Failed Ptosis repair in more ways than one. What caused this and what can be done? (Photo)

Thank you for sharing your question and posting your photos. It does appear that the ptosis has worsened. The surgery can become more difficult following each procedure. The cause cannot be determined without in person evaluation. Follow up with your doctor to determine how to correct your problem or get a second opinion from another oculoplastic surgeon.
Good luck!

The details of your particular eyelid, its physical resources, and what has perviously been done make a difference, so there is no substitute for a detailed, in person assessment. The most common type of ptosis surgery performed is posterior approach ptosis surgery, which goes by several names including Muellerectomy and Mueller muscle conjunctival ptosis surgery. Surgeons love this type of ptosis surgery because it is reasonably reliable, the anatomy is very simple, and the surgery takes a fraction of the time that anterior approach surgery takes. The problem is that it commonly fails. While your surgeons might have tried to convince you that surgery was successful, you need the position of the two eyelids to be within a 1/2 millimeter. That is a tall order for any ptosis surgery. The problem with the Muellerectomy is that in many eyelids, the levator aponeurosis is slipping centrally. When this occurs, the Muellerectomy will be ineffective (or not effective enough). The fix is to use the anterior approach. The anterior approach is much more powerful but also technically more difficult. Performing an anterior levator resection ptosis surgery after one or more Muellerectomies is fussy and time consuming. The rate of needing a revision is higher than performing it on an unoperated eyelid but it is extremely reliable and it will also allow the upper eyelid crease to be controlled and permit the upper eyelid fold to be made more symmetric with the other side. Your eyes can be your best feature.