Is It Possible to Use Brow Slings on Both Eyes for Correcting One Sided Ptosis?

I have one sided ptosis, had a brow sling operation but I'm not satisfied with the result. Is it possible to remove the levator function on the healthy eyelid and treat both eyes with a brow sling operation to achieve better symmetry? If possible, is it reversible?

Doctor Answers 2

Brow (frontalis) slings for droopy upper eyelid

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Is you dissatisfaction with symmetry in straight ahead gaze or only when looking down? Slings, by design, lock the lid that doesn't move (i.e. poor levator function) into a higher position, so the lid may actually look too high when looking down (or when the chin is tilted up). If the asymmetry is only in this position, a sling placed in the opposite (good) upper eyelid (with or without "removing levator function) could be considered to achieve down-gaze symmetry. (The sling will "hold up" the good eye when looking down to match the opposite side.) The ultimate question is whether you (and your surgeon) are willing to put the normal eyelid at some risk with surgery. 

Irvine Oculoplastic Surgeon

Bilateral frontalis (brow) slings for unilateral ptosis

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You are hitting on the key issue with one-sided eyelid ptosis (droop).  Whether you were born with this problem, or you acquired it, the problem is that your brain needs to consciously and continuously lift that side's eyebrow in order to raise that lid.  Unfortunately, you can not concentrate on your eyebrow every moment of the day, and thus, the lid will often still look droopy after this type of surgery.

The only way to get around this problem is to sacrifice the normal side.  Most surgeons who do this procedure are not comfortable doing that to the normal lid.  At least not at first.  But some will consider it if and when the unilateral sling fails to accomplish it's goal- and with a lot of informed consent.

Tough problem.  Hopefully we will have a more effective procedure for patients with your severely impaired levator muscle in the future.

Yoash R. Enzer, MD, FACS
Providence Oculoplastic Surgeon

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