Ptosis Repair
Ptosis (pronounced "toe-sis") is the medical term for drooping of the upper eyelid(s). This drooping of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia ("lazy eye") or developmental delay from limitation of their vision.
What causes Ptosis?
There are many causes of ptosis including age related weakening of the muscle, congenital weakness, trauma, or neurologic disease. As we age, the tendon that attaches the levator muscle, the major muscle that lifts the eyelid can stretch and cause the eyelid to fall. This represents the most common cause of a droopy eyelid. Ptosis may also occur following routine lasik or cataract surgery due to stretching of the muscle or tendon. Children may be born with ptosis or may acquire it due to trauma or neurologic reasons.
Can Ptosis be corrected?
Ptosis can be corrected surgically and usually involves tightening the levator muscle to elevate the eyelid. In severe ptosis, when the levator muscle is extremely weak, a "sling" operation may be performed, enabling the forehead muscles to elevate the eyelid(s). Other types of repair may include surgery on the muscle on the inside of the lid in cases of small amounts of ptosis. The surgeon will perform testing determine the best form of correction for the individual patient. The goal is to elevate the eyelid to permit a full field of vision and to achieve symmetry with the opposite upper eyelid.
Ptosis repair and simultaneous laser resurfacing of eyes. * Individual results may vary.
Ptosis Surgery Photo Gallery
You may wish to browse through the gallery of representative before and after ptosis surgery pictures. All procedures were performed by our surgeons and some patients may have had more than one surgical procedure performed. The text accompanying the photos describes the details of the procedures performed.
* Individual results may vary.
Does insurance cover the cost for Ptosis surgery?
Ptosis surgery may be considered a medically necessary procedure if it obstructs visions and in that situation it is typically covered by insurance. For ptosis correction surgery we accept most major insurance companies and we are a preferred provider for most major insurance companies in Seattle & Bellevue. We can help you find out the specifics of your insurance coverage as long as we have can have a copy of both sides of your insurance card.
Accepted insurance plans include:
- Aetna*
- Aetna Executive Health Plan
- Alaska Care Health Plans
- Assurant Health Plan*
- Beech Street*
- Blue Cross
- Blue Shield
- Boeing Traditional Medical Plan
- Carpenter Trust*
- Cigna*
- EBMS*
- Employee Painters Trust Insurance*
- Federal Employee Benefit Association
- First Choice*
- First Health*
- Great West Healthcare*
- Group Health Options
- Group Health*
- Guardian*
- HMA
- Health Net*
- KPS*
- L&I
- Lifewise
- Mail Handlers*
- Medicare
- Multiplan*
- Northwest Administrators*
- Northwest Roofers*
- Northwest Sheet Metal Workers*
- PacifiCare*
- Premera
- Premera Microsoft
- Providence Health Plan*
- Providence*
- Regence
- Regence Blue Cross
- Regence BlueShield
- Retail Clerks*
- Retirees Welfare*
- Samba Health Plan
- Seattle Area Plumbing & Pipefitting
- State Farm
- Teamsters Welfare*
- Uniform Plan*
- United Concordia*
- United HealthCare*
- WA State Health Insurance Pool*
- Washington Teamsters*
* We are considered an out of network provider with this insurance company. Depending on the specifics of your plan, this may or may not affect your coverage.
What type of anesthesia is used?
We use IV sedation anesthesia, which is a very safe and effective method of anesthesia for facial plastic surgery and rhinoplasty. IV sedation anesthesia is extremely safe compared to the standard general anesthesia techniques used today. The main advantages of IV sedation anesthesia are: (i) it does not require putting a breathing tube in the throat, (ii) it does not require a breathing machine, (iii) the recovery is much faster, (iv) there is much less "hang-over" from anesthesia, (v) and there is much less nausea. All these elements translate into greater comfort and safety. We have used this technique of anesthesia in several thousand plastic surgery procedures without any anesthetic complications.
During IV sedation anesthesia a small flexible IV (intravenous) needle is placed into one of the veins of the back of the hand. Through this IV line, relaxing medication is given to make you fall sleep. The amount of medication given is adjusted to the specific needs of each person. After you are sleeping, some numbing medicine is also placed in the skin to numb the area that is being operated on. The beauty of IV sedation anesthesia is that during the procedure you are unaware of anything going on and cannot hear anything, yet you are still breathing on your own.
When the procedure is finished, the relaxing medication is discontinued and you begin to wake up. Because the medications used in IV sedation anesthesia clear the system rather quickly, most of our patients are able to go home in less than 30 minutes after the procedure is completed.
Anesthesia guidelines [21kb PDF]
What is the recovery like?
There is minimal eye discomfort after the procedure, similar to having an irritated eye from allergies. Some swelling and discoloration may develop around the eyes for a few days. With make-up, most of our patients can return to work or social activities in less than one week.
