From sleepy-looking eyes to clear, open-looking eyes
Ptosis correction is a surgery that reveals the pupil covered by the eyelid, either by pulling and fixing the tendon sheet of the stretched eye-opening muscle or by reducing an accessory muscle.
If you opened this page because your eyes keep looking sleepy and you strain your forehead to open them, we will start by showing you the basic information.
The causes of droopy eyes and the criteria for choosing a surgery are summarized in Causes of Droopy Eyes and Criteria for Choosing Surgery.
This is a surgery that corrects blepharoptosis, a condition in which the force of the eye-opening muscle is not transmitted well to the eyelid or is weak, so that the upper eyelid covers the pupil.
This surgery goes by two names, which can be confusing, so we will clarify them first.
'Ptosis correction' is the commonly used name. The medical term is blepharoptosis repair. On this page, the two names are used for the same surgery.
Blepharoptosis is different from sagging skin. When the skin sags, the edge of the eyelid is in its normal position and the skin above it covers the eye. In blepharoptosis, the edge of the eyelid itself has dropped.
Blepharoptosis is a condition in which the edge of the upper eyelid sits lower than its normal position and covers the cornea (the dark part of the eye) and the pupil. The upper eyelid is lifted by the levator palpebrae superioris (the muscle that opens the eye) and Müller's muscle (a thin muscle that assists in raising the eyelid). The levator palpebrae superioris ends in a broad tendon sheet (aponeurosis) that attaches to the tarsus (the firm plate inside the eyelid).
Acquired blepharoptosis in adults is commonly aponeurotic blepharoptosis, which occurs when this aponeurosis stretches or detaches from the tarsus[1]. In aponeurotic blepharoptosis, the strength of the muscle itself is often preserved, and the double eyelid line is often seen to have moved higher.
In simple terms — The muscle that lifts the eyelid ends in a broad sheet attached to the eyelid. With age, this sheet can stretch or detach. The muscle still moves, but its force is not transmitted well to the eyelid, so the eye does not open as far.
A Word from the Doctor
"Even blepharoptosis that does not look very severe to other people can feel very uncomfortable to the person who has it."
If the strength of the eye-opening muscle is lacking from birth, it is hard to open the eyes naturally, and the dark pupil is largely covered, giving a sleepy look. The same appearance can occur when the muscle that lifts the eyelid has stretched with age. Ptosis correction is a surgery that adjusts how much of the dark pupil and the white of the eye are exposed, to make the eye shape clearer.
In consultations for double eyelid surgery, there are cases where eye-opening strength is weak and blepharoptosis correction needs to be done together. We recommend ptosis correction together only in cases where double eyelid surgery alone could look unnatural.
Ptosis correction is a surgery that improves eye-opening strength by adjusting the eye-opening muscle. When eye-opening strength improves, there is no need to use the forehead to open the eyes, and forehead wrinkles also naturally improve. The squinting, half-lidded look lessens, and you can have a much clearer impression.
※ This condition differs from person to person and can be determined after a close and careful examination.
Blepharoptosis in adults is often caused by the tendon sheet of the eye-opening muscle stretching with age.
However, the reasons the eyelid droops are not all the same.
Acquired blepharoptosis is divided by cause into aponeurotic (the tendon sheet stretches or detaches), neurogenic (a problem with the nerves that move the eyelid — oculomotor nerve palsy, Horner syndrome, etc.), myogenic (a disease of the muscle itself — myasthenia gravis, etc.), and mechanical (a tumor, scar, or swelling pressing on the eyelid). Known factors associated with aponeurotic blepharoptosis include aging, long-term contact lens wear, and previous eye surgery. Congenital blepharoptosis, which is present from birth, results from abnormal muscle development, and the muscle strength is often weak[1].
In simple terms — Divided into common and uncommon cases, it looks like this.
In the cases below, there is something to check before a surgical consultation.
If the eyelid suddenly droops together with double vision, unequal pupil sizes in the two eyes, or pain around the eye with a headache, it may be a cranial nerve abnormality, and brain imaging should be done promptly[1][2]. In this case, do not wait for a plastic surgery visit; call 119 (emergency services) or go to an emergency room, regardless of the time.
If the eyelid droops more toward the evening during the day and improves with rest, causes such as myasthenia gravis (a disease in which muscles tire easily) are checked first[1].
It is considered when the edge of the eyelid covers the pupil and you have to use your forehead to open your eyes.
Read the list below while picturing your own eyes in the mirror. If any apply to you, we will check at the consultation whether ptosis correction is right for you.
When your eyes feel uncomfortable
When you are concerned about how your eyes look
A Word from the Doctor
"It is not easy to think that the cause of forehead wrinkles lies in the eyes. Carefully identifying the cause through an accurate diagnosis is important."
