Ptosis evaluation and management.

Drooping of the upper eyelids is one of the most common complaints in oculoplastic practice. Other related complaints include difficulty seeing due to the attendant visual field obstruction and prefrontal headaches due to chronic use of the frontalis muscle in an attempt to lift the eyelids [1]. This anatomic and morphologic state is termed ptosis, from the Greek ‘‘to fall.’’ Ptosis causes a simultaneous cosmetic deformity that is apparent both to the patient and to others. A recent study suggested that photographs of patients with droopy lids are subjectively perceived by others as less intelligent and more negatively than their counterparts when compared with photographs after having undergone ptosis correction [2]. Ptosis surgery can be challenging for even the most experienced eye and facial plastic surgeon. The rate of reoperation in most series of acquired ptosis varies from 5% to 35% [3–5]. The correction of ptosis of more complex etiology, and congenital ptosis may even be more elusive. To minimize reoperations and maximize postoperative symmetry, detailed preoperative assessment and intraoperative anatomic dissection with respect to tissue planes and hemostasis are necessary. This article discusses some of the more common types of ptosis and provides an introduction to the evaluation and management of the ptosis patient. Complications of ptosis surgery and recent innovations in ptosis surgery are discussed.