Is there any difference in treating older patients as opposed to treating a younger patient for Ptosis?

There is certainly a difference between older patients and younger patients when it comes to any surgery, and that includes plastic surgery and cosmetic surgery. Here are some of the differences which may be present.

1. Diagnosis. Elderly patients tend to have senile ptosis which is a dehiscence of the levator mechanism for eyelid opening. The may have excessive upper eyelid skin and that would need skin excision and an open incision approach. Younger patients may have subclinical ptosis or milder forms of ptosis. Some cases of congenital ptosis (from birth) can be very challenging to treat. In younger patients there is usually less excess skin and sometimes no skin needs to be removed during surgery, just tightening of the levator mechanism.

2. Recovery. In the older patient, the recovery can take a bit longer due to the age and also the increased complexity of the surgery. The swelling will take a bit longer to resolve.

3. Medical conditions. Older patients may have underlying medical conditions. Most of these will not interfere with ptosis correction surgery. However there are some that do. Do inform your doctor of your medical condition, previous surgery especially eye surgery and the list of medications that you are on. Some of the common conditions that may affect include

• Patients who are on blood thinners or are taking supplements such as ginseng, garlic etc will need to have their medications reviewed before surgery.

• Patients who have high blood pressure will need to have their blood pressures controlled and continue with the morning medication before coming for surgery.

• Patients who are smoking will be advised to stop smoking 2 weeks before surgery to optimise wound healing.

Hope this helps and All the best on your journey!

It starts from the beginning, the older patients have a high chance of having medical problems, so we gotta make sure that they are medically healthy and are not on certain medications or blood thinners, so you want to clear that out.

The second thing is older patients tend to have more looser skin and are likely to have to live with this droopy eyelid for a long period of time that plays a role in recovery. Which means that let us say in a younger patient versus an older patient, the older patient has to remove more skin and I may have to do a lot more tightening, therefore, the recovery is expected to be longer. So, I do see that in my comparison that the older patients take longer for the swelling to come down in recovery. It is not something unexpected.

Yes, the type of procedure done may be very different, as the causes of ptosis are likely to be different.

In an older patient, the ptosis is more likely to be due to stretching out or thinning of the levator muscle attachments. This can usually be corrected by re-attaching the levator muscle which will restore function.

In very young patients with congenital ptosis, muscle function may be very weak and may require different procedures, for example static or dynamic slings which recruit the help of other muscles to improve eye opening.