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Oculoplastic Surgery · Ptosis · Eye treatments

Ptosis Surgery in Turkey — Levator Repair, MMCR and Frontalis Sling at Eyeglow Istanbul

Functional ptosis repair with precise lid measurement before any surgical recommendation. MMCR (no skin incision), levator advancement and frontalis sling — selected by etiology, not by request. Led by our oculoplastic surgical team, with neurogenic and myogenic cases fully evaluated before surgery is offered.

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Close-up of a patient with a drooping upper eyelid — ptosis surgery at Eyeglow Health, Istanbul
Procedure time45–90 minutes
AnaesthesiaLocal + sedation (adults); GA (paediatric)
Hospital stayDay case
Time in Istanbul4–5 nights
Return to work7–10 days
Follow-up6 months structured

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What it is

What is ptosis surgery?

Ptosis surgery (blepharoptosis repair) corrects a drooping upper eyelid caused by levator muscle weakness, aponeurotic disinsertion, or congenital levator dysplasia. Three techniques are used at Eyeglow: MMCR (Müller muscle resection — posterior, no skin incision, for mild ptosis), levator advancement (anterior approach, moderate-to-severe), and frontalis sling (severe cases with absent levator function). The technique is selected after formal levator function measurement and phenylephrine test — never by appearance alone.

Ptosis surgery is distinct from upper blepharoplasty. Blepharoplasty removes excess eyelid skin (dermatochalasis) without changing lid margin height. Ptosis repair elevates a functionally low lid margin by repairing the levator mechanism. When both conditions coexist — excess skin and a true levator deficit — a combined procedure is appropriate. Recommending blepharoplasty for a patient with untreated ptosis will not correct the lid height and is not clinically appropriate. At Eyeglow, every patient is assessed with formal lid measurements (MRD-1, levator function in millimetres, Bell\'s phenomenon, phenylephrine test) before any surgical option is discussed.

Ptosis surgery is not always elective. Congenital ptosis covering the pupil in a child is an ophthalmic urgency due to amblyopia risk. Sudden-onset ptosis in an adult requires neuro-ophthalmic evaluation before any surgical planning — ptosis from aneurysm or myasthenia gravis requires urgent medical attention, not eyelid surgery. Our surgical team\'s assessment includes a structured neuro-ophthalmic checklist; surgery is never offered based on photographs alone.

How it works

From initial assessment to eyelid symmetry

  1. 01

    Oculoplastic assessment and etiology review

    You share upper eyelid photographs from different gaze directions, prior medical records (neurology reports, Tensilon test results if relevant, previous lid measurements) and a description of onset — was the ptosis present from birth, gradual onset in adulthood, or sudden? Our oculoplastic surgical team reviews your case to classify the ptosis type (congenital, aponeurotic, neurogenic, myogenic or mechanical), measure the marginal reflex distance (MRD-1), and determine whether amblyopia risk applies (paediatric cases). A surgical technique is not recommended until the etiology is established — ptosis surgery on an undiagnosed neurogenic or myogenic cause without neuro-ophthalmic clearance is unsafe.

  2. 02

    Pre-operative measurements in Istanbul

    On day 1 we perform standardised ptosis measurements: marginal reflex distance (MRD-1 and MRD-2), levator function (LF) in millimetres of lid excursion from downgaze to upgaze, upper lid crease position, Bell's phenomenon (upward globe rotation on lid closure — critical for lagophthalmos risk), corneal sensation, dry eye assessment (Schirmer test, TBUT) and phenylephrine test (to determine Müller muscle responsiveness for MMCR candidacy).

  3. 03

    Technique selection and consent

    The surgical technique is matched to levator function and Müller muscle response: MMCR (Müller muscle conjunctival resection) for mild ptosis with good Müller muscle response to phenylephrine; levator advancement or resection for moderate-to-severe ptosis with measurable levator function (≥4 mm); frontalis sling for severe ptosis with absent levator function (LF <4 mm). Combined ptosis repair with upper blepharoplasty is performed when dermatochalasis coexists — the combined approach is explained with its specific indications and not offered as a cosmetic upgrade.

