Can internal ptosis surgery cause issues with eyelid closure? (Photo)

Question

I would like to get a slight amount of ptosis corrected in my right eye. Can this lead to problems with eyelid closure if done internally? If so, is another method better?

Kenneth D. Steinsapir, MD · Answer

Unfortunately that surgery is unlikely to help you. The internal ptosis surgery is also called a Müllerectomy. It is performed for small amounts of ptosis (1.5 to 2 mm). It really only works when the levator aponeurosis, the tendon for the muscle that raises the upper eyelid is firmly attached to the tarsus. That is unlikely to the case in your right upper eyelid. You have Post Upper Blepharoplasty Syndrome (Upper eyelid ptosis, high or absent upper eyelid crease, hollow sulcus, upper eyelid lash ptosis) These lids look this way because during the healing phase from the blepharoplasty, the scar that develops inside the eyelid cause the levator aponeurosis to disinsert from the tarsus. Because the levator is not properly attached, Müllerectomy may only lift the eyelid 1/2 mm. The surgeon will still claim that surgery was "successful." However, you will still have a heavy upper eyelid. Also this surgery will not address your upper eyelid fold issue. You need the upper eyelid crease lowered, the ptosis repaired, and the fold reconstructed. Only by addressing all of these issues will the right upper eyelid look like the left upper eyelid. Don't talk yourself into the wrong surgery. It will not fix your issue but will use up the resources needed to correctly repair the eyelid. I am attaching an article on the post upper blepharoplasty syndrome. Your eyes can be your best feature.

Mehryar (Ray) Taban, MD, FACS · Answer

No ptosis surgery is 100% safe, however internal ptosis surgery has very low risk when done with expert. Important to have more detailed evaluation and discussion in consultation with an oculoplastics expert.

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