Drooping Eyelids Turkey

What is Eyelid Drooping?

Eyelid drooping, medically known as ptosis, refers to the condition where the eyelid is lower than its normal position, resulting in a more squinted appearance. It can occur unilaterally or bilaterally and can be seen at any age, although the frequency increases with age.

What are the Symptoms of Eyelid Drooping?

We usually notice that our eyelid has drooped, especially if it’s unilateral, through the asymmetry we see in photos or when looking in the mirror. The side with eyelid drooping will appear more closed, or the other eye may appear larger.

If both eyes have eyelid drooping and it is more than a certain degree, we may hear questions such as "Are you tired?" "Did you not sleep well?" "Do you have something you're not telling?" from others, because the drooping of the eyelids can make us appear tired, unhappy, or depressed.

Depending on the degree of drooping, increasing eye fatigue and a decrease in visual quality can also be symptoms.

What Causes Eyelid Drooping?

The most common cause of eyelid drooping is the stretching of the levator muscle, which lifts the eyelid. As with all tissues related to aging, the muscles responsible for lifting the eyelid can also stretch, and this process can accelerate due to rubbing, swelling, and exposure to external factors over the years. However, the stretching of the muscle responsible for lifting the eyelid does not only occur in older age.

Eyelid drooping can also be seen in younger patients. The most frequent causes of this in young people, apart from structural flexibility, include rubbing the eyelids due to allergies or dryness, long-lasting eyelid swelling due to trauma or diseases, recurrent infections, or the stretching of eyelid tissue caused by prolonged contact lens use.

What Are the Types of Eyelid Drooping?

Eyelid drooping can be classified into true and false drooping. True drooping occurs due to the causes mentioned above and is characterized by the lowered position of the eyelid margin.

False eyelid drooping, on the other hand, is the appearance of drooping caused by the weight and sagging of the tissues on top of the eyelid, not the eyelid itself. It generally occurs due to the sagging of the skin and soft tissues of the upper eyelid and the eyebrows. The treatment for these conditions differs from the treatment for eyelid drooping. Detailed information on this can be found in the Eyelid Aesthetic section.

Congenital Eyelid Drooping

Eyelid drooping can also be congenital. This condition, known as congenital ptosis, occurs as a result of the levator muscle, which lifts the eyelid, developing in an inflexible, short, and stiff form during fetal development, unlike the stretching that happens with age. In contrast to the age-related stretching of the muscle, the muscle in congenital ptosis is both weak and incapable of stretching.

Although less commonly seen, another group of conditions causing eyelid drooping includes neurological diseases/conditions or muscle disorders. This group includes third nerve palsy, Horner’s Syndrome, Myasthenia Gravis, progressive muscular dystrophies, orbital (eye socket) or brain masses-vascular anomalies, and temporal arteritis.

If not diagnosed, these conditions can progress to blindness and even lead to death due to underlying problems. Therefore, these conditions must be evaluated in all patients with eyelid drooping through oculoplastic and neuro-ophthalmological examinations, where the eyelid function, eye movements, and pupil responses are assessed together.

Since I have received advanced training in oculoplastic surgery and neuro-ophthalmology, which are subspecialties of ophthalmology, I have been sharing my experiences with ophthalmologists from around the world at the American Academy of Ophthalmology (AAO) Congress, which approximately 10,000 eye specialists attend annually in the United States since 2009, in a course I prepared on the detection and treatment approaches for these diseases.

This information is very important in terms of preventing vision loss and life-threatening conditions and has prevented and continues to prevent many cases of blindness and loss of life worldwide. Therefore, eyelid drooping should not be perceived as just an aesthetic issue and must be treated appropriately after a thorough examination by an experienced physician.

Eyelid Drooping in Infants and Children

In congenital eyelid drooping in children and infants, the levator muscle responsible for lifting the eyelid typically does not develop properly in the womb. As a result, the eyelid cannot be lifted strongly enough by this muscle, and the affected side will appear more closed from birth. In this condition, infants cannot fully open their eye on that side, depending on the degree of involvement.

Since the levator muscle also lacks the capacity to stretch, when looking down, the eyelid on that side will remain higher than the other eyelid. During a detailed oculoplastic examination, these functions, visual level, and eye movements are assessed together. Since a high degree of visual impairment is often present on the same side, careful measurements are made to determine whether glasses are needed.

If the eyelid drooping obstructs the visual axis, surgery should be performed without delay to prevent permanent amblyopia (lazy eye). If there is also strabismus (misalignment of the eyes),it is necessary to first correct the strabismus.

If the visual axis is open, surgery is ideally performed between the ages of 2-4, with 6-month checkups. The surgical method is determined during the detailed examination. Based on the degree of drooping in the eyelid and especially the function of the levator muscle, there are three main surgical techniques: interventions targeting the Müller muscle through the eyelid, interventions targeting the levator muscle via the eyelid skin, and suspension techniques.

Congenital eyelid drooping cannot improve spontaneously or be treated with medication or drops. The idea that intervention should be delayed until a certain age is completely incorrect.

Can Eyelid Drooping Occur After Eye Surgery?

During cataract surgery, glaucoma surgery, or laser eye surgeries (commonly known as LASIK),the retractor used to pull the eyelid may stretch the already stretched levator muscle further. This situation can accelerate the drooping of eyelids that are already prone to it, although it is rarely seen in individuals with healthy muscle structure.

Does Eyelid Drooping Resolve on Its Own?

True eyelid drooping, whether due to muscle relaxation or congenital causes, does not resolve on its own. If we think of the levator muscle as a thick and tight rubber band, we can imagine how this tissue, when stretched for a long time, becomes looser and longer, like an extended rubber band. Just as a stretched rubber band cannot return to its original shape by itself, the levator muscle cannot repair itself and requires surgery.

However, there are a few exceptions to this. In eyelid drooping caused by trauma to the eye, if there is no muscle or nerve damage due to a cutting injury, the eyelid may return to its original state within 2-3 months. In these types of traumatic cases, an oculoplastic evaluation is crucial, as an experienced physician can determine whether emergency surgery is needed or if the damage is minor and will heal on its own.

Another situation that may resolve on its own is eyelid drooping that occurs very rarely after Botox injections. No matter how severe, ptosis caused by Botox injections will completely and spontaneously resolve within 1-2 months without causing any harm. If the process is desired to be accelerated, temporary treatments can be applied with drops prescribed by ophthalmologists or Botox injections aimed at relaxing the muscle that closes the eyelid.

Though rare, eyelid drooping in young patients related to contact lens use can improve partially or fully if the lenses have not been used for a long time, and if the drooping is about 1-2mm. In these cases, discontinuing contact lens use for a while and then teaching the patient how to wear the lens without touching the upper eyelid can lead to partial or full improvement.

How is Eyelid Drooping 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.