  4. 04

    The procedure (45–90 minutes)

    MMCR: performed through a posterior (conjunctival) approach — no visible skin incision. The Müller muscle and conjunctiva are resected en bloc based on the phenylephrine test result; the posterior incision is self-sealing or closed with absorbable sutures. Levator advancement / resection: through the upper lid skin crease incision, the levator aponeurosis is identified, advanced anteriorly and fixed to the tarsal plate with adjustable sutures — lid height is assessed during surgery under local anaesthesia with the patient seated. Frontalis sling: a sling material (silicone rod or autologous fascia lata from the thigh in paediatric cases) is passed through the lid and fixed to the frontalis muscle, allowing the brow to elevate the lid when levator function is absent.

  5. 05

    Day 1, day 5 reviews — asymmetry assessment

    Eyelid position is evaluated at day 1 and day 5. Minor asymmetry between the two sides is common in the first week due to swelling; the operated side often appears overcorrected (higher than desired) initially as oedema resolves. If lid height is clearly over- or undercorrected at day 5, early adjustment is possible while tissue is still mobile — levator sutures can be released (overcorrection) or advanced further (undercorrection) within the first one to two weeks.

  6. 06

    Structured follow-up and amblyopia monitoring

    Paediatric ptosis patients are followed at one month and three months for amblyopia treatment (patching or penalisation) if visual axis coverage was present. Adult patients are reviewed at one month and six months, with photographs documenting symmetry and lid height. Lagophthalmos (incomplete lid closure) is monitored at every visit — nocturnal lubricant drops are prescribed if residual lagophthalmos exceeds 2 mm. Our surgical team provides written instructions for emergency contact if sudden overcorrection threatens corneal exposure.

Technique selection

MMCR vs Levator Advancement vs Frontalis Sling — how the technique is chosen

The ptosis repair technique is determined by levator function (LF in mm), Beard severity classification and etiology — not by patient preference. Here is how the three approaches differ:

AspectMMCR (Müller Resection)Levator Advancement / ResectionFrontalis Sling
Technique nameMüller Muscle Conjunctival Resection (MMCR)Levator Advancement or ResectionFrontalis Sling
Approach (incision)Posterior — through conjunctiva, no visible skin scarAnterior — through upper lid crease (same as blepharoplasty incision)Small forehead and lid incisions for sling passage
Ideal patientMild ptosis (MRD-1 ≥0 mm), good levator function (≥10 mm), positive phenylephrine test (≥1.5 mm elevation with 10% phenyephrine drops)Moderate to severe ptosis, measurable levator function (4–10 mm LF), aponeurotic or congenital with partial functionSevere ptosis with absent or near-absent levator function (LF <4 mm), including congenital ptosis with amblyopia risk
Ptosis correction1–3 mm reliable lift; predictable for mild cases with positive Müller response2–5 mm lift; adjustable intraoperatively under local anaesthesia for precisionFunctional lift dependent on brow action; cosmetically less precise but clinically effective for severe cases
Risk of lagophthalmosLow — modest tissue shorteningModerate — depends on amount advanced; monitored closelyHigher — mechanical brow-to-lid coupling; lubricant drops often required long-term
Revision rateUnder 10% for mild cases; limited adjustability if overcorrected5–15% require minor adjustment; early adjustment possible within 2 weeks10–20% at 5 years as sling material stretches; second tightening procedure straightforward
Suitable for childrenLess commonly — phenylephrine test less reliable under age 5Yes — used for moderate congenital ptosis with partial levator functionYes — frontalis sling with autologous fascia lata preferred for severe congenital ptosis in children
Pricing

Personalised pricing

Every treatment plan is priced individually after your consultation and lid measurement review. Request a written, all-inclusive quote — clear, itemised, and with no obligation.

