Drooping Eyelids Turkey

Eyelid Drooping (Ptosis)?

Eyelid drooping, medically known as ptosis, is a condition where the eyelid sits lower than its normal position, giving the eye a narrower appearance. It can be unilateral (one-sided) or bilateral (both sides),and while it can occur at any age, its frequency increases with aging.

What are the symptoms of Eyelid Drooping?

We usually notice eyelid drooping, especially if it affects only one eye, through asymmetry visible in photographs or when looking in the mirror. The drooping eyelid will appear more closed, or the other eye will seem larger.

If both eyelids are affected and the drooping is significant, people around us may ask, “Are you tired?” “Didn’t you sleep well?” or “Is something bothering you?” because eyelid drooping can make us look fatigued, unhappy, or depressed.

Depending on the degree of drooping, increasing eye strain and reduced visual quality are also among the common symptoms.

What Causes Eyelid Drooping?

The most common cause of eyelid drooping is stretching of the levator muscle, which is responsible for lifting the eyelid. Just like other tissues in the body, this muscle can lose elasticity with aging, and the process can be accelerated by factors such as frequent rubbing of the eyes, swelling, or exposure to external elements. However, stretching of this muscle is not limited to older age.

Eyelid drooping can also occur in younger patients. Apart from structural laxity, the most common causes include rubbing the eyes due to allergies or dryness, prolonged eyelid swelling from trauma or medical conditions, recurrent infections, or tissue stretching caused by long-term contact lens use.

What Are the Types of Eyelid Drooping?

Eyelid drooping can be classified into two categories: true drooping and pseudo-drooping. True drooping occurs due to the reasons explained above and is characterized by a lowered position of the eyelid margin.

Pseudo-drooping, on the other hand, is not caused by the eyelid itself but by the weight and sagging of the overlying tissues, creating the appearance of drooping. It usually results from sagging of the skin, soft tissues, and eyebrows above the upper eyelid. The treatment of these conditions differs from the treatment of true eyelid drooping. More detailed information on this can be found in the Eyelid Aesthetic Surgery section.

Congenital Eyelid Drooping

Eyelid drooping can also be present at birth. This condition, known as congenital ptosis, differs from the age-related form described earlier. In congenital ptosis, the levator muscle responsible for lifting the eyelid develops abnormally in the womb, becoming short, stiff, and inelastic. Unlike age-related stretching, this condition involves both weakness and an inability of the muscle to extend.

Although relatively less common, another group of conditions causing eyelid drooping includes neurological and muscular diseases. These include third nerve palsy, Horner’s syndrome, Myasthenia Gravis, progressive muscular dystrophies, orbital (eye socket) or brain tumors/vascular anomalies, and temporal arteritis.

If undiagnosed, these conditions may progress to blindness and, in some cases, even death due to underlying complications. Therefore, in all patients with eyelid drooping, the function of the eyelids, as well as eye movements and pupil responses, should be thoroughly evaluated through oculoplastic and neuro-ophthalmologic examinations.

With my subspecialty training in oculoplastic surgery and neuro-ophthalmology—both part of ophthalmology subspecialties—I have developed a course on the diagnosis and treatment approaches for these disorders. Since 2009, I have shared my experience at the annual American Academy of Ophthalmology (AAO) Congress in the United States, attended by nearly 10,000 ophthalmologists each year from around the world.

This knowledge is critically important in preventing both vision loss and life-threatening complications, and has already helped save countless patients globally. For this reason, eyelid drooping should never be regarded as a simple cosmetic issue. A detailed examination by an experienced physician is essential to determine the most appropriate treatment.

Eyelid Drooping in Infants and Children

In congenital eyelid drooping (ptosis) seen in babies and children, the levator muscle responsible for lifting the eyelid fails to develop normally in the womb. As a result, the eyelid cannot be lifted strongly enough, and from birth, that eye appears more closed. Depending on the severity, infants cannot fully open the affected eye.

Since the levator muscle also lacks stretching capacity, when looking downward, the drooping eyelid stays higher than the other one. In a detailed oculoplastic examination, these functions, visual acuity, and eye movements are evaluated together. Because significant refractive errors are often present in the affected eye, careful measurements are performed to determine whether glasses are needed.

If eyelid drooping blocks the visual axis, surgery must be performed immediately to prevent permanent amblyopia (lazy eye). If strabismus (eye misalignment) is also present, it must first be corrected before ptosis surgery.

If the visual axis is clear, the ideal time for surgery is between ages 2 and 4, with follow-ups every 6 months. The surgical method is determined after a detailed examination. Depending on the degree of drooping and especially the function of the levator muscle, three main surgical techniques are available: Müller’s muscle resection performed from inside the eyelid, levator muscle surgery through the skin, and sling procedures.

Congenital eyelid drooping does not resolve on its own over time, nor can it be treated with medications or eye drops. The idea that one should simply wait until the child grows older before treatment is entirely incorrect.

Can eyelid drooping occur after eye surgery?

