Upper Eyelid Hollowness After Ptosis Repair

Hi, I am 32 years old Asian female. Apr 2011, I had a surgery to repair ptosis. However, my left upper eyelid became too hollow, stiff and sunken. I am frustrated that my eyelid are hugely assymetrical. I am fearful of another surgery as it may damage muscle function. I've read that fillers don't work and the only solution is fat grafting. I'm looking up fat grafting to correct this, and I'd like to know, are oculoplastic surgeons or plastic surgeon better at this procedure?

Doctor Answers (6)

Asian eyelid ptosis repair

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I have seen this issue time and again after a surgeon has attempted a ptosis repair on an Asian patient. You have quite a bit of scar tissue and a crease position that is far too high at least taste on this photo. I would not say that you require fat grafting but it may be needed. One variability that cannot be accounted for until the time of surgery is the quality of your levator tendon. So much of the success of your revision depends upon the quality of this anatomical structure and the function of the levator muscle. I would get several consultations and hold off on any fat grafting or filler. And when I referred to fat grafting I did not mean injecting fat although that may be an alternative.

Chase Lay, MD

double board certified facial plastic surgeon and Asian eyelid surgery specialist


Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 43 reviews

Ptosis repair is one of the most challenging procedures.

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In general, I don't recommend using filers for upper lid hollowness and rarely use fat grafting except in severely deformed cases because of its associated risks and unpredictability.

In your case, your main problem is ptosis of the left upper eyelid causing severe asymmetry and accentuating the hollowness. 

Ptosis repair is one of the most challenging procedures, even for skilled surgeons, thus you need to find a surgeon who has a lot of experience in ptosis repair on Asians. Don't be afraid to ask doctors how many ptosis repair they have performed and what their success and revision rates are.

Eric I. Choe, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 32 reviews

Ptosis repair should be done first

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Levator advancement surgery to correct your ptosis will definitely bring the crease down and may correct the hollow area. If it is still hollow then a filler or fat transfer could be discussed. Find someone who does a LOT of ptosis repair (usually an oculoplastic surgeon) and who operates on a good number of Asian eyes.

Good luck!

Jeffrey Schiller, MD
Staten Island Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

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Ptosis repair int eh Asian upper eyelid

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The left eyelid ptosis should be addressed, and unfortunately you will need further surgery on the levator muscle. The high crease, hollowness, etc. are by-products of the ptosis. Fat grafting, double eyelid surgery, etc., will not improve the situation. Because ptosis appears to be more common in Asians (my personal observation), surgeons that perform Asian eyelid surgeries, whether plastic surgeons or oculoplastic surgeons, will usually be experienced in ptosis repair.

Charles S. Lee, MD, FACS
Los Angeles Plastic Surgeon
4.5 out of 5 stars 52 reviews

Need more information about upper eyelid ptosis repair

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Hi, sorry to hear about your eyelid asymmetry.  First, it appears that you have a levator dehiscence ptosis of the left upper eyelid as well as volume loss of the upper eyelid (superior sulcus) as evidenced by the eyelid position MRD1 1.0 and elevated eyelid crease.   What did you left eye look prior to any surgery?  Was the crease as high or indistinct?  Were there multiple folds?  Is there an element of congenital ptosis (present since birth?)  A good history and review of old photographs would help to determine a treatment plan.  What kind of ptosis repair did you have - anterior/posterior?  Filler or fat would not be my first choice but rather a repair of the levator dehiscence.  Best of luck in your care.  

Bobby S. Korn, MD, PhD
San Diego Oculoplastic Surgeon
5.0 out of 5 stars 1 review

Eyelid Ptosis and Hollowness

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You must have returned to the original surgeon, have you not?  In your narrative, it would be helpful to know whether your initial ptosis was unilateral (one side only) or bilateral, and what your pre-surgical appearance was.  Your MRD (marginal reflex distance, between pupil and upper lid margin) is ZERO on the left side.  This is the primary asymmetry, and needs to be the focus of any procedure to restore symmetry and left upper lid function.  Fat grafting is NOT part of the initial solution, and should not, in my opinion, be a part of the operative plan at this time.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.