Failed Ptosis Surgery/any other options? (Photos)

Question

Updated Question: I had ptosis surgery 5 weeks ago now. I had the levator muscle tightened by a specialized oculoplastic surgeon. He tightened my muscles as far as he could so there is no way to do a revision later on. When I go back after 3 months post op he suggested a sling. I have been advised against that by doctors here Did the surgery made things worse? Is there any other surgery options out there for me? I hate my eyes anymore and it's becoming more difficult on my vision?

Mehryar (Ray) Taban, MD, FACS · Answer

I need to examine you to better tell you. Revision eyelid ptosis surgery using a different approach may be an option. See following link.

Ali Ghafouri, MD · Answer

It appears that you have ptosis with poor levator function. There are certain medical coditions that may result in ptosis with poor levator function, especially if this condition was aquired later in life. So, they need to be ruled out prior to undergoing surgery. There is also change in eyelid contour which needs to be addresed at the time of surgery to obtain more natural results. Good Luck!

Jeffrey M. Joseph, MD · Answer

It's difficult to know what options are available just from photos. It would be determined by the prior approach and the "function" of the elevator muscle of the eyelid. Getting a second opinion is reasonable at this point.

Mark L. Mazow, MD, FACS · Answer

You do still appear to have some ptosis, but it doesn't appear to be worse. Your lids are above your pupils. There could still be some swelling. I would wait at least 2-3 more month if not a full 6 months after surgery to re-assess the situation. A sing can be done, if necessary, but I wouldn't make this decision for a while. I would follow up with your surgeon as scheduled.

John R. Burroughs, MD · Answer

Sorry to hear about your ptosis problems.  All the Denver area ASOPRS oculoplastic surgeons are very well trained.  It appears you have poor levator function ptosis, and there are limits on how much lift you can get by tightening the tendon, muscle, and/or shortening the tarsus to maximize the lift.  It does not appear your ptosis is worsened.  If you are functional with your current eyelid heights and it appears your pupils are "cleared," in that the lid margins are at them or just above then you can put off a frontalis sling.  The sling procedure is very powerful, but the lid contours and getting perfect symmetry in terms of equal opening of the eyes is very difficult.  We usually will reserve this for the worst of cases for these reasons.  With that said, good cosmetic as well as functional results can be obtained with slings.  Best regards.

Matthew Sniegowski, MD · Answer

Thank you for the question, ptosis can be a very challenging surgery. In general terms there are three major ways to elevate an eyelid, the conjunctiva and mullers muscle (minor lifting muscle) can be shortened from the underside of the eyelid, the levator aponeurosis can be shortened (as it sounds that you have had done) or a sling can be used to attach the eyelid to the brow lifting muscles. The type of surgery will depend on how low the eyelid is and how well your lifting muscles are functioning. Revision ptosis surgery is always a challenge but I think it would be reasonable for you to discuss with your surgeon attempting to use the levator muscle to get adequate elevation sometimes the minor lifting muscle also has to be shortened once the levator has been dissected free. I typically use frontalis slings in congenital ptosis (children born with a very low eyelid) or as a last resort in adults.

Failed Ptosis Surgery/any other options? (Photos)

Answers (6)

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