MMCR failure. What can be done? (Photo)

Question

Hello, I have acquired Horners syndrome after a thyroidectomy. I recently had MMCR surgery to repair my left lid. Surgery does not appear to be a success and the eye appears worse than before. The lower lid looks higher and eye asymmetry is more noticeable. I did see a great occuloaastic eye surgeon. What can be done

Allan E. Wulc, MD · Answer

Hi Cheerful331303
You are definitely asymmetric. If anything the right upper eyelid appears retracted. That would be consistent with your history of thyroidectomy--you may have thyroid related upper eyelid retraction. You and your doctor would need to look at pictures of you from years ago before you developed any thyroid problems to see whether the right upper eyelid has changed position--actually gone upwards. I also don't see any asymmetry of the pupils in this photo--something I would expect in a patient with Horner's syndrome.
Your options are to consider additional ptosis surgery to the left eye--either using an internal approach as was done prior and which has been described, or more likely an anterior approach where the tendon to the muscle not affected by the Horner's syndrome, the levator muscle and its aponeurosis can be tightened.
Another option--one that I would probably recommend-- would be to lower the right upper eyelid. This procedure would probably give you the most natural and aesthetically appearing result. The procedure, like the MMCR, can be done with an internal approach.
Good luck!

Ayse Dolar Bilge, MD · Answer

I think your other eyelid has retraction so retraction surgery for your retracted eyelid is a better surgical option.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your experience and posting your photo. You should have revision surgery with an oculofacial surgeon. Most are skilled enough to manage your problem. 
Good luck,

Michael A. Burnstine, MD · Answer

Before having additional surgery, I advice getting thyroid function tests. These include T3, T4, TSH, Thyroid Peroxides Antibody and Thyroid Stimulating Antibody. My concern is that you have thyroid eye disease. Comparing your current photograph to a driver's license or older photos will help to determine weather the right upper eyelid is retracted. It is critical to compare old photo eyelid position to your present photo.

Alan Gonzalez, MD, FACS · Answer

Hello @Cheerful331303, thank you for your question. To make an informed recommendation, more information is needed. A consultation is vital to establishing a surgical plan that meets your needs, meets your expectations, and takes into account what is possible. Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

MMCR failure. What can be done? (Photo)

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Answer: MMCR failure. What can be done?

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MMCR failure. What can be done? (Photo)

Answers (6)

Answer: Medical Evaluation

Answer: Medical Evaluation

Answer: MMCR failure. What can be done?

Answer: MMCR failure. What can be done?

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Our mission is to create a world where every investment in modern beauty is Worth It.