Question
A patient has had bilateral moderate droopy eyelids since birth, accompanied by deep forehead lines, limited upward gaze, inverted eyelashes, and skin tags around the inner corners of the eyes. The patient is hesitant about surgical treatment and worries about uneven eye sizes or recurrence of drooping after surgery.
Answer
Surgical treatment for droopy eyelids typically begins with anesthesia. During the procedure, the doctor will cut through the skin and subcutaneous tissue along pre-designed lines, excising the orbicularis oculi muscle in front of the eyelid plate while retaining a single strip of orbital muscle along the eyelid margin. Next, the upper eyelid is pulled down, and the incision is lifted upwards, continuing to separate within the orbital septum. An eyelid protector is placed at the separated upper eyelid levator aponeurosis to support the upper eyelid. A specialized periosteal elevator is inserted into the subconjunctival submucosal tunnel to elevate the upper eyelid edge to the anticipated correction height, while pulling the upper eyelid levator downward. The doctor will ask the patient to look upwards horizontally to observe the height and curve of the upper eyelid line.