Is surgery for levator dehiscence ptosis following an upper bleph covered as part of the original surgery?

Doctor Answers 4

Levator dehiscence?

Dear mailui

Thank you for the question. You must be a nurse or doctor or have seen another physician who told you this might be a "Levator dehiscence".  Most people would not recognize or have even heard of this terminology.  There are several things which would prevent a precise discussion of how to manage this diagnosis, including the fact that your tissues are obviously still swollen, and that the ptosis visible in your picture is not only minimal, but is symmetric, and could be due only to the swelling in the lids. I would give your lids more time to heal and lose the post-operative swelling, and go back to your surgeon. If he or she agrees with this diagnosis after adequate healing time, talk about the options to treat, or seek a referral to a board-certified plastic surgeon experienced in complex eyelid procedures. Good Luck.


Saint Louis Plastic Surgeon
4.6 out of 5 stars 23 reviews

Ptosis after blepharoplasty, exotropia

You have several diagnoses based on the photograph including 1) probable levator dehiscence, 2) brow ptosis, and possibly 3) wide angle exotropia (eyes wander outward, sometimes upward at the same time due to muscle imbalance). The photo is taken at close range which can distort the picture. Whether or not the surgery is covered, only an expert oculoplastic surgeon can give you the information you need and correct your complex problems. When exotropia is present, achieving perfect symmetry with ptosis repair may be very difficult. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

A better question would be does your surgeon even know how to repair upper eyelid ptosis?

It is one thing to do offer eyelid surgery.  It is entirely another matter to be able to perform ptosis surgery.  Very few surgeons who offer blepharoplasty understand the deeper eyelid anatomy need to repair a elevator dehiscence ptosis. Due to the specialized nature and need to have extensive experience with repairing ptosis, you have to ask yourself if your eyelid surgeon has that necessary skill, training and experience to correct this type of post eyelid issue.  

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Eyelid surgery

Hello and thank you for your question. I recommend that you return to your primary surgeon and share your concerns.  It is difficult to determine based on this picture and you are also still swollen from your surgery.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 78 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.