Hi! I am 14 and have mild congenital ptosis on my left eyelid.
I am planning to get a Frontalis Sling surgery, but my surgeon mentioned that there will be lagophthalmos and eyelid lag in downward gaze. Is this only a risk or will it definitely happen after surgery? Please tell me! Thanks in advance!

(I am asking because I'm afraid the doctor may over exaggerate things to prevent any dissatisfaction after the surgery)
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replied November 14th, 2012
Hello, thank you for your question. It is always best when you feel you can trust your doctor to be forthright with you about treatment options and what to expect following surgery. This response is for informational purposes only, and can not replace the one-on-one examination, diagnosis, and expertise with your particular case provided by your doctor.

Ptosis refers to a drooping of one or more of the eyelids. This drooping can be mild, or may be enough to partially or fully restrict vision reaching the pupil. The goal of ptosis surgery is to recreate as nearly perfect an anatomic result as possible by elevating the position of the lid or lids and by creating a lid fold, if necessary.

A frontalis sling, or brow suspension, is where the muscle of the forehead (frontalis muscle) is used to help lift the eyelid by placing a sling of material, either taken from the child or synthetic, between the forehead and the eyelid.

While enjoying high rates of overall success, risks and benefit considerations need to be weighed carefully in any case of surgical repair for mild ptosis.

The expectations and goals of the surgery must be discussed carefully with the patient and/or the parents preoperatively. The lid level can be changed, but dynamic limitations of the abnormal muscle persist postoperatively, and these may result in significant lid lag and lagophthalmos (incomplete closure of the eyelid). Often the best result that can be hoped for is a normal lid level when the eyes are looking straight ahead, understanding that there is potential following surgery to have the inability to fully close the eyes while sleeping or while looking downward, leading to secondary exposure keratopathy (drying out of the cornea). Oftentimes, lubricating ointment or wearing a sleep mask at bedtime help minimize the risk of exposure.

Summary of potential risks of surgery include:
*Bruising of the eyelids and around the eye.
*A small risk of infection of the eyelid or the eye.
*Possibility of under-correction or over-correction of the eyelid height
*Unable to close the eyelid completely, with the eye slightly open at night.

Best of luck to you!

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replied November 15th, 2012
ptosis of eyelid
My son had this done, but his surgeon insisted on doing the procedure to both eyes, including his "good" eyelid to keep his appearance similar when gazing down. 6 years later we still love the results. Most people don't even know he had anything wrong. Good luck.
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