Yes. During cataract, glaucoma, or laser surgeries (commonly known as “eye laser procedures”),the speculum used to hold the eyelids apart may overstretch an already weakened levator muscle. This can accelerate drooping in predisposed eyelids, although it rarely occurs in patients with healthy muscle structure.

Does eyelid drooping resolve on its own?

True eyelid drooping caused by muscle laxity or congenital defects does not resolve spontaneously. The levator muscle can be compared to a thick elastic band: once it stretches out and loses its tension, it cannot return to its original state on its own and requires surgery.

However, there are a few exceptions:

• Trauma-related ptosis: If eyelid drooping occurs after an injury without muscle or nerve damage, the eyelid may return to normal within 2–3 months. Oculoplastic evaluation is essential to distinguish cases needing urgent surgery from those likely to recover naturally.
• Botox-related ptosis: Very rarely, Botox injections may cause temporary eyelid drooping. Regardless of severity, this resolves completely on its own within 1–2 months without lasting damage. If desired, the process can be accelerated with prescription eye drops or additional Botox injections targeting the eyelid-closing muscle.
• Contact lens–related ptosis: In some young patients, mild eyelid drooping (1–2 mm) caused by prolonged contact lens use may improve or fully resolve after discontinuing lens wear for a period of time. Later, learning proper lens application techniques can help prevent recurrence without the need for eyelid surgery.

How is Eyelid Drooping (Ptosis) Treated?

The only treatment for true eyelid drooping is surgery. There is no such thing as a non-surgical treatment for eyelid drooping, which is often seen on social media. In false eyelid drooping (such as skin sagging or mild eyebrow drooping),temporary treatments such as Botox, fillers, and plasma can be used. However, these methods are not curative for true eyelid drooping, and the terms are often misused, causing confusion among patients.

Eyelid Drooping Surgery

In the treatment of eyelid drooping, there are three surgical methods determined according to the underlying cause and examination findings: Levator muscle surgery, Müller muscle surgery, and suspension methods...

Following a detailed history, the appropriate surgical method will be determined through an examination that includes assessing visual level, the degree of eyelid drooping, the function of the levator muscle responsible for lifting the eyelid, the function of the orbicularis muscle that closes the eyelid, the position of the eyelid when looking down or when closed, eye position/strabismus, eye movements, pupil response to light, the condition of the ocular surface, the relationship between the levels of both eyelids, the presence of dry eyes and allergies, the structure of the lash margin, among other assessments. This detailed ocular and oculoplastic examination, along with additional tests using drops, will help determine the most suitable surgical method.

In suitable patients, the conjunctivo-Müllerectomy method, where no incision is made on the skin and the procedure is entirely performed inside the eyelid, has many advantages. The possibility of giving a sedative or fully anesthetizing the patient during the surgery, the very short duration of the surgery and recovery, the absence of an incision on the skin, and the fact that there is no likelihood of any alteration in the eyelid shape make this method attractive. In this method, while the patient is asleep, the eyelid is turned inside out, and the Müller muscle on the inner surface is shortened. This surgery, which takes an average of 8 minutes, allows the patient to quickly return to normal life after the procedure.

Another surgical method is levator surgery via the skin, which is performed in patients who are not suitable for Müllerectomy based on the examination and drop tests. In this method, the patient must be fully awake during the surgery to make the necessary level adjustments. After applying approximately 1cc of local anesthesia, the patient will not feel any pain or discomfort during the surgery.

The incision made during the procedure is hidden in a line that is not visible from the outside while the eye is open. The eyelid skin and the orbicularis muscle beneath it are opened, and the thick membrane (septum) covering the fat in front of the levator muscle is safely opened. The levator muscle, which lifts the eyelid, is shortened and tightened. If necessary, excess skin and fat are also removed, and a symmetric skin fold is created to match the other eyelid. The skin is then closed with cosmetic stitches.

The third method is the suspension technique, which is applied in cases where the levator muscle responsible for lifting the eyelid does not work at all (usually in congenital eyelid drooping, neurological conditions, muscular dystrophies, and drooping due to nerve cuts). In this method, the task of lifting the eyelid is transferred to the frontalis muscle, which lifts the eyebrow.

The eyelid is lifted using suspension material passed through microscopic incisions made in the hidden crease of the eyelid and at three points on the eyebrow. Creating a symmetric fold is extremely important in these surgeries. In infants, the surgery is performed under general anesthesia, while in adults, local or general anesthesia may be used depending on the situation, but local anesthesia is preferred.

There are various options for suspension material, but in recent years, two materials have gained widespread acceptance: silicone suspension and a membrane called 'fascia lata,' taken from the upper outer part of the thigh. Both materials have their own advantages and disadvantages. Silicone suspension is more preferred today due to its ability to stretch and ease of adjustment, as it does not require a second surgical site.

Eyelid Drooping Surgery Price 2025

The price of eyelid drooping surgery varies depending on the technique used. To have an idea about the cost, a detailed evaluation and examination should be done to determine whether surgery is necessary and, if so, which method is appropriate.

