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Blepharoplasty with underlying ptosis


Oculoplastic surgeon William Mack, M.D., says identifying and surgically correcting (or referring) ptosis in cosmetic blepharoplasty patients is key to delivering optimal results.

William Mack, M.D.

Dr. Mack

Despite the overwhelming preference for minimally invasive treatments, surgery still plays a critical role in aesthetic medicine. Blepharoplasty, specifically, continues to maintain a top 5 position among the most popular surgical procedures performed every year, according to 2014-2018 data collected by the

American Society for Aesthetic Plastic Surgery


The surgical eyelid procedure is used to improve the appearance of the eyelids by removing and/or repositioning excess skin, muscle and fat. But what should you do when there’s an additional underlying defect that also contributes to eyelid appearance?

Ideally, it’s identified and surgically corrected at the time of cosmetic blepharoplasty. That’s according to William Mack, M.D., an oculoplastic specialist in Tampa, Fla., who presented “The Importance of Addressing Ptosis to Maximize Cosmetic Blepharoplasty Results,” at this year’s Global Aesthetics Conference in Miami, Fla.

“…if someone has droopy eyelids, it could be from extra skin, or it could be from the muscle being weak and the lid being down or it could be both,” says Dr. Mack.

Although Dr. Mack admits that most blepharoplasty patients probably don’t have an underlying ptosis, “I'm seeing a lot of these [blepharoplasty] patients… from West Florida that that haven't had the ptosis corrected.”

And hence the motivation behind the message: Being able to diagnose underlying ptosis means being able to deliver comprehensive patient treatment. “So at the same time you're doing your cosmetic blepharoplasty, you'll also be able to correct the ptosis,” he explains.

As an oculoplastic specialist, it’s not unusual for Dr. Mack to see patients for a second opinion on eyelid surgery, he says.

“They may have had a previous blepharoplasty from other surgeons. They did a great job with removing skin and recontouring the eyelid, but they didn't address the weakness to the muscle underneath, so the results are less than optimal,” he says.


In their foundational paper, “Blepharoplasty With Ptosis Repair,” Carraway et al. note that recognizing and treating eyelid ptosis with blepharoplasty “…makes the process much more effective and economical.”

To be able to do so, however, means being able to diagnose the defect and knowing how to correct it.

“Most patients do not come in with the complaint of ptosis, even though this is part of the complex. Rather, they note that they have been looking tired, or others may ask them if this is the case,” point out the study authors.

It’s an issue that needs to be aware of, according to Dr. Mack.

“I think the goal would be that if you don't do ptosis repair, you probably should not operate on that patient. Because you're really doing [only] part of the surgery… it's like, I'm going to repair your ACL but you have an MCL tear too, but I don't really do that. So, I’m just going to do the ACL and hope you can still jump.”


Carraway JH, Tran P. Blepharoplasty with ptosis repair. Aesthet Surg J. 2009;29(1):54-61.

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