Bulletin Board for Patient's Questions and Answers
Eyelid Surgery for Drooping (Ptosis)

Explore what others have to say about eyelid surgery for drooping (ptosis) with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

Reconstructive Reconstructive Surgery Hand Hand and Nerve Cosmetic Cosmetic aesthetic Congenital Breast Breast Breast Head & Neck plastic surgeon Skin Cancer skin cancer Microsurgery

This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Eyelid Surgery for Drooping (Ptosis)

Subj: RE: Ptosis

Have you had any experience with Ptosis in children? Please post message or E-Mail: Internet: x Thanks, Kathy

Dr. Bermant comments:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. Yes I have experience in this problem as should any well trained Plastic & Reconstructive Surgeon. Ptosis is a condition of the eyelid where it does not raise well above the pupil enough for good vision. There are various types of ptosis and each form can present to various degrees. Congenital ptosis (a form than may be what you are talking about) is most commonly from a defect of the muscle that lifts the eyelid. Most cases occur randomly but some may reoccur in certain families. (There are other conditions that also have low eyelids that have other genetic patterns.) 3/4 of patients have only one eyelid involved while the remaining have both sides affected. The muscle does not pull well enough nor relax well resulting in the lid drooping and covering the pupil to a varying degree. If the degree of involvement is severe enough, surgery may be indicated. The type of surgery depends on the degree and the actual problem. Your child will need an examination by a competent physician trained to handle this type of problem. In your community this can be either an ophthalmologist or plastic surgeon. Not all surgeons of any one specialty have the same training nor practice. The American Society of Plastic and Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

Good luck

Michael Bermant, MD


Subj: Re: ptosis

I read your message posted in eyes and I have a 3 year old daughter who was born with ptosis but also they named something else called blesph.... something. She has a wide opening between her eyes on the top of her nose. The eye doctor said she will need 3 surgeries each 2 years apart and its to lift the eyelids and do plastic surgery around them to make that wide area correct. I am very nervous about this and she should have the surgery by this summer. She seems to see fine, the lids are about halfway down and she doesn't need to lift her head to see, do u think i should definitely have the surgery, or should i wait until she is older to do it? Is this safe? I am afraid she will look like a totally different little girl and I am of course afraid about the anethsia (spelled incorrectly). Please E-mail me and let me know your opinion at ..... Thank you so much, I haven't met anyone who has heard of ptosis so I was thrilled to find that message board! Hope to hear from you soon. E

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Consultation by computer mail/bulletin board is not safe nor appropriate. There is too much information missing. My typical evaluation takes 30-60 minutes face to face. Depending on the problem, the evaluation may take much more time. Your surgeon who has seen your child has a major advantage in discussing the case. Without knowing or seeing the child, my only question is if the deformity is only external or crainiofacial (involving the boney structures). If it is the latter, usually a team of crainiofacial surgeons is involved (one frequently a plastic surgeon). Ptosis alone is also possible but you talk of a wide space between the eyes. Such a displacement of the eyes can be a hypertelorism and involve more than just the skin and muscles. This can involve BIG TIME surgery and multiple operations.

Other conditions include blepharophimosis where the lids do not move well from birth. Affected individuals tend to tilt their head back to see. Surgery converts other muscles to assist in eyelid opening.

You should feel comfortable with whoever you decide to work with. Take the time to ask your questions, be patient, get your answers. If you are concerned about the recommendations, seek another opinion.

The American Society of Plastic Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. We make every effort to make our patients who come from afar comfortable during their evaluation and surgery.

Michael Bermant, MD


Subj: Re: Ptosis

I have stumbled across your web site describing Ptosis. I have a moderate case of Ptosis and would like to move in a direction to correct it. I live in the Washington, DC area. Could you please give me advice on this. Is there any doctor who you could suggest in the DC area.

Thanks

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

You will need an evaluation by a competent physician who does eyelid surgery. Generally ophthalmologists and plastic surgeons work on eyelid ptosis. Not all eyelid problems are surgical. There are a variety of surgical options depending on the actual pathology.

Our office is easily reached from the D.C. area, however you might try the yellow pages for local physicians and ask if they do ptosis work. If you plan to come to Richmond, our usual consultation and patient education time for this problem is about 1 1/2 hours.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: blepharophimosis

Dear Dr. Michael Bermant,

I visited your page in the web about "ptosis with blepharophimosis". My son F (2.5 years old) is affected by this rare defect (bilateral). According to what has been said by the physician who visited him this should be an isolated one. Neither I nor my wife have had this desease in our families.