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Package transparency

What's included in your ptosis surgery package

Included in package

  • Pre-op oculoplastic assessment (lid measurements, levator function, phenylephrine test, Bell's phenomenon, Schirmer dry eye test)
  • Surgeon-led consultation + technique selection
  • Ptosis repair procedure — MMCR / levator advancement / frontalis sling as planned
  • 5-star hotel — 4 nights
  • VIP airport transfers (return)
  • Post-op drops kit + wound care instructions
  • Day-1 and day-5 slit-lamp review in Istanbul
  • 1-month and 6-month structured photo follow-up
  • Multilingual oculoplastic coordinator — 24/7
  • Complication insurance policy (Türkiye Ministry of Health certified, covers surgical complications including infection, retreatment, and emergency intervention up to package value)

Paid separately

Items below are not part of the medical package — your coordinator helps arrange them at no markup.

  • Flights to/from Istanbul
  • Personal expenses
  • Amblyopia treatment materials (patching, occlusion therapy — paediatric cases)
  • Unrelated medical treatments
  • Travel insurance (recommended — covers flight cancellation, baggage, non-surgical medical emergencies abroad; we coordinate referral if needed)
Our team

The surgeons who will care for you

Your procedure is carried out by our oculoplastic surgical team at our partner accredited hospital in Istanbul. Their training and sub-specialty focus are shown below.

Medically reviewed by Assoc. Prof. Dr. Muhammet Derda Özer, FICO

Assoc. Prof. Dr. Muhammet Derda Özer, FICO

Assoc. Prof. Dr. Muhammet Derda Özer, FICO

Operating Surgeon

Specialises in ocular oncology, vitreoretinal diseases, cataract, refractive, corneal transplantation, glaucoma and pediatric ophthalmic surgery — more than 30,000 ophthalmic operations across a 14-year clinical career.

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Op. Dr. Önder Aslan

Op. Dr. Önder Aslan

Operating Surgeon

Board-certified ophthalmologist whose surgical practice spans anterior-segment procedures with oculoplastic and retinal sub-specialties — cataract, refractive, eyelid surgery and pediatric eye examinations including retinopathy of prematurity.

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Op. Dr. Muhammed Talha Sadık

Op. Dr. Muhammed Talha Sadık

Operating Surgeon

Board-certified ophthalmologist working across vitreoretinal disease, refractive, cataract and glaucoma surgery, with an active anterior- and posterior-segment surgical caseload.

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Candidacy

Are you a candidate for ptosis surgery?

You may be a good candidate if

  • You have confirmed blepharoptosis — your upper eyelid consistently covers the pupil or significantly reduces your visual field, documented by marginal reflex distance measurement (MRD-1 ≤2 mm is the standard threshold for functional ptosis).
  • You have aponeurotic ptosis — age-related thinning or disinsertion of the levator aponeurosis, typically with normal or good levator function (≥8 mm LF) and a high or absent lid crease.
  • You have congenital ptosis from birth with measurable levator function and no amblyopia currently managed under a paediatric ophthalmologist.
  • You have neurogenic ptosis from Horner syndrome (confirmed with cocaine/apraclonidine test) or incomplete third nerve palsy with stable neurological workup.
  • You have myogenic ptosis from chronic progressive external ophthalmoplegia (CPEO) or myasthenia gravis in remission, with neuro-ophthalmic clearance.
  • You are seeking combined ptosis repair and upper blepharoplasty where both a functional levator deficit and significant dermatochalasis coexist.

Surgery should be deferred or reconsidered if

  • Active or incompletely worked-up neurogenic ptosis — ptosis from third nerve palsy, myasthenia gravis, or unexplained sudden-onset ptosis requires neuro-ophthalmic investigation and a stable period before elective surgery.
  • Absent or severely reduced Bell's phenomenon — if the eye does not rotate upward adequately on lid closure, aggressive ptosis correction creates a high risk of corneal exposure and ocular surface damage; a more conservative approach is necessary.
  • Severe dry eye syndrome not yet managed — ptosis repair reduces lid closure range and will worsen dry eye; ocular surface must be treated before surgery.
  • Paediatric ptosis with active amblyopia currently under treatment — the amblyopia plan should be coordinated with a paediatric ophthalmologist before surgical timing is decided.
  • Patients seeking ptosis repair purely to achieve a cosmetic appearance change without a measured functional levator deficit — the correct procedure for eyelid aesthetics without ptosis is upper blepharoplasty, not ptosis repair.

