Why Congenital Ptosis May Require More than One Ptosis Correction Surgery in a Lifetime скачать в хорошем качестве

Why Congenital Ptosis May Require More than One Ptosis Correction Surgery in a Lifetime

A man has had ptosis since birth but did not have surgery until he was 4 or 5-years-old, but his eyelids are continuously drooping. He wants to know the procedures to correct this, the cost of the surgery, and if insurance will cover it. Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that congenital ptosis is a condition wherein the muscle that lifts the eyelid called the levator muscle did not develop fully during gestation. It tends to run in families but is expressed differently in several siblings. The levator muscle can either be mildly to severely affected in terms of the level. The actual activity of the muscle ranges from fully functional to very weak. When he does a ptosis examination, he looks at a patient, sees their eyelid level, and how much the eyelid blocks their pupil. He asks them to look down and up to establish how much muscle function they have. From an ophthalmologic point of view or from the point of view of eye health, he also wants to look at conditions such as dry eyes and Bell’s phenomenon. This phenomenon is a protective mechanism to make sure that the eye rolls a little so that when someone is sleeping, even if their eyes open a bit, they’re still protected. In choosing the type of surgery, patients are divided into those with good enough muscle function versus those who have no muscle function. Dr. Prasad typically does a levator muscle resection for those with good enough muscle function, which is shortening the muscle so that the eyelid can come up. When the muscle is shortened, the eyelid will open but it will not relax and close the exact same way as the other eye. In addition, patients need to add lubrication to the eyes as part of the post-operative care for the long-term. For patients who have congenital ptosis, it is not surprising for them to have more than 3 operations in their lifetime: one in childhood for visual development, another one at adolescence to early adulthood for aesthetics, and one later in life for functional and aesthetic reasons because the tissue stretches and the facial aging process goes on. Another type of ptosis is levator muscle dehiscence or aponeurotic ptosis. This is normal age-related attenuation or thinning of the muscle that causes the eyelid to droop. Patients may be dealing with that in the other eye and so an examination has to be established whether or not there’s any merit to addressing the other eye at the same time. Dr. Prasad tests for Hering’s Law where he lifts the droopier eyelid and very often, the other eyelid will actually descend. It has to do with amount of signal that is generated by the brain to push the eyelid open. The other option aside from levator resection is a procedure called a frontalis sling. This is done routinely in younger children but when it is done for an adult, there is a challenge. However, when this procedure is done in adults, one eye is always open because the frontalis muscle has to be forced to function to effectively to open the other eyelid. It takes a long time for an adult to acclimate this function. In terms of the cost of this procedure, patients have to see if the doctor they choose accepts insurance and is willing to go through the process of insurance approval. The problem with the modern world and why over 10 years ago Dr. Prasad stopped accepting any kind of medical insurance is that insurance companies are openly deceptive in their practices. They will approve a procedure and then later on deny the procedure. Or they will go back and audit doctors and say their procedures are not indicated and ask for refunds. Dr. Prasad has seen how very deserving patients whose eyes are completely closed are denied by insurance companies. This man is going to have to try and find a doctor that either accepts insurance and is willing to go through the process, or find a doctor he can afford. Cost is a factor and the procedure does require the: surgeon's fee, anesthesia and facility costs which are all part of delivering high quality care. Dr. Prasad suggests meeting with doctors, most likely oculofacial or oculoplastic surgeons who have extensive experience in this area. Most general plastic surgeons are not trained in this area and don’t really practice this so he’s not likely find too many who are willing to do this type of surgery. He should meet with doctors he is comfortable with and figure out what options he wants. For more information about ptosis surgery, please visit our website: http://prasadcosmeticsurgery.com/pras...