Eyelid Ptosis

Ptosis is a term used for a droopy eyelid. This may be one upper eyelid or both upper eyelids.  Dr. Iyengar is well versed in the most current approach to droopy eyelids, or ptosis, an approach that does not require external incisions or scars.  There are some surgeons in the San Diego area that still do not offer this approach to their patients.  Some of the advantages of this procedure include the quicker recovery, less pain, and better aesthetic contour of the eyelid.  We also regularly perform this procedure in patients who have had blepharoplasty done already by surgeons who are not eyelid specialists.  Having been performing this procedure for over a decade, Dr. Iyengar is the most experienced surgeon in scarless ptosis repair in the community.  The external approach to ptosis surgery involved an external incision in the eyelid and is helpful for patients with large amounts of ptosis.

Case 1: This is a nice attorney who had blepharoplasty and direct brow ptosis performed by a plastic surgeon who is not an eyelid specialists.  She was unhappy with the result.  She had eyelid ptosis and Dr. Iyengar was able to fix this in the office with a scarless approach to ptosis repair.  She was pleased with the result.

ptosis 2 1
ptosis 2 2

Case 2:  This kind woman was tired of looking tired all the time and had drooping eyelids.  She saw Dr. Iyengar to lift her eyelids through a scarless approach and was pleased with the result. This is an other example of a patient that needs ptosis surgery and not blepharoplasty.

Eyelid ptosis

Case 3: This Trauma Surgeon (M.D.) here in San Diego had a droopy left upper eyelid (ptosis). She underwent scarless ptosis repair by Dr. Iyengar under local anesthesia and is back to saving lives as a part of the surgical team at a local hospital. Small amounts of eyelid ptosis are best corrected by this approach.

09 B A

Case 4: This nice woman is a nurse injector here in San Diego who works in the aesthetics industry performing Botox and filler injections. She had previous upper eyelid blepharoplasty by a La Jolla Cosmetic/Plastic surgeon. She has ptosis, a droopy left upper eyelid, something that is not corrected by blepharoplasty. We were able to fix this with a scarless approach on the inside of her left upper eyelid. Unfortunately many plastic surgeons miss this detail since they do not perform ptosis surgery or do not perform a detailed eyelid evaluation. Our practice fixes botched eyelid surgery every week and this is yet another example of why it is important to see an eyelid specialist, an oculoplastic surgeon, for your eyelid surgery.

Bonnie before photo
Bonnie after photo

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. Iyengar’s recommendations after a complete oculoplastic exam. Dr. Iyengar 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. Iyengar  uses a minimally invasive, advanced ptosis surgery 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. Iyengar 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. Iyengar 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. Iyengar 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. Iyengar 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. Iyengar will identify your natural crease carefully, and make a incision over the natural crease. The incision heals well within the natural crease. Dr. Iyengar pays careful attention to the wound closure using very fine sutures which are removed in 7-8 days.

Why Patients Choose Dr. Iyengar

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

Dr. Iyengar will evaluate ptosis through various examination findings and measurements. Dr. Iyengar 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. Iyengar will have to perform a detailed examination to rule out other particular causes.

Important Factors For Droopy Eyelid Surgery

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. Iyengar 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. Iyengar 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. Iyengar’s use of minimally invasive surgery and advanced techniques in wound closure, Dr. Iyengar is very cautious and will monitor the function of the eyelids before and during surgery very carefully.

Combine Brow Lift With Droopy Eyelid Surgery

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 surgery repair. There are several types of brow lifting procedures that Dr. Iyengar 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.


“I saw Dr. Iyengar for ptosis correction and I am so happy with the results! He’s an excellent surgeon, and just as importantly, he’s understanding and patient and really takes time to listen and answer questions. Highly recommend!”

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