Hello!                                                                                                                                Ptosis can be mild, moderate or severe as shown in these photographs. In your case, the ptosis is 'severe'. Here is useful information that is specifically applicable to 'severe' ptosis by birth.

What is the cause of severe ptosis?                                                                                      Severe ptosis is most commonly caused by a birth defect. The muscle that lifts the eyelid does not develop well, leading to a droopy eyelid. It is like a curtain that does not have a functioning string in it. In children less than 10 years old, severe ptosis can affect vision. In adults, it is mostly a cosmetic issue. 

                                                                                             

Surgery for severe ptosis                                                                                                                         For severe ptosis, there are two surgical options:
a) Tighten the existing eyelid muscle (levator resection): This is performed through a hidden incision in the upper eyelid fold and does not involve any marks on the brow.

b) Connect eyelid muscle to the brow muscles (Sling surgery): This involves 2-3 small marks over the eyebrow, to pass a thread/silicone string to connect the two muscles.
The right option is chosen by a complete evaluation. Both procedures take 30 minutes to an hour and get done in a single day as an out-patient procedure. Hospital admission is not required.                                      

Preparation for your surgery                                                                                                During your consultation, we measure the eyelid aperture, and muscle function (levator function), which decides the severity of the ptosis. A few blood tests are mandatory for anesthesia fitness. All this can be done in a day or two, prior to surgery. If sling surgery is being planned, we will discuss various options of sling material.       

                                                                                                                                                                       

Charges                                                                                                                                         To give an exact estimate, I first need to measure your eye findings. The extent of surgery (and therefore its cost) is dependent on measurements. However,  a rough range of costing would range from  33,000 INR to 1,22,900 INR, depending upon type of surgery, type of anaesthesia, and the service package chosen. The differences in the packages will be explained to you by the councelor after your check-up. I can send you the differences between packages via email if you wish. 

General anesthesia (required for children and apprehensive patients) and hospital room charges will be additional, nominal, and charged separately if applicable.

How many visits will you need?                                                                                           Ptosis surgery is not a one-day process, and follow-up visits are important. The typical visit schedule is:                    

Pre-Surgery check-up: Day 0                                                                                               Surgery day: Day 1                                                                                                                   Post-op check-1:  At 2 weeks                                                                                                   Post-op Check-2: At 2 months                                                                                                                                   

Recovery                                                                                                                                                   We understand, that it is important to know how soon can you get back to work, or how soon can you look normal? Here is a short outline of the expected recovery:  

Week 1: Your eyelids will have swelling, bruising, and minimal pain. There will be watering, but you can perform visual tasks and indoor activities. Gym and jogging to be avoided.                                                            

Week 2: Pain will be gone, and swelling would have reduced by 60-80%. You can get back to outdoor activities and routine work along with gym or jogging.                                             Week 3-6: You would see swelling only in the morning hours, and the rest of the day would be fine.                                                                                                                                           Week 12: Complete healing, with no swelling. if any stitch adjustment is to be done, it is ideally done at this time.

Drawbacks and complications                                                                                             When the drooping is severe and since birth (as is in your case), surgery will lead to incomplete closure of the eye, including a visible gap between the two eyelids during sleep. Moreover, the average life of a sling surgery is 2-4 years, and it needs revision thereafter over the lifetime to maintain the lid height. It is important for you to understand, that one surgery won't last a lifetime. In 1% of cases, the eye may not be able to tolerate the incomplete closure, and a reversal of the surgery may be needed to avoid a permanent scar on the cornea. The eyelid position can be too high or too low  in 5% of cases and can be improved by stitch readjustment.

Stitch readjustment                                                                                                                Ptosis surgery is not an exact science. Despite our best efforts, sometimes the lid position does not appear perfect due to individual differences in healing. In 5% of cases, you may have over/under-correction. This is corrected by stitch adjustment at the 6-12 week visit or later.

Stitch adjustment is not a re-surgery. We simply adjust the internal stitch to correct the asymmetry. In most cases, a single stitch adjustment may suffice. Rarely, more than 1 may be required. Complete healing and return to normalcy may take up to 6-12 weeks.

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Before and After photos explaining what to expect in 'severe' ptosis