Disclaimer. This page is consistent with American Academy of Ophthalmology (AAO) Oculoplastic Section clinical guidelines, American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) published position statements, and Beard's ptosis classification. It is educational and not a clinical recommendation. Ptosis surgery requires formal levator function measurement and etiology evaluation by a qualified surgeon before any technique is selected — photographs and symptom descriptions alone are insufficient. The Eyeglow consultation is provided at no charge and without obligation.

Risks & outcomes

Realistic outcomes — the risks that matter

Ptosis surgery has a good safety record in skilled hands, but its complications are different from standard eyelid procedures. Our oculoplastic surgical team explains these in full during the pre-operative consultation:

Asymmetry requiring revision

Mild height asymmetry between the two upper eyelids occurs in 10 to 20 percent of bilateral cases as swelling resolves unequally. Most asymmetry settles within 4 to 8 weeks without intervention. If a clinically significant asymmetry remains at three months, a minor in-office adjustment is performed. Major revision requiring full re-operation occurs in under 5 percent of carefully selected cases.

Lagophthalmos (incomplete lid closure)

Incomplete closure during sleep or blink is an expected short-term consequence of ptosis repair — the lid is being advanced or tightened. Nocturnal lubricating drops or ointment are prescribed routinely for the first month. Clinically significant lagophthalmos beyond 2 mm at one month that does not resolve with lubrication requires adjustment. Bell's phenomenon assessment before surgery identifies higher-risk corneas.

Under-correction (ptosis recurrence)

Inadequate correction occurs in 5 to 15 percent of cases and is most common in congenital ptosis with poor levator function or in advanced aponeurotic ptosis with very thin tissue. Intraoperative adjustability under local anaesthesia and careful pre-operative grading reduce but do not eliminate this risk. Secondary surgery to advance the levator further or convert to a frontalis sling is straightforward.

Over-correction (lid retraction)

Over-elevation of the lid, causing a startled or wide-eye appearance, occurs in 3 to 8 percent of cases. Early intervention (within 2 weeks while sutures are accessible) can release the levator advancement. If caught late, a small lid-lowering procedure is required. This risk is minimised by intraoperative height assessment under local anaesthesia, which is standard at Eyeglow for levator advancement cases.

FAQ

Frequently asked questions about ptosis surgery

What is ptosis and how is it different from a droopy eyelid from ageing?
Ptosis (blepharoptosis) is a medical condition in which the upper eyelid droops because the levator muscle — the muscle responsible for lifting the eyelid — has weakened, become detached, or never developed normally. The key defining feature is a deficit in levator function (measured in millimetres of lid excursion from downgaze to upgaze) that causes the eyelid margin to sit too low relative to the pupil (marginal reflex distance MRD-1 below 2 mm is the standard threshold). This differs from dermatochalasis — the excess, loose upper eyelid skin that accumulates with age and creates a similar appearance of heaviness or hooding. Dermatochalasis is corrected with upper blepharoplasty (skin removal). Ptosis is corrected by levator repair, MMCR or frontalis sling. The two conditions often coexist and can be corrected together in a combined procedure, but they require different surgical techniques and different consent processes.

What is the difference between ptosis surgery and blepharoplasty?
Upper blepharoplasty removes excess eyelid skin (dermatochalasis) and, when indicated, a small amount of orbital fat — it does not change the height or position of the eyelid margin itself. Ptosis surgery repairs the levator muscle mechanism to raise a lid that sits too low because of functional muscle weakness. Both procedures are performed through similar or identical upper lid crease incisions and both improve the visual field in appropriate cases, but they address different anatomical problems with different surgical objectives. A patient with both conditions — excess skin AND a low lid margin — benefits from a combined procedure (ptosis repair + blepharoplasty in one session). However, recommending blepharoplasty to a patient whose primary problem is ptosis, without repairing the levator, will not address the lid height and is not clinically appropriate.

