Treatment Options for Congenital Ptosis (25 Yrs Old)

I saw 2 oculo surgeons on ptosis-left eye. I use my brows to open my eyes. 1st surgeon suggests a sling only on the left eye and said the right side will likely droop later/need 2nd surgery. The 2nd surgeon gave options: super maximal levator advance on left eye only/may need 2nd surgery later. 2nd option: a sling on both eyes which would consist of breaking my good eye. Im considering the 2nd option as it sounds more promising but very nervous/wanted to know is this common/ok? Please help! =/

Doctor Answers (2)

Congenital lid ptosis correction will require compromise

+2

Congenital ptosis is a complicated repair that requires experience and compromise, and is ordinarily outside of the practice of cosmetic surgery, though it sounds like you have selected two good physicians. The type of repair will depend very much on the amount of muscle function in the lid. The primary opening is produced by the levator muscle, and a 'normal' result can be had with 8mm of levator function. The second factor is the amount of droop of the lid, 1-2mm mild, 3mm moderate, 4mm severe. The amount of droop will determine how much levator muscle shortening is needed, factored by how well the muscle itself will function. If possible the muscle shortening on your most affected eye would probably be considered the procedure of choice (maximum levator resection/advancement either through the underside or outside the lid).

If your exam shows that the levator will not work, then the 'sling procedure' on both eyes would be the best second choice as it allows the most cosmetically pleasing symmetric movement of the lids. Slings can be fashioned that are removable or adjustable. I really like levator shortening procedures when they will work, and I like the options that your second surgeon has given you. Spend more time with your decision, perhaps a second visit with surgeon #2.

Best of luck,

peterejohnsonmd


Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

These are very difficult situations.

+2

Surge

WIthout an examination, it is impossible to help you decide the best option for you.  This is a circumstance where there will never be a single right choice.  A lot depends on how much levator function you actually have.  Generally in congenital ptosis the levator function is poor.  This means that tightening the tendon in the eyelid does not give the effect that this surgery would when the levator muscle works well. On the other hand there are down sides with the sling surgery.  Personally, if I had too choose, I might accept a lessor result and not have slings if there was a reasonable chance of some improvement.  

Bottom line here is you need to be working with someone with a great deal of experience and trust your doctor because at the end of the day there is no best choice.  What you elect to do and how you feel about the result of surgery will be greatly influenced by your confidence in your surgeon.  This is a situation where I would recommend seeing a University based eye plastic surgeon.  You should consider going to the University of Michigan.  There is added benefit of going to a department like that because there is usually a good deal of case discussion among colleagues regarding treatment options.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

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