I have been working in Japan in the last years so that I had the chance to ask also the Japanese doctors. Unfortunately no one but the Japanese have been able to define a plan talking just about "the matter of facts". This happened especially about the timing of a possible surgery, steps of the surgery (2 steps for instance according to the Japanese), number of operations during the growth (I don't want my son to undergo to many operations, as you can imagine). Somebody says that the best solution would be just to wait until he is 15. It is very strnge to me that no one was able to say for instance whether or not the muscle which devoted to rise uo the eylid works, is weak, exists ..... F has all the other muscles ok and also that which are in the eylid itself as that to close tightly it. His eyes seem to work properly. Of course he seems to be affecte by convergent strabism and to some extent this is surely due to the phimosis.

I would like to show you a couple of photoes. Can I sen a couple of them via ordinary mail to get your feedback through the web? I would like you to show a photo of the Chineese little girl some time after the surgery, why you have not shown the picture?

I look forward for hearing from you.

Yours sincerely,

Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

I would be glad to look at the photographs but without a clinical examination, I could not render much of a medical opinion. Ptosis is a dynamic problem. When evaluating the eye, I need to see how the eyelids work, how strong they move, how much they move among other things. In addition, what some may think is blepharophimosis is some other problem like hypertelorism (the orbits spread out too far). Initially I make my assessment by appearance and then feel the underlying boney structures. On appropriate cases I then order additional studies to see how much of an underlying crainiofacial problem exists. Some patients do not have a problem of eyelid movement / ptosis and do not have blepharophimos but only epicanthal folds instead.

Two surgeries for several of these problems are not that unusual. It depends on the problem and what your doctors proposed. I do not like to wait that long, and prefer to get done something to help the young patient before the 15 years you mention.

In a typical blepharophimosis patient there are problems both with the position of the medial canthus (corner of the eye near the nose), and with eyelid movement. Each has its own surgical maneuvers for correction. In crainiofacial problems a much more detailed analysis is necessary before surgical options can be discussed. Such surgery is usually very extensive. In simple epicanthal folds a single operation usually corrects this deformity.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


From: GSBMD
Subj: Re: ptosis

The most important thing to do now is to be sure the child has vision in the affected eye and is not developing amblyopia from inability to fully expose the pupil. Time is short as amblyopia is usually fixed and irrevesable by one year. Full diagnosis may require sophisticated evaluation technology. A competent pediatric ophthalmologist in a major teaching hospital should be able to diagnose and treat.

GSB


Subj: Re: Just to say thank you /re ptosis

I just wanted to send you a note of thanks for making your web site available. I live in San Diego, Ca. and was looking for additional information on eyelid ptosis. The information I found on your web site was very helpful. I have congenital eyelid ptosis and will be consulting with a local Opth . (sp) Specialist next week.

Thanks again - you are offering a available service (and I especially enjoyed the pictures from the children)

Dr. Bermant responds:

Your welcome

Please remember both ophthalmologists and plastic surgeons both work on this problem. In certain communities one may be better than the other depending on individual training and interest.

Good luck

Michael Bermant, MD


Subj: Re: PTOSIS

First sorry for my bad english,because I am Spanish. I am 18 years old,and I have a Ptosis since I became a woman when I 15 years old.It is only in my right eye,but I can see very good,and I do not have any problem with my vision,only is an appearance problem. I wanna Know if I have the surgery,Can my right eye be like my left eye?

Thank you very much for your attention.

Dr. Bermant responds:

Your English is very good. Much better than my Spanish.

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are many types of eyelid ptosis. Often the affected eye can be made to look and work like the normal eye. Sometimes some asymmetries remain, particularly with movement. It depends on the problem and what tissue is available.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD



Subj: Re: Infant with Blepharophimosis

Dear Dr. Bermant,

I have a 4 month old girl who was born with Blepharophimosis. She needs to lift her chin to see past her eyelids. A local optometrist suggested that we might be able to find someone who would give her a sling to help lift her eyelids until she is old enough to have all the corrective surgery she will need.

