Revision for two previous ptosis surgeries?

Question

I am hoping that I can have procedure to improve the symmetry of my eyes. I have had two ptosis surgeries to the left upper eyelid. The last one was six months ago. I think the crease is the problem.

Mehryar (Ray) Taban, MD, FACS · Answer

Revision ptosis surgery is complex but it can definitely be done. See an expert oculoplastic surgeon for evaluation and surgery.

Kenneth D. Steinsapir, MD · Answer

I have previously post on one of your earlier posts. I am so sorry that you are not making progress to resolution. I suspect that you will need to travel to get the care you need. Do not seek help from well meaning folks really don't know what they are going. First let me reiterate that the wedge excisions you had for chalazia were most likely not necessary. Generally these inflammatory lesions respond beautifully to injection with Kenalog, Surgery is seldom necessary. Sadly, ophthalmologists get almost nothing for the injection of a steroid. A full thickness wedge excision pays better. That should not be the reason to perform a surgery and likely your surgeon felt this approach was appropriate. It's still an issue because it likely contributes to your current situation. We do not know what type of ptosis surgery you had but the most common ptosis surgery is a posterior approach Muellerectomy or Mueller's muscle conjunctival resection ptosis surgery (MMCR). Ninety percent of ptosis surgery in the United States is performed with the MMCR.  However, I do not find it helpful in eyelids like yours. You need a crease reconstruction in addition to a ptosis surgery repair. I do not think you will get what you need from local eyelid plastic surgeons. There is no substitute for a detailed in person assessment.

C. Blake Perry, MD · Answer

You could benefit from an additional ptosis surgery on the left side. It appears the muscle needs to be tightened more and the fat needs to be released to come fill the superior sulcus. You need an in person exam to determine the exact cause of the ptosis before proceeding with surgery. Best to see an eyelid expert.

Gary M. Horndeski, MD · Answer

You have facial asymmetry. Your orbital orbits seem to be at different levels and your eyebrows are at different levels. You may benefit from a brow lift. This will lower your hairline, decrease the vertical height of the forehead and create more symmetry of the eyebrows.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

Based on this photo your problem is not properly corrected yet. It may be a time to consult a new surgeon and see what are your options now. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

I’m guessing your provider selection may have been inadequate.
Finding the right oculoplastic surgeon to do this kind of work is a bit tricky.
I generally recommend patients have multiple consultations before selecting a provider.
Ask them to open up their portfolio of before, and after pictures to get an idea of what their outcomes look like, but more importantly, how many cases They’ve done.
Sufficiently experienced provider should have accessed 100s of examples to choose from.
Those who do this procedure every once in a while May not have the skill or experience necessary.
Some plastic surgeons may have experienced with this procedure, but I believe it’s more commonly performed by oculoplastic surgeons.
Having had multiple previous surgeries will always make things more complicated, but I don’t see why this could not be adequately corrected.
From your picture it looks like your left eye socket sits higher in your skull than the right side.
This is unrelated to the eyelid position in relation to the Iris and pupil.
Best,
Mats Hagstrom MD

Revision for two previous ptosis surgeries?

Answers (6)

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