Acquired Blepharoptosis for the Dermatologic Surgeon: Recognition, Assessment, and Nonsurgical Management

Document Type

Article

Publication Date

6-22-2026

Publication Title

Dermatologic Surgery

Abstract

BACKGROUND: Blepharoptosis, or drooping of the upper eyelid, is commonly encountered by dermatologic surgeons due to aging, medical conditions, periocular procedures, and/or inadvertent neurotoxin administration. Proper recognition and management are critical for both functional and cosmetic outcomes. OBJECTIVE: To review clinically relevant anatomy, diagnostic evaluation, and nonsurgical treatments for acquired ptosis, emphasizing considerations specific to dermatologic practice. MATERIALS AND METHODS: A literature review of PubMed and Embase identified English-language studies and clinical trials addressing the diagnosis and management of blepharoptosis, with emphasis on nonsurgical and dermatologic applications. RESULTS: Key diagnostic tools include the marginal reflex distance 1, levator function testing, and standardized preprocedure and postprocedure photography. Oxymetazoline 0.1% demonstrates modest but statistically significant improvement in marginal reflex distance 1 and superior visual field improvement in randomized trials. Off-label adrenergic agents and targeted pretarsal botulinum toxin injections may offer adjunctive benefits, although supporting evidence is limited. CONCLUSION: Dermatologic surgeons are positioned to identify and manage mild acquired ptosis using validated metrics and nonsurgical options. Selective botulinum toxin placement can be considered in selected cases; supporting evidence remains limited. Appropriately identifying cases that need referral for surgical repair will also benefit patient care by improving vision, daily function, and cosmesis.

PubMed ID

42319274

Rights

© 2026 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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