What is the recovery process after eyelid surgery?

After the surgery, the patient is observed for 2-3 hours and then discharged. During the recovery period, ice is applied to the eye for 48-72 hours. An antibiotic ointment is applied to the wound for one week. It is recommended to avoid water contact with the wound for about five days.

Pain, discomfort, or soreness is not expected. Stitches are removed approximately 5-6 days later, which is a painless procedure. For the first week, activities such as bending forward, lifting heavy weights, or engaging in strenuous activities are restricted. Swelling and bruising are normal and may last for 1-2 weeks, depending on the individual and the surgery's specifics. Most people can return to their normal life, excluding strenuous movements, by the 3rd day. However, sports activities, especially contact sports, and the use of pools or the sea are prohibited for up to 2 weeks.

By the end of the first week, mild activities such as walking can begin, at one-third of the usual intensity. Makeup can be safely applied starting from the 10th day. It is possible to return to work starting from the 3rd day with camouflage glasses, but if not necessary, resting for about a week is recommended for quicker recovery. The eyelid level returns to normal after about 2-3 weeks, although in some special cases, this may take 1-2 months.

Laser Eyelid Drooping Surgery

There is no method or option for laser treatment of eyelid drooping, neither in Turkey nor anywhere else in the world. During the first stage of the surgery, methods such as laser, radiofrequency, electrocautery, or a scalpel can be used to make the eyelid incision.

Personally, I have been using radiofrequency for many years due to its practicality and faster recovery. These methods, which are solely used for making the incision, all have the same long-term effects on the surgical outcome.

From what I have learned from those who ask this question, some methods used to tighten the eyelid skin for a certain period are misleadingly advertised on social media as "laser solution for eyelid drooping," which causes confusion.

The truth is, the condition mentioned on these types of sites is not true eyelid drooping (ptosis) but rather excess skin, and the method used is not laser treatment. When encountering such claims, ask for the brand of the laser, what exactly it does, how it can lift the loose muscle responsible for eyelid drooping with skin application, and how long the effect will last. The answers you receive will help you understand the reality.

Risks of Eyelid Drooping Surgery

The most important risk in eyelid drooping surgeries is being operated on by someone who is not experienced in this field. Because this surgery, from history taking to examination, from surgical planning to each surgical step, requires very serious expertise, errors at any stage can lead to irreparable damage.

The most common issue encountered in poorly performed surgeries is patient dissatisfaction due to asymmetry and drooping not being corrected in cases where ptosis was not noticed or, even if it was, the ptosis surgical technique was not known, and only skin was removed.

Technically, errors can result in asymmetries, improper wound closure, irregular scarring, distortion of the eyelid shape, skin irregularities or wounds, the eyelid turning inward or outward at the edge, eyelashes turning inward or pressing against the eye surface, excessive or insufficient eyelid elevation, incomplete closure of the eyelid, and secondary ocular surface problems. Sometimes, removal of the lacrimal gland mistaken for fat, resulting in patients needing correction surgeries years later, can occur.

In essence, surgeries performed by specialists who have received specific training in eyelid surgery and performed thousands of surgeries carry very low risk. When an expert handles the case, the likelihood of accurate diagnosis, correct surgical planning, and smooth completion of the surgery steps is much higher, making the surgery risks lower.

It should be remembered that no surgery is risk-free. Even in the hands of an experienced surgeon, some issues may occur, such as prolonged swelling or bruising, complaints of dry eyes, a temporary increase in existing dry eye symptoms, or the need for a second surgery.

Is Eyelid Drooping Genetic?

Most of the time, no. However, some congenital eyelid drooping conditions may be inherited. Also, in cases of eyelid drooping due to rare muscle dystrophies, genetic transmission can be observed.

An important detail to note is that muscle laxity is directly related to the elasticity of collagen structures in the body. Therefore, family members with similar collagen structures may experience muscle stretching and similar eyelid drooping in later years, although this does not mean a hereditary disease.

Does Eyelid Drooping Affect Vision?

The amount of drooping of the eyelid directly affects our vision. Just like when we lower a curtain on a window, reducing the light in the room and making visual details blurry, when the eyelid droops in front of the eye like a curtain, it reduces both the brightness of colors and the contrast of images. When the eyelid is fully closed, it completely blocks the light, preventing us from seeing. In extreme cases, patients who raise their eyelid with their hand may be able to see.

Does Eyelid Drooping Cause Headaches?

When the eyelid drops significantly, the brain assigns the task of lifting the eyelids to the forehead and frontal muscles, which work hard all day. These muscles can become tired, leading to pain and discomfort, which can manifest as a headache in the forehead area.

Which Doctor Should You See for Eyelid Drooping?

Eyelid drooping surgeries are commonly performed by oculoplastic surgeons. With over 20 years of domestic and international experience in eye health, and more than 30,000 oculoplastic surgeries, Prof. Dr. Altuğ Çetinkaya performs these surgeries safely in Ankara, Turkey. For detailed information and appointments about eyelid drooping in Ankara, you can call 0530-2790315.