Cases where ptosis correction is done together with double eyelid surgery are also explained on this page. Double eyelid surgery itself is covered in Double Eyelid and Canthoplasty information.
If eye-opening strength is weak, it is ptosis correction; if excess skin remains, it is upper blepharoplasty or under-brow incision. If both are present, the two surgeries may be done together.
The three surgeries work on similar areas and are easy to confuse. We have sorted them by eye condition in the table.
| Eye condition | Suitable surgery | Incision site | What the surgery does |
|---|---|---|---|
| The problem is not the skin but that the eye-opening force is not transmitted well to the eyelid, so the edge of the eyelid covers the pupil | Ptosis correction (blepharoptosis correction, this page) | For skin-side incisional ptosis correction, the double eyelid line; for conjunctival-side non-incisional ptosis correction, the inside of the eyelid (conjunctiva) | The skin side pulls and fixes the tendon sheet of the stretched eye-opening muscle. The conjunctival side reduces the accessory muscle inside the eyelid (Müller's muscle) |
| Stretched skin covers the entire eye, all the way to the inner corner near the nose | Upper Blepharoplasty information | Double eyelid line (eyelid crease) | Excess skin is cut away at the crease line |
| Stretched upper eyelid skin mainly covers the outer corner of the eye. The eyelid skin tends to be thick | Under-Brow Incision (Sub-Brow Lift) Surgery information. Upper blepharoplasty is also possible | Border below the eyebrow | Excess skin close to the eyebrow is cut away |
| The eyebrow itself has dropped considerably and presses on the eyelid | Surgery to raise the forehead or eyebrows is discussed together | — | — |
If only the skin is cut away, the problem of weak eye-opening strength remains. Conversely, if only the muscle is pulled, the excess skin may continue to cover the eye.
Which of the two surgeries is right is decided through an examination. The selection criteria are summarized in more detail in Causes of Drooping Eyes and Criteria for Choosing Surgery.
We perform both skin-side incisional ptosis correction and conjunctival-side non-incisional ptosis correction. The choice depends on the degree of drooping and muscle strength.
"Incisional or non-incisional?" is a question we often hear at consultations. First, here is a table showing the differences between the two methods.
| Type | Skin-side incisional ptosis correction | Conjunctival-side non-incisional ptosis correction |
|---|---|---|
| Point of entry | The skin is incised along the double eyelid line | The eyelid is flipped over and entered from the inside (conjunctiva) |
| What the surgery does | The tendon sheet of the stretched eye-opening muscle is pulled and re-fixed to the tarsus | The accessory muscle inside the eyelid (Müller's muscle) and part of the conjunctiva are reduced |
| Outer skin | An incision scar remains along the double eyelid line, and a double eyelid line forms at that site | Because the skin is not incised, there is no incision line on the outer skin |
| When it is mainly used | When some function of the eye-opening muscle remains. Excess skin can be addressed at the same time | When the drooping is mild to moderate and the eye-opening muscle function is good |
| Stitches | The skin stitches are removed on day 7 after surgery |
Two main approaches are used in surgery for adult aponeurotic blepharoptosis. The skin approach (the skin-side incisional ptosis correction on this page) incises the double eyelid line, finds the levator aponeurosis, and pulls it forward to re-fix it to the tarsus (levator advancement). The conjunctival approach (the conjunctival-side non-incisional ptosis correction on this page) flips the eyelid over and cuts to reduce Müller's muscle and part of the conjunctiva from the inside (Müller muscle–conjunctival resection).
The conjunctival approach leaves no skin scar and is mainly used when the drooping is mild and muscle function is good. When levator function is very weak, frontalis suspension (connecting the eyelid to the forehead muscle) is used[1][4].
In simple terms — There are two methods.
Which method is right is decided by looking at the degree of drooping and muscle strength.
Which of the two methods is right is decided through an examination. It does not mean that either one is better.
The method and target height are decided through an examination, and surgery is performed, usually after local anesthesia. Surgery takes about 1 to 2 hours.
Since it may feel vague the first time, we have laid it out step by step.
| Step | Details |
|---|---|
| 1. Examination and design | We measure the degree of drooping and muscle strength, and decide the method, target height, and incision line |
| 2. Anesthesia | Local anesthesia is usually used. Sedation can also be added if needed |
| 3. Muscle correction | In skin-side incisional ptosis correction, the stretched tendon sheet is pulled and fixed to the tarsus. In conjunctival-side non-incisional ptosis correction, the accessory muscle inside the eyelid is reduced |
| 4. Height check | In skin-side incisional ptosis correction, you are asked to open your eyes during surgery so that height, left-right balance, and the eyelid curve can be checked |
| 5. Closure and going home | In skin-side incisional ptosis correction, the double eyelid line is stitched. |
For skin-side incisional ptosis correction, the stitches are removed on day 7 after surgery, and bruising and swelling are worst in the first few days and then gradually subside. It takes several months for the eyelid height and curve to settle.