What does “board certified” actually mean for eyelid surgery?
Board certification tells you what a surgeon was trained and examined in. On its own, the phrase “board certified” does not say in which field. Certification exists across many specialties, and a certificate in another specialty is a genuine credential in that specialty. It is simply not the same thing as certification in a specialty that trains surgeons to operate on the eyelids. So the useful follow-up question is always: certified by which board, and in what?
Eyelid surgery is unusual in one respect. Three different specialty pathways legitimately lead to operating on the eyelid, and each publishes a free public tool that lets you verify a surgeon yourself in under a minute.
| Board | What it certifies | Verify a surgeon |
|---|---|---|
| American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) | Facial plastic and reconstructive surgery specifically. Certification requires that the surgeon already hold certification from an American Board of Medical Specialties board in either otolaryngology–head and neck surgery or plastic surgery, pass a two-day examination, and submit for peer review operative reports from a minimum of 100 facial plastic surgery procedures. | ABFPRS Physician Finder |
| American Board of Plastic Surgery (ABPS) | Plastic surgery of the entire body, including the face and eyelids. ABPS is a member board of the American Board of Medical Specialties. | ABPS Verify Certification |
| American Board of Ophthalmology (ABOp) | Ophthalmology — the eye and its surrounding structures, including the eyelids, orbit and tear drainage system. ABOp is a member board of the American Board of Medical Specialties. Surgeons who subspecialise in eyelid and orbital surgery complete an additional oculoplastic (ophthalmic plastic and reconstructive surgery) fellowship after their ophthalmology residency. | ABOp Physician Search |
Why three pathways, and why it matters here
The eyelid sits at the boundary of three specialties, and the reason is anatomical rather than political. A cosmetic upper blepharoplasty, a ptosis repair that restores a drooping lid to its proper height, and reconstruction of the orbit or tear drainage system are different problems that happen to occupy the same few millimetres of tissue. Training that prepares a surgeon well for one does not automatically prepare them for another.
Two details are worth knowing. ABFPRS certification cannot be the only board a surgeon holds — it is granted on top of an existing ABMS certification in otolaryngology–head and neck surgery or plastic surgery, so an ABFPRS diplomate is double boarded by definition. And oculoplastic surgery is a fellowship, not a separate board; an oculoplastic surgeon is certified in ophthalmology and has completed dedicated subspecialty training in eyelid and orbital surgery on top of it. Asking which fellowship, and where, is a fair question.
What to ask, and how to check
- Which board certified you, and in what specialty? Not simply “are you board certified.”
- Is that board a member of the American Board of Medical Specialties? Boards exist with similar-sounding names that are not ABMS member boards.
- Did you complete a fellowship, and in what? For eyelid surgery this is often more informative than the board alone.
- Where do you hold hospital operating privileges, and for this procedure? Hospital privileges are granted by peer review against training.
- How many of these do you perform each year? Certification is a floor, not a measure of current volume.
- Verify it yourself. All three boards above let you search by surgeon name. The ABFPRS states that its website is a primary source of verification.
The surgeons at this practice, and how to verify them
| Surgeon | Board certification | Training pathway |
|---|---|---|
| Sam Naficy, MD, FACS | American Board of Facial Plastic and Reconstructive Surgery American Board of Otolaryngology – Head and Neck Surgery |
Otolaryngology – head and neck surgery, followed by facial plastic surgery fellowship at the University of Michigan |
| Keith Hurvitz, MD, FACS | American Board of Plastic Surgery American Board of Otolaryngology – Head and Neck Surgery |
Otolaryngology – head and neck surgery residency at USC, followed by a general plastic surgery residency at UC Irvine |
| Bryan Sires, MD, PhD, FACS | American Board of Ophthalmology | Ophthalmology, followed by an Ophthalmic Plastic and Reconstructive Surgery fellowship at the University of Wisconsin–Madison. Director of the Oculoplastic Surgery Fellowship at the University of Washington. |
Ptosis repair is performed here by Dr. Sires, whose ophthalmology training and oculoplastic fellowship are specific to the levator muscle and the anatomy of the lid margin. Dr. Naficy and Dr. Hurvitz perform upper and lower blepharoplasty and brow lift alongside him, and a consultation is matched to whichever of the three fits your case. Each of these certifications can be confirmed through the verification links above, or with the certifying boards directly. We would encourage you to check ours, and to check the credentials of any other surgeon you consult.
I am interested! What do I do next?
If you are considering this procedure we encourage you to complete this Surgical Consultation Intake Form. Dr. Sires will tell you whether you are a suitable candidate for this procedure and inform you of the potential risks of the procedure. There is a great variety in eyelid shapes and features and each procedure must be custom tailored for the patient to get the best possible result. You will also have a chance to view before and after photo albums of patients who have undergone procedures similar to what you are considering.
