Ptosis
For people with heavy eyelids or who raise their brows to open their eyes
Ptosis can cause heavy eyelids, difficulty opening the eyes without raising the brows and forehead lines.
Ptosis is a condition in which the upper eyelid covers part of the pupil. In addition to changing appearance, it may contribute to shoulder stiffness or headaches. At our clinic in Kobe and Motomachi, we examine the eyelids and assess whether treatment may be available under Japan’s public health insurance.
Contents
Ptosis symptom checklist
Ptosis may be related when the eyelids feel heavy, the eyes tire easily or you raise the brows to open the eyes. If several of the following apply, consider a medical examination of the eyelids.
If several items apply, ptosis may be involved. You may book an examination at our clinic in Kobe and Motomachi to discuss whether care may be available under Japan’s public health insurance.
What is ptosis?
Ptosis is present when the upper eyelid covers the pupil while the eye is open. The upper eyelid can narrow and darken the visual field.
This can lead a person to raise the brows to open the eyes. Continuing to do so may create forehead lines and increase the distance between the brows and eyelashes, changing the facial appearance.
Continuous tension in the frontalis muscle may contribute to headaches. Raising the chin to look upward can also tense the trapezius from the shoulders through the neck and back, contributing to shoulder stiffness.
How ptosis can look when using the forehead muscles
Figure 1: Forehead muscles relaxed
My eyes are naturally narrow, and an injury to the right eyelid made it narrower. The right upper eyelid has descended to the center of the pupil, indicating moderate ptosis. The left eye opening is slightly narrow but within the normal range.
Figure 2: Forehead muscles engaged
The eyes appear larger and the upper eyelids rise because the forehead is pulling the brows upward. This creates forehead lines and increases the distance between the brows and eyelids.
Causes and prevention of ptosis
Anatomically, ptosis can result from reduced function of the levator muscle and excess upper-eyelid skin. It may be congenital or caused by nerve palsy, but commonly develops with age. Long periods of contact-lens wear and repeated insertion and removal may also contribute.
Some people without ptosis also wrinkle the forehead and raise the brows to open the eyes, using the frontalis rather than the eyelid muscles. Reduced use of the levator muscle may contribute to loss of its function.
Repeatedly raising the brows may widen the space between the brows and eyelashes and stretch the eyelid skin. Addressing these habits is presented on the source page as part of prevention.
Figure 3: Exercise for the upper eyelid
Close the eyes and gently hold the skin above the brows with your fingers. When opening the eyes, keep the brows from moving upward.
Treatment for ptosis
For people with ptosis, surgery may be available under Japan’s public health insurance. The main methods are outlined below.
Excision of excess skin
This method removes excess skin to reduce heaviness and make the eyelid easier to open. The examination determines whether skin is removed from the eyelid, below the brow or above the brow.
Levator advancement
The levator muscle is shortened so the eyelid can open with less movement.
Clinical case photographs of ptosis
These photographs are from ptosis and related cases published on the clinic’s blog and Instagram and show changes before and after treatment.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Ptosis surgery; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Ptosis surgery; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Ptosis surgery; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Ptosis surgery; preoperative → postoperative comparison; the month numeral is not reliably legible in the retained source.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Upper-eyelid skin-excision surgery; preoperative → postoperative comparison; the month numeral is not reliably legible in the retained source.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Treatment sequence: baseline → botulinum toxin injections to the forehead and glabella → ptosis surgery → lower-eyelid fat-removal surgery → JUVÉDERM VOLUMA 6 cc injection.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Ptosis surgery with levator advancement; preoperative → four months postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Revision after ptosis surgery at another clinic. Difficulty opening the eyelids and asymmetry had persisted; revision was performed at this clinic. Preoperative → three months postoperative, with a favorable course.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Lower-eyelid fat removal plus upper-eyelid skin excision; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Incisional double-eyelid surgery; preoperative → postoperative comparison; the month numeral is not reliably legible in the retained source.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Upper-eyelid skin excision plus lower-eyelid fat removal; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Incisional double-eyelid surgery; preoperative → six months postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Double-eyelid surgery with orbital-fat and ROOF resection; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Incisional eyelid surgery comparison; preoperative → one month postoperative.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): After three buried-suture procedures at another clinic, asymmetry and fine lines were noticeable before surgery. At one month after revision, the image reports resolved asymmetry and lines with a natural eye appearance.
Frequently asked questions about ptosis
Is difficulty opening my eyes without raising my brows a symptom of ptosis?
Ptosis can make the eyelids difficult to raise, leading to the feeling that you cannot open your eyes without lifting the brows. Because there are several possible causes, the eyelids need to be examined.
Can forehead lines be related to ptosis?
When the eyelids are difficult to raise, the forehead muscles may lift the brows to open the eyes, creating forehead lines. Headaches or shoulder stiffness may also occur.
What does the ptosis symptom checklist cover?
It covers eyelid heaviness, eye fatigue, a narrowed visual field, asymmetry, difficulty opening the eyes without raising the brows and forehead lines. Even if several apply, seek a medical examination rather than self-diagnosing.
Can ptosis be treated under Japan’s public health insurance?
Depending on the condition, surgery may be available under Japan’s public health insurance. This is assessed by examining eyelid droop, its effect on the visual field and symptoms.
What surgical methods are available?
Methods include excision of excess skin and levator advancement. The approach is selected after assessing excess skin, levator function and brow position.
Can contact lenses contribute to ptosis?
Long-term contact-lens wear and repeated insertion and removal can irritate the eyelids. Seek an examination if symptoms concern you.
If you think you may have ptosis
Treatment for ptosis varies with symptoms and eyelid condition. If your eyelids feel heavy, your eyes are difficult to open or your visual field seems narrow, the first step is an examination.