Featuring Dr. Guy Massry — a world-renowned ophthalmologist and ocular plastic surgeon based in Beverly Hills, California. Dr. Massry is co-director of the Thyroid and Orbital Service at Cedars-Sinai Medical Center, a clinical professor at the USC Keck School of Medicine, and maintains a private practice in Beverly Hills. He has received numerous honors for his contributions to patient care and patient education, he has spoken at medical conferences worldwide, and has published extensively on the subject.
What is ptosis, and how is it different from a regular eyelid lift?
Ptosis is when the muscle that opens the eye becomes weakened or detaches, causing the eyelid to fall — sometimes enough to block vision. It’s often confused with blepharoplasty (standard eyelid surgery), which removes excess skin, muscle, or fat for either functional or cosmetic reasons. Ptosis surgery is different: it’s not about removing skin, but about reattaching or tightening the muscle itself so the eye can open properly. The two can be done together or separately, depending on the case.
What causes ptosis?
There are several types. Congenital ptosis is present from birth — a dystrophy of the Levator muscle (the voluntary muscle that opens the eye) that also affects how well the eye closes, since the muscle is infiltrated with fat and fibrous tissue. It’s more complex to repair. The most common form, though, is acquired (or “involutional”) ptosis, which develops as the eyelid’s supporting tendon thins and detaches over time — this can happen with age, but also in younger people. Less common causes include mechanical ptosis (a mass pushing the lid down), traumatic ptosis (injury-related), and neurogenic ptosis (a problem with the nerve controlling the eyelid muscle).
How is ptosis corrected?
There are two main surgical approaches. The first is an external incision where the surgeon reattaches the muscle directly — this requires the patient to be awake during the procedure so the surgeon can adjust the eye’s opening and closing in real time, and it demands a higher level of surgical skill to get the height and curvature right. The second approach works through the eyelid from the inside, targeting the involuntary “fight or flight” muscle (Mueller’s muscle); this method doesn’t require the patient to be awake and follows a more predictable, algorithm-based process. Which approach a surgeon uses often depends on their training and region — practices in areas where patients are especially focused on cosmetic outcome, like Los Angeles, tend to favor the internal approach.
Does insurance cover ptosis surgery?
It depends on why the surgery is being done. When ptosis is significant enough to obstruct vision, insurance is more likely to cover correction. When the goal is primarily cosmetic, coverage is much less likely. It’s worth asking any surgeon directly, before scheduling, whether they accept insurance and how your specific case would likely be classified.
How is ptosis diagnosed, and what else should be ruled out?
The most visible sign is simply one eye appearing lower than the other. But diagnosis isn’t just about confirming ptosis — it’s about ruling out what’s causing it first. Ptosis can be a warning sign of something more serious, so a proper evaluation should rule out neurological causes, tumors, or vascular issues like those related to diabetes that can affect the nerve’s blood supply. Treating any underlying medical condition always comes first, before deciding on a surgical approach.
Who is at higher risk for complications from ptosis surgery?
Dry eye and other ocular surface issues are the main things to rule out beforehand, since surgery can sometimes make dry eye worse — some patients are comfortable accepting that tradeoff for improved vision, while others aren’t good candidates. Anyone who has had LASIK surgery has a higher likelihood of dry eye complications. The use of a surgical speculum can, in rare cases, contribute to ptosis as well. That said, the large majority of patients — around 95% — can have this surgery done safely and successfully.
How do I find the right specialist for ptosis?
Look specifically for an Ocular Plastic Surgeon rather than a general eyelid or cosmetic surgeon — ptosis repair is one of the hallmark procedures of that specialty, much like mole removal is a routine, high-frequency procedure for a dermatologist. Check credentials carefully before choosing a surgeon.
Want the full conversation?
Watch the full interview with Dr. Guy Massry on the Fifty Up Health and Beauty YouTube channel. https://youtu.be/aGDt2zWG_mE?si=dqn0Uk6AJZBlXo2l
Get the book: https://stan.store/myfiftyup Join the email list: fifty-up-health-and-beauty.kit.com
Fifty UP 