If you have work or an important appointment coming up, this is probably what you most want to know. We have written it by time point.
| Time point | Status |
|---|---|
| Day of surgery to a few days | The eyelids may swell and bruise. Because of the swelling, the eyes may open less or close less fully |
| Day 7 | For skin-side incisional ptosis correction, the skin stitches are removed |
| Most bruising and swelling subsides | |
| Several months | Eyelid height and curve settle into place |
| After 6 months | We decide whether revision surgery is needed |
| Activity | Time point |
|---|---|
| Going to work | |
| Washing your face | |
| Eye makeup · Contact lenses |
While there is swelling, the left and right heights may look different. The speed of recovery differs from person to person. If you have an important schedule, please tell us in advance at the consultation.
High blood pressure, aspirin use before and after surgery, vomiting after surgery, and increased activity have been reported as common factors in patients who developed the complication of blood collecting after eyelid surgery[8]. For that reason, strenuous activity is avoided for several days after surgery.
While the swelling goes down, if the eyes do not close fully, the surface of the eye may dry out.
Ptosis correction is generally the method used for eyes with 'blepharoptosis,' that is, when the muscle that lifts the eyelid is weak.
— Dr. Park Jung Keun, Plastic Surgery Specialist · Face Plus Talk
When consulting about eye surgery, there are cases where simply doing double eyelid surgery alone is not enough. If the eye-opening strength is weak, that is, if there is blepharoptosis, it needs to be corrected. It is commonly called ptosis correction surgery, and it is a surgery that corrects blepharoptosis.
If the eye-opening strength is weak, the double eyelid looks higher than in a normal eye even at the same height. Therefore, for men, who need the double eyelid set low so that it is barely visible, blepharoptosis must be corrected if present. That is what actually makes it more natural. Doing the surgery simply does not necessarily make it natural. Only by diagnosing properly and deciding the method can a good result be obtained.
At this point, people wonder whether to have incisional ptosis correction or non-incisional ptosis correction. Some people prefer the incisional method because they do not want it to come undone, while others prefer the non-incisional method because they do not want it to be noticeable. Most people say things like this when choosing between incisional and non-incisional, but these are not the criteria a plastic surgery specialist actually uses to decide on a method.
First, let's look at the difference between incisional and non-incisional ptosis correction. In incisional ptosis correction, after making an incision, a double eyelid is created and the eye-opening muscle is actually located. By manipulating the eye-opening muscle while looking at it directly, the strength is adjusted. In other words, more detailed adjustment is possible.
In contrast, non-incisional ptosis correction is not done while looking at the eye-opening muscle. Only a small hole is made and the muscle is pulled with thread by feel. Therefore, detailed manipulation like that done by direct viewing is not possible.
Ptosis correction is a surgery that improves eye-opening strength by adjusting the eye-opening muscle. When eye-opening strength improves, there is no need to use the forehead to open the eyes, and forehead wrinkles will naturally improve as well. The squinting, half-lidded look lessens, and you can have a much clearer impression.
Ptosis correction is usually done under local anesthesia, and sedation can also be added if needed.
We fully understand wanting it all to be over while you sleep soundly. However, ptosis correction sometimes requires a moment of opening your eyes.
For skin-side incisional ptosis correction, a method is used in which the surgery is done under local anesthesia and you are asked to open your eyes during surgery to set the height[5].
If you are deeply asleep, you cannot open your eyes to check. For that reason, under general anesthesia, a separate method is used to determine the height without the patient's cooperation[6].
Left-right differences, eyes that open too little or too much, and dryness from the eye not closing fully can occur, and rarely there is bleeding that threatens vision.
This is information you need to know before deciding on surgery, so we have written it out in full without shortening it.
A review article (a paper that gathers and explains multiple studies) that organized the complications of eyelid plastic surgery by time period listed, within 1 week after surgery, corneal abrasion (scratching of the surface of the dark part of the eye) and retrobulbar hemorrhage (blood collecting behind the eye), which can threaten vision; at 1 to 6 weeks, eyelid malposition, strabismus (the two eyes pointing in different directions), exposure of the eye, and epiphora (tearing); and after 6 weeks, problems with eyelid height and contour, asymmetry, scars, and long-lasting swelling[7]. This review covers eyelid plastic surgery in general.
In plain terms — it is organized by time period as follows.