Will ptosis surgery correct my vision as well as my appearance?
Ptosis repair is a functional surgical procedure first and foremost. Its primary goal is to lift a lid that is obstructing the pupil and reducing the superior visual field. For patients with MRD-1 ≤2 mm, Eyeglow-issued quotes are supported by documented functional measurements (lid height, levator function, visual field assessment when relevant). Most patients with moderate-to-severe ptosis report subjective visual improvement and a reduction in brow-ache from the chronic effort of using the frontalis muscle to elevate the lid. The aesthetic improvement — a more open, symmetric eyelid appearance — is a secondary benefit of functional repair, not the primary indication.

What is congenital ptosis and when should children have surgery?
Congenital ptosis results from a dysplastic or absent levator muscle from birth — the eyelid droops because the levator never fully developed. The timing of surgery is driven by two considerations: (1) Amblyopia risk — if the drooping lid covers the pupil during the critical visual development window (birth to approximately age 8), the brain may permanently suppress vision in that eye (stimulus deprivation amblyopia). Severe congenital ptosis covering the visual axis is an ophthalmic urgency requiring early surgery. (2) Mild-to-moderate congenital ptosis that does not cover the visual axis can often be deferred until age 3 to 5 to allow accurate measurement and to avoid general anaesthesia at a very young age, with patching and glasses as bridge management if needed. Every paediatric ptosis case is assessed individually; a paediatric ophthalmology co-assessment is arranged as part of Eyeglow's evaluation before any surgical timing is decided.

Can ptosis come back after surgery?
Ptosis recurrence depends on the etiology and technique. Aponeurotic ptosis (age-related levator disinsertion) repaired with levator advancement has a low recurrence rate — under 10 percent at five years in published ASOPRS series. Congenital ptosis with poor levator function (treated with frontalis sling) has a higher recurrence rate — 10 to 20 percent at five years — because sling material stretches gradually over time; secondary sling tightening is a straightforward procedure. Myogenic ptosis (myasthenia gravis, CPEO) has a higher natural recurrence because the underlying disease is progressive; surgery is staged carefully and expectations are set accordingly. Neurogenic ptosis from Horner syndrome or third nerve palsy can recur if the neurological condition changes.

What is the Müller muscle conjunctival resection (MMCR) and who is it suitable for?
MMCR (also called posterior approach ptosis repair or Putterman procedure) is a technique in which the Müller muscle — a smooth muscle lying behind the main levator muscle, innervated by the sympathetic nervous system — is resected together with the overlying conjunctiva from inside the eyelid. Because it approaches from the posterior (conjunctival) surface, there is no visible skin incision. MMCR is suitable for mild ptosis (MRD-1 ≥0 mm, levator function ≥10 mm) in patients with a good Müller muscle response — confirmed by the phenylephrine test: if 2 drops of 10% phenylephrine instilled in the eye raise the lid by 1.5 mm or more, MMCR is predicted to provide adequate correction. The procedure is predictable for mild ptosis cases with a positive test, but has limited adjustability if over-correction occurs. MMCR is not appropriate for moderate-to-severe ptosis (levator function below 8 mm) where levator advancement achieves more reliable correction.

What is a frontalis sling and does it look unnatural?
A frontalis sling suspends the upper eyelid from the frontalis muscle in the forehead using a material passed through the lid and fixed above the eyebrow — when the patient raises their brow, the lid elevates. It is indicated for severe ptosis where levator function is absent or near-absent (LF <4 mm). The cosmetic appearance of frontalis sling repair is inherently different from normal lid mechanics: the lid elevates and retracts with brow movement rather than with gaze, the lid crease position differs from the fellow side, and the resting lid position may be lower than the corrected side due to the mechanical coupling. For children with severe congenital ptosis and amblyopia risk, the functional benefit of preventing amblyopia far outweighs the cosmetic limitation. In adults with acquired severe ptosis (CPEO, third nerve), expectations regarding symmetry and naturality are discussed frankly before surgery, as a frontalis sling achieves functional vision but not a cosmetically identical appearance to a normally innervated lid.

