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Farber et al. Plast Aesthet Res 2020;7:20 I http://dx.doi.org/10.20517/2347-9264.2020.05 Page 5 of 23

Figure 5. Close-up view of the deris of the lid crease moving higher as the levator withdraws and the lid drops

Figure 6. Patient 1 year after upper blepharoplasty and early postoperative left hematoma managed conservatively

Acquired ptosis can be due to forces extrinsic or intrinsic to the upper lid [Figure 8]. Extrinsic lid ptosis
is secondary to factors outside of the upper lid, such as mechanical forces on the upper lid (brow ptosis,
dermatochalasis, or tumor), contralateral lid retraction (most commonly secondary to thyroid disease),
[4]
enophthalmos, orbicularis spasm, or facial nerve abnormalities .

Intrinsic lid ptosis can be aponeurotic, myogenic, or neurogenic. The management of neurogenic and
myogenic lid ptosis requires a specialized neurological evaluation. Aponeurotic ptosis will be the focus
of this article and can be secondary to attenuation of the aponeurosis, trauma, eyelid swelling, or ocular
surgery . One form of trauma after which patients may develop lid ptosis is following cataract surgery due
[4]
to retraction injury and stretching of the levator muscle.