What to do if the upper eyelid droops? This is the best correction

There are two types of ptosis: congenital and acquired. If it is the former, surgery is generally recommended after the age of 2-5 years. For the latter, the function of the levator palpebrae superioris muscle can be enhanced by shortening it or shortening it and moving the muscle end forward, thereby achieving a cosmetic effect of double eyelids.

The best time to treat congenital ptosis

1. Generally, surgery is recommended after the age of 2-5 years;

2. Severe ptosis can be treated with surgery at around 1 year old;

3. If ptosis blocks the pupil and affects vision, surgery can be performed before the age of 2 years;

4. The current trend takes the mental health of the child into consideration and surgery can be performed earlier. After the cause of acquired ptosis is identified and the condition has stabilized for 6 to 12 months, surgery can be considered. Surgical effect: The surgical incision is buried in the folds of the double eyelids.

It is usually not noticeable that double eyelids are formed after the operation and the eyelids are not fully closed in the early stage, but they can usually be closed after 6 months. lead

Correction of ptosis

In summary, it can be roughly divided into two categories:

① By shortening the levator palpebrae superioris muscle or shortening it and moving the muscle end forward, the function of the levator palpebrae superioris muscle can be enhanced;

② Use adjacent muscles or implants to strengthen or replace the function of the levator palpebrae superioris muscle, such as using the frontalis muscle and superior rectus muscle to traction and raise the position of the upper eyelid margin.

(1) Levator palpebrae superioris muscle shortening surgery: After numerous improvements by surgeons, the current surgical methods have changed a lot and can be roughly divided into transconjunctival incision (internal incision method) and transcutaneous incision (external incision method) or combined conjunctival and skin incision methods. It is suitable for patients with bilateral or unilateral mild or moderate congenital ptosis, and whose levator palpebrae superioris muscles still have partial function (the strength of the levator palpebrae superioris muscles is 5mm or more). It can also be used for acquired aponeurotic ptosis. This surgical method maintains the original movement and direction of the muscles, is more in line with the physiological requirements of the eyes, and the postoperative effect is also ideal. However, this method is only limited to mild to moderate ptosis in which the levator palpebrae superioris muscle has partial function. If the levator palpebrae superioris muscle function is poor (levator palpebrae superioris muscle strength is less than 5mm), shortening the levator palpebrae superioris muscle or moving the muscle end forward may not produce ideal surgical results. If the muscle function is completely lost, it will be even more difficult to be effective. Forcing a large amount of muscle shortening may lead to serious complications such as severe incomplete eyelid closure and diplopia after the operation.

(2) Frontalis muscle lift: There are two methods of frontalis muscle lift: one is to use various materials or tissues to connect the tarsal plate and the frontalis muscle, and indirectly use the strength of the frontalis muscle to correct ptosis. The materials and tissues currently used include autologous wide fascia, skin, muscle, allogeneic dura mater, allogeneic sclera, silk thread, silver wire, stainless steel wire, silicone strip, etc. Among them, autologous wide fascia is the best. It will not be rejected or elongated after implantation, and the palpebral fissure height and eyelid shape will be stable after surgery. The disadvantage is that more incisions need to be made on the patient's thigh, which is not easy for the patient to accept and the surgeon also finds it troublesome. In addition, the patient has to use the frontalis muscle contraction to lift the eyebrow to widen the palpebral fissure, so the patient has different degrees of eyebrow lifting after the operation. Allogeneic dura mater or allogeneic sclera is used for lifting, but after a few years the palpebral fissure will slowly droop or some part of the eyelid will become deformed. In a few cases, the implanted tissue will be absorbed or fibrosed early and the treatment will lose its efficacy. Silk thread has a very good short-term correction effect and the operation is easy, but its maintenance time is much shorter than that of allogeneic dura mater or sclera, and it is basically not used at present. Another method is to directly use the frontalis muscle to create a frontalis muscle flap, move it downward and suture it to the upper tarsal plate, and directly use the frontalis muscle power to lift the upper eyelid to correct ptosis. This is called direct suspension of the frontalis muscle flap. This method does not work through an intermediate connection, thus avoiding the disadvantages of indirect use of the frontalis muscle. It is suitable for patients with good frontalis muscle function, congenital or acquired ptosis, especially severe ptosis. It can also be used in cases where other surgical methods have failed to correct ptosis. Since the operation is dynamic, the patient can not only open his eyes but also close them after the treatment. In addition, the deep wrinkles on the forehead can disappear naturally after the operation, making the forehead appear wide and flat, and the patient can also achieve the cosmetic effect of double eyelids after the operation.