Ptosis repair revealed dis-inserted levator muscle. This was fixed during surgery. However now when I raise my eyebrow, my upper lid is dragged downward. This is much worse if I am looking upward - then the lid totally obscures the pupil. I really would like to know what the cause of this could be, if anyone can shed light on this please.
Post Lid-ptosis Repair, my Brow Forces Lid Down? (photo)
Doctor Answers 2
You are demonstrating tethered ptosis.
I would be curious to know the type of surgical specialist who repaired your droopy eyelid. Post surgical tethered ptosis can occur from scaring after surgery, an uncommon but not unheard of post operative situation that fits under the heading of "additional surgery may be needed in the future" that is part of your surgical consent. However, I have also had the experience of repair this work from non-ocuoplastic surgeons where the well intended surgeon sutured the levator aponeurosis, the tendon from the muscle that raises the eyelid, to the fixed septum (once opened a eyelid operated on by a "world famous" plastic surgeon and there as a neat row of 9 sutures anchoring the levator aponeurosis to what was left of the septum.) The significance of suturing these structures together is that the eyelid is no longer mobile: The eyelid does not move down when you look down and it does move up when you look up. For may issues we often recommend letting the eyelid heal for 6 to 12 months before revising this situation. For me tethered ptosis is an exception to this rule. I personally feel that this is an indication for immediately exploring the eyelid surgically.
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The symptoms you refer to are related to the levator repair, and scar contracture which is unpredictable. Revisions can be done to improve this, and the timing here will be important. I suggest you keep in touch with your surgeon who knows better. You should ignore the paid political advertisement from other physicians who answer your question. All the best