Is Ptosis after upper and lower blepharoplasty caused by mistake during surgery? Will it resolve on its own? (photo)

Question

I am 15 days post surgery and my right eye seems to have ptosis. The lid partially covers the iris and the difference is pronounced when looking up. When I look up or laterally, I feel a pulling sensation on the outer side above the right eye. Left eye is normal. I see little visible swelling now. Could it be the result of a mistake during surgery that damaged the levator? If so is there a way to correct it and how serious is it? Not scheduled to see PS for another 2 wks.

Thomas Fiala, MD, FACS, FRCSC · Answer

Hi.  Assuming that this ptosis is a new finding - the most common explanation is related to the swelling of the area post-surgery.  Sometimes this swelling is enough to temporarily stretch the levator aponeurosis, and cause a temporary mild ptosis.  It typically resolves with time, and no surgical intervention.  Naphcon A drops may help.

Paul M. Parker, MD, FACS · Answer

Ptosis of the upper eyelid after blepharoplasty is seen from time to time. Usually it is due to swelling and will resolve on its own. We have had good success with a trial of oral steroids and a diuretic for quicker resolution. Call your surgeon to let them know your condition and get their evaluation.

John J. Martin, Jr., MD · Answer

You have a mild ptosis on the right.  At 15 days you are very early in the healing period.  It is not uncommon for one or both lids to be a little low for several weeks.  Give it more time and see if the lid comes up.  At 6 months it can be lifted if necessary.  Sometimes a ptosis may not be noted pre-op if there is a lot of excess skin.  Removal of the skin may "unmask" the ptosis.  But still need more time to heal.

Kenneth D. Steinsapir, MD · Answer

The tendon that raise the upper eyelid is very thin in some people.  It certainly can be inadvertently damaged during eyelid surgery and this is common but it usually does not cause ptosis.  However, the tendon is really held in the eyelid with very thin tissue and even the swelling associated with the surgery can cause ptosis after eyelid surgery.  Generally you should let this heal a very long time before having a repair.  The rationale for this is that many of these droopy eyelids do get better on their own.  I recommend letting this heal for at least a couple of months.  Generally it is best to let the tissues heal at least 6 months to increase the accuracy of the repair.  I do make an exception to this timing if there is evidence of a tethered ptosis with corneal exposure and irritation of the cornea.

Soheila Rostami, MD, FAAO, FAACS · Answer

It appears that there is some eyelid lag and ptosis of the RUL. This could be thought to scarring of levator muscle to septum. Please, return to your surgeon and explained your problem. Sometime just little injecting of Kenalog-40 can help extensively.

Thomas Trevisani, MD · Answer

Without pre-op photos- it's impossible to give an accurate comment. Also, 15 days post-surgery is far too early to evaluate. Therefore, give it more time- address the issue with your Board Certified Surgeon and hopefully the end result will be in your favor.

Alexandre Marchac, MD · Answer

Hi, upper blepharoplasty does not induce ptosis by itself, because the levator muscle is located behind the septum, miles away (surgically speaking) from the skin (+/- orbicularis muscle) which is removed during a blepharoplasty. No board certified plastic surgeon would injure the levator during surgery.Nevertheless, if you had a slightly elongated levator aponeurosis prior to your operation, a standard upper bleph can induce a decompensation. This is probably the case because both of your upper lid crease are higher than usual (normal crease is located at 9 mm from eyelashes, yours are probably 11 to 12 mm). This usually improves over time, nevertheless, it might be necessary to correct your ptosis over the long run, but you should wait at least 6 months to allow for spontaneous recovery.  Hope this helps,

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

At 2 weeks postop, your eyelids are healing still. Continue to 
follow your surgeon's postoperative instructions. If your issues 
persist, discuss with your surgeon.

Darryl J. Blinski, MD · Answer

At 15 days postop might NOT be ptosis but could be postop lagopthalmus issues. Best to see your surgeon or eye doc ASAP.

Is Ptosis after upper and lower blepharoplasty caused by mistake during surgery? Will it resolve on its own? (photo)

Answers (9)

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