Ptosis Surgery (Droopy Eyelid Surgery)

Ptosis surgery raises an upper eyelid that droops over the pupil because the levator muscle has lost function, restoring the lid to its normal level. Ptosis occurs when the levator muscle, or the nerve pathway that activates it, weakens; the lid margin sits lower than normal and can cover part of the pupil. This differs from sagging caused by excess skin, since its source is muscle function, not skin volume — a distinction that decides the treatment. Op. Dr. Anıl Kaya, an eye surgeon (ophthalmologist) in Istanbul, plans the surgery after assessing the degree of ptosis and muscle function on examination, usually as day surgery under local anaesthesia. Although often seen as cosmetic, ptosis can also narrow the visual field, so the assessment covers its effect on daily vision too.

Anaesthesia: usually local anaesthesia. Duration: varies with muscle function and technique, about 45–90 minutes. Hospital stay: day case. First check-up: within a few days. The exact timing depends on the degree of ptosis.

Ptosis surgery is used for patients diagnosed with droopy eyelid (ptosis), where the lid-lifting muscle has weakened and the lid can cover part of the pupil. Ptosis can be congenital or develop later due to ageing, eyelid injury, long-term contact lens wear, or certain neuromuscular conditions; the cause can influence the surgical plan. It may affect one eye or both — the more pronounced the difference, the more noticeable the asymmetry. Degree is classified by how much the lid margin covers the pupil, and mild, moderate and severe cases can call for different approaches. One-sided cases are usually noticed quickly; bilateral, symmetric cases may be noticed later. Some patients also develop forehead tension from constantly raising the eyebrows to keep the eyelid open.

Patients with drooping caused by loss of function in the lid-lifting muscle, a restricted visual field, or cosmetic discomfort are evaluated for this surgery. When muscle function is preserved at a measurable level, the result is generally more predictable — especially when the lid margin has dropped noticeably while muscle function itself remains well preserved.

If the drooping is caused only by excess skin rather than muscle function loss, upper blepharoplasty may be more suitable. Surgery may be postponed for active eye inflammation or an uncontrolled systemic condition. Where muscle function is completely lost due to a progressive neuromuscular disease, a different approach — such as a frontalis sling — may be needed, clarified during examination. Patients with an active eyelid infection or uncontrolled bleeding disorder wait until the condition is treated. For those expecting perfect symmetry, the goal is explained as a functional, balanced appearance, not perfect symmetry.

Before surgery, the function of the lid-lifting muscle is measured, the degree of ptosis is determined, and general eye health is assessed — these measurements decide which technique is used. The evaluation records the level difference between the two lids, levator excursion (lid movement on upward and downward gaze), and the degree of dry eye. The patient's health history, current medications and any previous eyelid surgeries are also asked about, so the surgery can be planned safely. Levator excursion is a key measure of how functional the muscle remains and directly affects the technique chosen.

The technique is determined by the levator muscle's remaining function, as measured during examination. If function is well preserved, levator resection or advancement is preferred; if markedly weak, a frontalis sling — connecting the forehead muscle to the lid — may be used instead. Under local anaesthesia, an incision along the lid crease reaches the muscle tissue, which is freed and shortened by the planned amount or advanced and reattached to the lid margin. In the sling technique, the lid margin is instead connected to the frontalis muscle with a thin band or suture, so the lid can be raised by forehead movement. While the patient opens and closes the eye, the lid level is checked during surgery to keep asymmetry to a minimum. Once the planned level is reached, the incision is closed with fine stitches and the patient goes home the same day. How much muscle is shortened is decided by weighing the measured function against the targeted level, so planning is millimetre-precise and tailored to the patient.

1. 1Choosing the Technique. Levator resection or a frontalis sling is chosen based on the function of the lid-lifting (levator) muscle measured during examination.
2. 2Local Anaesthesia and Incision. The procedure begins with local anaesthesia; an incision along the lid crease is used to reach the muscle tissue.
3. 3Shortening the Muscle or Placing the Sling. The levator muscle is freed and shortened or advanced by the planned amount; in the sling technique, the lid margin is connected to the frontalis muscle with a thin band or suture.
4. 4Checking the Level During Surgery. While the patient opens and closes the eye, the lid level is checked to keep the asymmetry between the two lids to a minimum.
5. 5Closing. Once the planned level is reached, the incision is closed with fine stitches; the procedure is performed as day surgery.

