Steinsapir is widely respected among his fellow plastic surgeon colleagues, and has patients from all over the world who travel to California to benefit from his oculofacial expertise and advanced surgical skillset. Dr. Steinsapir is highly experienced performing surgical corrective measures to address several common types of eyelid malpositions:
before & afters
- Eyelid Ptosis: eyelid ptosis is themedical term used to describe sagging or drooping of the upper and/or lower eyelids. Ptosis of the upper eyelids can change the natural contour of the upper eyelid, potentially impairing the patient’s vision, while ptosis of the lower eyelids may result in inferior scleral show (white showing below the colored region of the eye). Eyelid ptosis may be congenital (hereditary) or acquired over time or as a consequence of surgery or trauma.
- Developmental Dystrophy: the levator muscle is responsible for opening the eyes by lifting the upper eyelids. Patients with the form of congenital eyelid ptosis known as developmental dystrophy are born with a levator muscle that is incompletely developed, and have fat and connective tissue replacing the muscle that should be present, which often leads to the appearance of a droopy eyelid. As the levator muscle does not effectively lift the lid, there may also be insufficient traction to generate a crease in the affected upper eyelid. It is not uncommon to see a heavy eyelid and an absent eyelid crease. Occasionally the heavy eyelid is associated with other eyelid abnormalities such as the blepharophimosis syndrome. This syndrome is hereditary and can be passed down through generations of family members.
- Marcus-Gunn Jaw-Winking Ptosis: for patients with this less common form of congenital eyelid malposition, movement of the jaw causes a fall in the position of one of the eyelids, leading to a drooping or sagging appearance
- Acquired Eyelid Ptosis: the majority of upper eyelid ptosis cases in adults are acquired, rather than congenital. There are several causes of acquired ptosis. The most common cause appears to be attenuation of the levator aponeurosis, which becomes stretched out over time. Other causes of acquired ptosis generally fall into one of four broad categories: neurogenic, myogenic, traumatic, and mechanical. It is helpful to classify and properly diagnosis the basis of the droopy eyelid, as this has a bearing on the treatment choice to repair the condition.
- Entropion: laxity (looseness, sagging) of the lower eyelid is most often found in older individuals, and can present as either a turning in or turning out of the lower eyelid. When the lower eyelid retractors become attenuated, the forces on the eyelid tend to favor an inward rotation of the lower eyelid—this is called entropion. Entropion causes the eyelashes to rub against the eye and can cause severe irritation and discomfort
- Ectropion: when the lower eyelid is lax and there is contraction of the lower eyelid skin or weakening of the orbicularis oculi muscle (as occurs with Bell’s Palsy), the lower eyelid rotates away from the eye—this is called ectropion. With cases of ectropion, the lower eyelid does not rub against the eye; however, the eyelid does not protect the eye, which can also cause irritation.
Eyelid Malposition Treatments
There are two principle approaches to repairing upper eyelid ptosis:
- Conjunctival Muellerectomy: for patients with a mild degree of ptosis (1-2 mm) a simple test is performed during the preoperative assessment. During this test, drops are placed into the eyes and the patient’s response is measured—if the drop raises the eyelids to the desired height, the lid position can usually be corrected with a surgery referred to as a Conjunctival Muellerectomy. This surgery is performed from behind the upper eyelid using a special clamp called a Putterman ptosis clamp.
- Anterior Levator Resection Ptosis Surgery: this form of surgery is appropriate for patients whose eyelids did not respond successfully to the preoperative eyelid test. This surgery is performed through an incision at the eyelid crease on the outside of the eyelid. The levator aponeurosis is dissected and sutures are tied to effectively shorten the aponeurosis. Surgery is performed under local anesthesia to facilitate proper repositioning of the eyelid. During surgery, the patient is asked to open and close the eye, and the sutures can be repositioned to adjust the eyelid position. Once satisfactory eyelid positioning has been achieved, the sutures are permanently tied and the eyelid is closed. Skin sutures are removed within a week.
Treatment for Entropion: there are various approaches to address and correct cases of entropion. For most patients, successful outcomes can be achieved by reattaching the lower eyelid retractors and shortening the lower eyelid
Treatment for Ectropion: surgery to correct cases of ectropion focuses on lengthening the lower eyelid and re-suspending the eyelid back against the globe
For patients with entropion and ectropion, a careful preoperative assessment of midface support is highly important, because failure to address midface ptosis (sagging, drooping) can lead to an unsatisfactory surgical result.
Swelling and bruising after any of the aforementioned eyelid surgeries usually resolves in 10-14 days. A personal consultation with Dr. Steinsapir will determine if you are a candidate for any of the Beverly Hills eyelid surgery options discussed above.
Eyelid Malposition Surgery Beverly Hills
Dr. Steinsapir is a UCLA- and University of Chicago-trained surgeon who has performed separate fellowships in both Cosmetic Surgery and Oculofacial Microsurgery. Many individuals travel nationally and internationally to undergo eyelid surgery and other facial rejuvenation procedures with Dr. Steinsapir. To learn how reconstructive eyelid surgery can restore proper functionality to your eyelids and help you achieve your desired facial improvements, please don’t hesitate to contact our office.
You may also continue to explore LidLift, where you will find supplementary information pertaining to various types of reconstructive eyelid surgery, before-and-after eyelid surgery case studies, and answers to frequently asked questions about these procedures. Your eyelid surgery can serve as a key stepping stone along the path to become the best possible version of yourself, and you can take the first step by calling to schedule your personal consultation with Dr. Steinsapir today.