How do you feel about this suggestion? Do you know anyone who has done this procedure on an infant? In case you are unable to reach me at the return address, please try me at:

Thank you

Desperate Mom

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Blepharophimosis is a condition that can be variously expressed. Different patients have the problem to different degrees. When vision is blocked, correction should be done early (before 1 year old) so that the eye - brain connection can properly develop. Amblyopia - ignored vision - can be a problem. Evaluation early with a knowledgeable physician can help you determine what age surgery is best performed. I prefer to wait until the child is at least several months old to correct the more severe deformities. Lesser deformities can sometimes be done between the ages of 1-3 years of age. Most physicians who do this operation, do it on infants.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Ptosis

Dear Dr. Bermant,

I am seriously considering surgery for ptosis at this time and am in search of help/advice on what course would be best for me to follow. I provide the following background information.

I am 40 years old and have congenital ptosis of my left eyelid (I do not have amblyopia). My father also has congenital ptosis, but of his right eyelid. At about 2 years of age or so, I had eyelid surgery (in Hartford, CT) which consisted of muscle shortening/resecting (I believe it was only the levator muscle). Given my parents feedback and continuing conditions, I believe the operation had only limited success. During childhood and adolescence, my ptosis condition was noticeable, but did not bother me in as far as any sight/vision/eye problems. But, I did notice a problem with peripheral vision when playing some sports (e.g., baseball-batting). Of course, looking up was always a problem with that left eye.

At 23 years of age, I decided to have surgery again (in Rochester, NY). It is important to note that I had good vision in both eyes at that time (I think it was 20/20), a fact the doctor found quite remarkable given the ptosis. The operation performed was again muscle shortening/resecting. That operation had very limited success in my opinion (the before/after pictures were barely identifiable). The doctor found a good deal of scar tissue in the eyelid during the surgery, so his ability to see how much he was shortening/resecting the muscle was restricted (he thought he had done enough though).

As an aside, I want to point out that my father waited until he was 35 years old to have surgery and his surgery consisted of fascia suspension. While it is noticeable that his right ptosis eyelid works differently than his normal left one (and it is slightly ajar when he sleeps at times), his surgery (which was in 1962) could be categorized as successful I believe. He still has a good field of sight with that eye at 70 years of age.

At 36 years of age (1991), I began to notice a slight loss of vision (I went to Grad school at 28 years old and began working extensively with computers), so I had an eye exam and got glasses. The eye doctor noticed a slight stigmatism in my left eye (the one with ptosis). Once I had glasses, I noticed that my left eye continued to deteriorate some. At the time of my last eye exam, the stigmatism was a bit worse.

Over the last year, I've had more trouble with my ptosis eye. I spend a great deal of time working at computers and my left eye waters and actually hurts at certain times. Furthermore, it seems that my ptosis has gotten a bit worse and sometimes I can actually feel the weight of my eyelid on my eyeball (growing up, I rarely felt that-in fact, I often forgot I had the condition altogether since I didn't feel it). Of course, this is at its worse when I'm tired.

So, with that information, I am writing for your opinion on where I should go and what type of procedure might be best (of course I realize I will need to be examined). As you will note from the information herein, the other surgeries(particularly the last one) have left me a bit sceptical about the potential for success with my ptosis. I currently reside in Alexandria, Virginia and have Blue Cross/Blue Shield/Standard Option for insurance (having insurance cover a significant portion of any procedure is important to me-my vision is being affected and I am not considering this for merely cosmetic purposes). I thank you in advance for your consideration and time.

Dr. Bermant responds
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

You need an exam and evaluation by a competent physician who feels comfortable handling such problems. How much movement does you lid still have? Are there any signs that the muscle attachment to the lid has partially disrupted? Is there extra skin or tissue in your lids that overworks the muscle? Is your brow drooping such that the muscle is forced to do additional work? (All of these questions are rhetorical.)

Eyelid ptosis can frequently be corrected by shortening the levator muscle. What operation is best is determined by an examination and evaluation. Overshortening the levator muscle can also be a problem. A sling from the eyelid to the brow muscle (frontalis) in some cases give an assist to eyelid opening. Sometimes a blepharoplasty or brow lift are valuable options. Any surgery can not compete with time and changing anatomy. Gravity continues to drag our tissues down. Such pull can sometimes overcome marginal function recreating the original problem.