In the first days, swelling, mild asymmetry and temporary difficulty closing the eye may occur. If the eye does not fully close during sleep, the doctor may recommend artificial tears or a lubricating ointment at night. Cold compresses can help reduce swelling for the first 1–2 days. Stitches are removed in about a week, and the doctor's check-up schedule should be followed. The asymmetry usually eases as swelling subsides and tissues settle. Although swelling largely subsides within the first week, the final lid level may take longer to become clear, so early judgements should be avoided.

The rise in lid level is usually noticeable early on, but lasting symmetry can take several months of healing. The lid margin is brought to a level suited to the measured muscle function, aiming to open the visual field and give the two eyes a natural, closely matched appearance. Results with the levator technique generally give more natural lid movement than the sling technique, since the lid keeps moving with its own muscle. The change is usually clearer in the mirror and in photographs; most patients feel more awake and rested from the first weeks onward.

A slight asymmetry between the two lids can remain after surgery, and some patients may need a second correction. The more advanced the muscle function loss, the more limited the predictability of the result; not every patient gets the same outcome. With the sling technique, lid movement relies on the forehead muscle rather than natural muscle movement, so blinking can look less natural than with the levator technique.

Risks include over- or under-correction, temporary difficulty closing the eye, dry eye, a slight asymmetry between the two lids and, rarely, infection. With over-correction, the lid can sit more open than normal and may not fully close during sleep; artificial tears and a lubricating gel for the night may help. With under-correction, the lid level can stay below target, and once healing is complete, an adjustment may be considered. The weaker the muscle function, the more limited the predictability, so risks are discussed in more detail for this group. Early check-ups help catch over- or under-correction early, though a permanent correction is not decided until healing is complete. Pre-existing dry eye can become temporarily more noticeable and is usually managed with artificial tears. Careful pre-surgery measurements lower the risk of over- or under-correction, but since healing varies between patients, it cannot be fully eliminated; these risks are explained individually, based on the patient's measured muscle function.

Op. Dr. Anıl Kaya takes care to measure muscle function accurately and achieve a symmetric result between the two lids. Which technique — levator resection or sling — is used is clarified with pre-surgery measurements, and the lid level is checked while the patient is awake to improve predictability. In patients with limited muscle function especially, he reviews the measurements with the patient to decide which technique is likely to give a more predictable result, and discusses the chance of a second adjustment openly beforehand.

If the drooping is mild or excess skin is the main issue, upper blepharoplasty alone may be enough; if a patient is unhappy with a previous surgery, eyelid revision surgery is considered. If muscle function is markedly weak and the levator technique will not suffice, a frontalis sling is an alternative — the suitable technique is determined by the examination measurements.

For the clinical picture of ptosis, see the droopy eyelid (ptosis) page; for a similar complaint that can be confused with sagging, see the sagging upper eyelid page.

A comparison of ptosis surgery with other eyelid procedures is available on the procedure comparison page. Sagging caused by excess skin is often confused with muscle-related drooping (ptosis); for this distinction, see the upper blepharoplasty page as well.

Most patients return to daily life within a few days; activities that tire the eyes should be limited at first, and the doctor's check-ups should be kept. Reading and screen use should be done in short intervals, with breaks when eye fatigue is felt. Driving can resume once lid swelling no longer restricts the field of vision. Strenuous sports, pressure on the eye area, and prolonged sun exposure should be postponed for as long as the doctor advises — this supports faster healing of the incision site.

The change in lid level achieved after ptosis surgery can be shown through before-and-after examples shared with the patient's consent.

Before

After

Before

After

Before

After

To find out whether the drooping in your eyelid is caused by the muscle, you can book an appointment with Op. Dr. Anıl Kaya.