When one eyelid is raised, the opposite side may look droopy. The nerve signals that raise the two eyelids move together. Because of the drooping on one side, the opposite side is also raised higher than usual; when surgery relieves one side, the drooping of the opposite side is revealed. This is called Hering's law[1].
If something feels wrong after surgery, do not put up with it on your own.
Bleeding behind the eye is reported to occur most often within 24 hours after surgery, especially within the first few hours, and in some cases it occurred a few days later[8].
Symptoms to have checked promptly
Outside clinic hours, do not wait: call 119 or go to the nearest emergency room.
Tell us at your next visit
So that you do not have to get through recovery alone, Dr. Park Jung Keun and the nursing team check on swelling, pain, and how you are feeling together.
They can. Once the eyelid is raised, there is less need to lift the eyebrow with the forehead.
This is a change we tell you about in advance so that you are not startled when you look in the mirror after surgery.
When the eyebrows drop, the distance between the eyebrow and the eye gets shorter, and the remaining upper eyelid skin may become more noticeable. We look at this possibility together at the consultation.
Revision surgery is considered at least 6 months after the first surgery.
We fully understand being worried when the left and right look different right after surgery.
Eyelid height and curve change over several months as the swelling goes down. For that reason, we do not judge the result by how it looks right after surgery.
Revision surgery for the eyes is explained in detail in Revision Eye Surgery information.
Yes. Typical examples are when a nerve or muscle disease may be the cause and when the eyes are severely dry. Criteria based on your health condition are checked at the consultation.
This surgery is not right for every drooping eyelid.
For neurogenic and myogenic blepharoptosis (oculomotor nerve palsy, Horner syndrome, myasthenia gravis, etc.), diagnosing and treating the underlying disease comes first[1]. Raising the eyelid can cause lagophthalmos, in which the eye does not close fully, and the resulting corneal exposure[1][7], so if your eyes are severely dry before surgery or your eye-closing strength is weak, the degree of correction is decided carefully.
In plain terms
Please tell us about all medications you take and any conditions you have at the consultation. Even things that seem minor are fine to mention.
Yes. 'Ptosis correction' is the commonly used name, and the medical term is blepharoptosis correction. Both are surgeries that reveal the pupil covered by the eyelid, either by pulling and fixing the tendon sheet of the stretched eye-opening muscle or by reducing an accessory muscle.
When the skin is sagging, the edge of the eyelid is in its normal position and the skin above it covers the eye. In blepharoptosis, the edge of the eyelid itself drops and covers the pupil. The two can also occur together, so they are distinguished through an examination. The differences between the surgeries are summarized in Comparison of the Three Surgeries.
Face Plus Plastic Surgery performs both. Skin-side incisional ptosis correction is a method in which the double eyelid line is incised and the tendon sheet of the stretched eye-opening muscle is pulled and fixed; a double eyelid line and a scar form at that site. Conjunctival-side non-incisional ptosis correction is a method that reduces the accessory muscle from the inside of the eyelid; there is no incision line on the outer skin, and it is used when the drooping is mild to moderate and muscle function is good. Which method suits you is decided through an examination. The differences are summarized in Two Surgical Methods.
When one eyelid is raised, drooping of the other side that had been hidden may become apparent. Because the height also changes as swelling goes down, revision surgery is considered at least 6 months after the first surgery. If you are uncomfortable before then, please tell us at your next visit.
Whether our clinic performs ptosis correction (blepharoptosis correction) under national health insurance: . For reference, the health insurance criteria state that surgery for blepharoptosis caused by an abnormality of the eye-opening muscle itself or of the nerve is a covered item, and that blepharoptosis caused by aging may become a covered item when the eyelid covers the pupil and causes a visual field impairment that interferes with daily life.
Yes. Many patients come from countries with advanced medical care, such as the United States and Japan. Among overseas patients, about 60% are from Japan and about 30% are from the United States.
This links to a video on the Face Plus Plastic Surgery YouTube channel. View All FacePlus TV
These are surgeries and procedures often discussed together with this surgery during consultations. Whether to have them together is decided after an examination.
He personally consults on and performs facial aging treatments such as facelift, droopy eyelid surgery, and thread lift. The doctor personally sees you from consultation through recovery.
About the DoctorThe content of this page is general medical information provided in accordance with the Medical Service Act, and the effects and recovery time of surgeries and procedures may vary by individual. All surgeries and procedures can cause side effects, so please make your decision only after a thorough consultation with a plastic surgery specialist.
Facelift, droopy eyelid surgery, and thread lift: Dr. Park Jung Keun personally checks every stage, from consultation to recovery. Please schedule by phone or KakaoTalk, or leave a consultation request form.
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