Yes we participate in the Blue Cross plans.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: ptosis

Dear Doctor,

I suspect, but have no way of knowing for sure, that my 7 month old boy has a form of levator disshenisence (sp?) I am from a small area in Canada and my baby's ophthalmologist has had very little experience with ptosis and none with birth-related ptosis. In a nutshell, this is my story... My seven month old son has ptosis of the right eye (he opens his eye halfway, has consistent swelling of that eyelid particularly at naptime, has two creases in lid - one symmetrical with good lid and one just below brow bone, has normal eyeball movement but not full eyelid range of movement i.e., cannot lift it fully. At birth, he looked like a boxer who took a lot of punches to the right side of face. Forceps were not used, but the labour and delivery was very lengthy. My baby went into distress and needed to be placed in an oxygenated isolette for 12 hours. His nose was literally twice the size it is now and his lids were very puffy and bruised. He didn't open his right lid at all for two weeks and then gradually improved over a period of several months. My husband and I are very concerned that in a few years, the RIGHT surgery be performed. My question to you is what are the symptoms of a levator disinsertion as opposed to a weak levator muscle? Also, why do you think our baby's ptotic eyelid consistently swells when he naps with that side down (the swelling is considerable, has happened since birth and subsides a few hours after he awakens)? Thanks so much for any info you can provide. -

Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are several reasons for an eyelid not opening well at birth. The levator muscle which lifts the lid may not be attached to the lid, be malformed, not be innervated (the nerve that makes the muscle move be injured or not developed, or just be weakened. There may be too much material for the muscle to move the lid (such as in a hemangioma or growth of blood vessels causing a colored mass like shape in the skin). Having the child examined by a doctor comfortable with eyelid problems is the best way to find out what should be done AND WHEN.

An eyelid covering the pupil during the first year of life can cause vision problems (the brain fails to incorporate the image from covered eye - amblyopia). This problem occurs when the lid does not uncover the pupil adequately and may require intervention BEFORE the age of one year. Your ophthalmologist should be able to help you determine if this is a factor or not. Other resources you have are a network of plastic surgeons and ophthalmologists through out Canada. Ask your doctor.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Usual Cost bleph

Hello, my name is T... and I would like to know if you could give me an estimated cost of a Blepharoplasty. The reason I need this is because I have a drooping Eyelid that was caused by surgery and be- cause I might have to pay this cost out of my own pockets. Thank-You.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are many operations that could be called "blepharoplasty" and each has a different price which also varies if for one or both eyelids. Drooping eyelids come under another surgical category (ptosis). This also has several different surgical options.

In short it is difficult to advise you a price without an evaluation to determine what type of surgery. Prices also vary in different parts of the country.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: congenital ptosis

Dear Doctor Bermant,

I was so glad to chance upon your website. You can just imagine the lack of information and good specialized surgeons we have here in Asia. We also don't have government assistance or policies. So parents with afflicted children are largely left on their own.

Pls. give me more details about ptosis. My daughter was born with both eyes drooping. She is 4 years old and I haven't had a doctor touched her yet. I just let them examine her.

She is a very active, bright and smart girl. She has no developmental delays as of now. And she is very mobile. Does she really need to be operated? She is very much a normal child. The only clue to her disability is that she tilts her head to look at something. But she appears to see clearly many small things and details.

Doctors here recommend surgery but to be blunt, I have no faith in them. They are very radical and mostly unconcerned with their patients. They give injections for even mild childhood diseases! Some even ordered for blood sample for her general anesthesia on the first visit! No talks, no discussions. This is the way here.

Pls, are there serious risks involved during and after the operation? What are its chances of success? Will she undergo not just 1 operation in her lifetime?

I am still very brokenhearted and worried about my child. Pls. help me, I need some very encouraging advice.

Thank you in advance.

Desperate mom,

T

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are many types of eyelid ptosis as you found on my website. Each type can be present to various degrees. At 4 years of age the connections between the retina (seeing portion of the eyes) and the brain have already formed. Eyelid surgery is essential in the very young when the eyelids block the pupils such that these connections do not form well. After that issue, eyelid surgery can readjust the lids to a more natural resting state. The child tilts her head back to compensate for the lids not raising enough. This compensation sometimes is not enough or can be a problem.

Eyelid surgery methods depends on how well the eyelid muscles function. If they are working enough to produce eyelid movement, removing some of the length of the muscle can reset the lids to a more normal condition. Sometimes other factors are causing the problems like the blepharophimosis case shown. Other times the muscles do not work well enough and other muscles are asked to assist.

