Ptosis correction — a different operation from double eyelid surgery, and it is not about skin

An eye can look small for several reasons. Eyelid skin may hang over it, or the muscle that lifts the lid may be weak, or its attachment to the lid may be loose. The second is ptosis.

The two look similar from outside but what has to be fixed is different. Do only double eyelid surgery on a muscle problem and you get a crease without a bigger eye. Trim only skin on a muscle problem and the result sits awkwardly in between.

The operation advances and re-fixes the muscle's attachment to the tarsal plate, or shortens a structure behind it. A crease is often created at the same time, so the two are done in one sitting — but they are separate operations.

It is done under local anaesthetic, often asking you to open your eyes during surgery so the height can be set.

Exact symmetry is hard. The two eyes differ in lifting strength to begin with, and anaesthetic and swelling both affect that strength. A height set during surgery is not guaranteed to hold once the swelling goes.

Over-correction and under-correction are both common. Lift too much and the eye does not close fully, drying the cornea overnight; lift too little and the reason you came is still there.

Judge the result at three to six months. While swelling remains it usually looks opened too far.

If the eye does not close fully afterwards, if it becomes severely dry, or if one side is noticeably different, do not put it all down to swelling. Tell the surgeon who operated.

Establish the cause first. Whether skin is covering the eye or the lifting muscle is weak decides which operation you need. If you habitually use your forehead to open your eyes — brows riding up, lines across the forehead — that points toward the muscle.

A more modest height is safer. Undoing an eye opened too far is harder than opening one a little more.

You will need artificial tears for a while. A more open eye has more surface to dry out.

Say in advance if you wore hard contact lenses for years. That can be why the attachment loosened, and it changes the plan.

How much can be undone is limited. An adjusted attachment can be reoperated and moved, but it is harder to work with the second time and there is less tissue.

Revision is not rare. Coming back over asymmetry or height is relatively common with this operation. It is better to have counted on that possibility in advance.

If a bigger-looking eye is the goal, note that the impression is not made by the eye alone. Brow position, shadow under the eye and the proportions of the whole face all work together.

Whether to have it done is settled with a doctor.