What are the risks specific to ptosis repair compared to standard eyelid surgery?
The risks unique to ptosis surgery (as distinct from cosmetic blepharoplasty) are: (1) Lagophthalmos — incomplete lid closure after correction, more significant with ptosis repair than with skin-only blepharoplasty, because the lid is being positionally elevated rather than simply de-bulked. Bell's phenomenon assessment before surgery identifies patients who cannot protect their cornea with lid closure and who require a more conservative approach. (2) Recurrence — ptosis recurrence over 5 to 10 years is more common than recurrence after blepharoplasty, particularly for sling procedures and myogenic cases. (3) Overcorrection — lid retraction causing a startled appearance, more relevant than after blepharoplasty because levator advancement changes lid dynamics. (4) Asymmetry — bilateral ptosis rarely corrects to perfect symmetry; most patients achieve clinically satisfactory and socially unnoticed symmetry, but identical lid heights are not guaranteed.

Can ptosis surgery be combined with cataract surgery or other eye procedures?
Ptosis and cataract frequently coexist in older patients. The standard practice is to perform cataract surgery first and reassess ptosis 3 to 6 months post-operatively — because the surgical trauma from phacoemulsification can temporarily worsen or occasionally improve ptosis, and the final lid position after cataract recovery must be measured before ptosis grading. In cases of severe ptosis obstructing the visual axis prior to cataract surgery (making biometry and surgery planning unreliable), ptosis may be repaired first. Ptosis repair can be combined with upper blepharoplasty in the same surgical session as planned. Combining ptosis with corneal procedures or retinal surgery requires individual risk assessment with our surgical team and the relevant specialist.

How long is recovery from ptosis surgery?
Most adult patients undergoing MMCR or levator advancement return to desk work and light activities within 7 to 10 days. Significant bruising and eyelid swelling are expected for the first 5 to 7 days. The operated eyelid often appears overcorrected (higher than intended) in the first week before swelling resolves; final lid position is assessed at the one-month follow-up. Sutures, if non-absorbable, are removed at 10 to 14 days. Contact sport and heavy lifting are restricted for 4 weeks. Vision is typically not significantly affected during recovery unless a combined blepharoplasty was performed, in which case mild blur from lubricant drops is expected for 1 to 2 weeks.

How is ptosis surgery priced at Eyeglow Health?
Every Eyeglow ptosis surgery package is priced individually after your consultation and lid measurement review — the procedure (MMCR, levator advancement or frontalis sling) and exact scope are determined by levator function grading, phenylephrine test result and Bell's phenomenon assessment before any quote is issued. All packages are all-inclusive: pre-operative lid measurements, surgery, hotel for 4 nights, VIP transfers, day-1 and day-5 reviews, and 6-month structured follow-up. Request a written, itemised quote — no obligation. Note: in many countries, functional ptosis with documented visual field deficit is covered by health insurance — confirm your insurance status before considering any destination.

Why is a proper etiology diagnosis important before ptosis surgery?
Ptosis surgery on a misclassified or incompletely evaluated case can be unsafe. The most important example is neurogenic ptosis: sudden ptosis from a posterior communicating artery aneurysm compressing the third cranial nerve is a neurological emergency — operating on such a lid without neurological clearance delays life-saving vascular intervention. Ptosis from myasthenia gravis requires systemic management first; surgery during an unstable myasthenic state risks myasthenic crisis. Horner syndrome from a new pulmonary apex mass requires oncological workup, not eyelid surgery. Eyeglow requests prior neurological records for all ptosis that is not clearly aponeurotic (age-related) or congenital, and our surgical team's assessment includes a neuro-ophthalmic review checklist. Ptosis surgery is never offered based on photographs alone without a complete clinical evaluation.
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