Risks depend on what surgery is performed and are usually not very severe. The most common is a mismatch or misadjustment requiring a revision of the heights of the lids. Other complications including severe ones are possible but not very common. A risk discussion is best carried out with the doctor doing the surgery, and for my patients this happens after an examination and evaluation.

In my practice patient and family education are very important. We do see patients from all over the world.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Ophthalmoplegia

Dear Dr. Bermant,

My name is LL and I am 18 years old. I have had ophthalmic pledgia all of my life. This causes Ptosis of my upper eyelid. This has been a great interference in my life. I have been searching for a way to correct it, and I stumbled upon your webpage. I would so appreciate any information you can send me on how to correct this problem. Please help me.

Thank you,

L L

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Just keeping the eye open can damage the eye surface. The eye needs protection from a moving upper eyelid.

The eyelid muscles need nerves to activate them. There are many conditions where these nerves do not work. Ophthalmoplegia is the paralysis of one or more of the motor nerves of the eye. Different nerve branches can be involved causing different problems. When the branch to the levator muscle is not working the eyelid does not open well (ptosis). If the frontalis muscle (brow lifting muscle) still works, a sling can sometimes be fashioned to assist in eyelid function. The function cannot work as smoothly as what the levator muscle would do, but after learning how to move the brow in order to get the lid open most patients are happy.

To see if you are a candidate for correction of your problem you would need a consultation and evaluation.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Blepharophimosis

Dr. Bermant,

I just finished looking through your web-site and noticed the girl who had blepharophimosis. My 5 month old grand-daughter was diagnosed with the same problem only today. I am totally devastated! No one in either family has had this defect before. I had never heard of this disorder. Do you know of any place I can learn more about this? I am curious as to how many children are born like this. The opthamologist we took her to would like to do surgery only to string-up the lids. I don't feel this will correct the whole problem. Have you done this type of corrective surgery often? Please advise us on this, we don't know where to go for answers.

Sincerely,

V M

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

I designed my web page to offer some information about this condition. There is not much public information about blepharophimosis, I recently added a web resource that may be of value, please check it out. The doctor's office is the next best place to go to learn about this condition. Blepharophimosis is a group of problems that can affect each patient to different degrees. The treatment recommendations have to be designed for that patient own needs.

Yes I have done this surgery and feel comfortable offering it, but the problem is rare and no I have not done "it often".

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: ptosis

Dear Dr. Bermant,

Thank you for your immediate response. I was down with a flu these few days so wasn't able to respond sooner.

I am still taking in more information on my daughter's condition, could you direct me to more sources for her condition? (websites, books, articles?)

I have also used the plastic surgeon referral site for a list of plastic surgeons in Taiwan. I have already consulted the doctors listed. With all due respect, I am not comfortable with them, only 2 of them. I tried to look for specialists in the Philippines, since I think they might have better specialists there, but none are listed. Could you refer me to good eye plastic surgeons in Asia (preferably Philippines and Singapore) but if none, I may need your assistance in the area of America.

I know I have to bring my daughter with me, and I have already prepared myself to do so. I will do whatever it takes to give her a better future.

Please give me your best recommedation for best eye surgeons. The reason I am pleading with you for your recommendation is because I have an idea on the operation my daughter has to undergo. Her eyelids will be suspended because she has no or little muscle movement on her eyelid. But I was told that her eyes may not close completely, after the operation. I am so scared for her. This may lead to ulcers, whitening and eventually blindness. So I need a very very good eye surgeon. Failure cannot be an option here. She is just a little girl with a whole future right in front of her. If the doctors I have so far consulted cannot guarantee that her eyes will close completely, why should I let her undergo the operation and let her be possibly blind?

Once again, I am thanking you for your kindness and help to me and everyone.

Best regards,

T

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are no guarantees in medicine, and no good surgeon I know offers any. Failures never are desirable but do occur even in the best of hands. Blepharophimosis correction occasionally does need an adjustment. It IS the NATURE of the operation and the variables of a frontalis sling. Good doctors explain the surgery, risks, benefits and alternative methods of care.

My skills and educational experiences for my patients are all I have to offer. I am sorry, I do not have the time to be a referral service.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: daughter's ptosis

Dear Dr. Bermant,

I appreciate your advice and frank comments regarding my daughter's condition. I will research further and plan a course of action to take. I hope I will do the right thing for her sake.

Thank you once again and more power to your contribution to the world.

Sincerely,

T

Good luck and let us know if our office can be of assistance.

Michael Bermant, MD


Subj: Re: ptosis info

I hope you can help me. About 8 months ago, I noticed that after sleeping my right eye would not open. After "blinking" several times it opened. This happends usually after sleep. I went to see an Ophthalmologist. He several test...he though maybe it was M.G. but is puzzled that it occurs "after my eye is rested". He said he also checked my pupils, and did not think it was Horner's syndrome. He sent me to see a Neurologist. Since Im not having any headaches, he wants to take the "wait and see" approach. That was 4 months ago. I have noticed that sometimes after my eye opens, my vision is very blurry or foggy. My eye usually feels very dry and irriated and at times it aches. Also, at night "before" sleep, my eye will feel hard to move from side to side. Neither Dr. seems to know what to do, and both have said that they have never heard of a case where ptosis has occured "after sleep". I had 3/4 of my thyroid removed due to a non-cancerous tumor three years ago. Any information would be helpful.

Thank You,

B

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

From your description it is difficult to understand if your problem is one of ptosis or dry eye crusting and sticking the lids together. Your doctors have had the opportunity to examine and evaluate you. Most experienced doctors know how to pick up a problem with poor tear production.

Eyelid ptosis from myasthenia gravis tends to worsen with activity and fatigue, not the first thing in the morning. I do not know of a condition that causes ptosis after sleep either. There are a number of medical conditions that can cause a problem with tear production and some are related to some thyroid conditions. Eyelid and eye problems can be the gateway to discovering general medical problems.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD



Subj: Re: eyelid ptosis

Dear Dr. Bermant,

We are from Belgium and would appreciate your advice with regard to our son of 4,5 years old. He has a congenital bilateral ptosis. There has been a surgery when he was 3,5 years at both eyelids. The muscles of his eyelids don't work and the doctor has placed some synthetic material to replace the muscles. There was a little improvement but the surgery has to be done again as soon as possible. His view is good (it was already before the surgery) but he has to lift his chin and the risk of malformation of his vertebral column becomes higher. Doctors will now take a membrane of a muscle in his leg and use it to pull up his eyelids. As we don't find any information on this method of surgery we would appreciate your opinion. Many thanks in advance.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

When the eyelid muscles do not work well enough to lift the eyelids, some patients are candidates to borrow lifting power from muscles that normal lift the eyebrow. Slings that connect the eyelid to a section of eyebrow muscle can be made from synthetic material or something thin and strong from the body. The fascia lata is a thin tough layer of the thigh that covers thigh muscles. This tissue is a common source of donor material for several types of surgery.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: ptosis

Terrific Web Pages Dr.

I viewed all the photos of patients with drooping of the upper eye lid. I had some tightening once but now as I get older and have lost weight I am drooping more. The problem is that my opthalmologist says the eyeball protudes more than the other and thinks that the eyelid can not be raised any more. I disagree, as my father had his done when he was 75 years old. I know the lid can be raised, but in the event that it can not cover a bulging eye, what do you do? Of course this congenital defect has been the bane of my existance. But now it is interfering with my eyesight. Since the eyebal is held by muscles is it possible to tighten some so that the eyeball can recede. This prominent eye is really not that noticeable, but the eyelid is.

Thank you for a reply,

R

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The function of the upper eyelid is to protect the eye, help get the lubrication across the surface, and get out of the way so that the eye can see. With ptosis the eyelid muscle is not doing as good a job of getting out of the way. Congenital ptosis may have several forms as you saw on my web pages. One surgical correction is by shortening the eyelid raising muscle (levator). It depends on how much this muscle is able to move the lid. Remove too much and the eye does not close well and there goes the protection. In some patients during aging, the attachment of the eyelid muscle to the eye thins out causing the eyelid to droop. This problem can happen to both the congenital ptosis patient as well as the normal population. In some patients it is not shortening the muscle as much as reattaching it. With a protruding eyeball, the eyelid muscle has to do extra work to get around the globe to close and protect it.

Your doctor has had the chance to evaluate and examine you. Without such an examination, I would be foolish to comment otherwise. Over aggressive surgery may leave you miserable with less eye protection. A conservative approach is reasonable. Has anyone evaluated the protruding eye as to why? Is it a general weakness of all the muscles of that area, an anatomical variant, or a medical condition that needs an evaluation? You may want to ask such questions of your doctor.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

 

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