Ptosis surgery failure? (Photos)

I had Ptosis surgery two weeks ago and I am not seeing any difference. I had the stitches out now. My doctor says come back in three months and if failed he will do a sling. He tightened the muscle as far as it could go so it's not possible to do another of the same surgery. I am starting to feel sad that as I was so excited for this to work.

Doctor Answers 4

Ptosis Surgery Failure

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Fantasy,

I'm curious as to what surgery was performed on your lids.  In your preop pics I can see an elevated crease which generally means that you have fair to good levator (muscle which elevates the eyelid) function.  If so, the surgeon may not have elevated the lid enough, though you did mention that your eyes wouldn't have closed otherwise.  I recommend that you wait a couple months and seek a second opinion. Providing levator function measurements and pictures with your eyelids closed would also help.

Cheers,

Hugo


Honolulu Oculoplastic Surgeon
5.0 out of 5 stars 1 review

Still droopy after ptosis repair

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Thank you for your question and for submitting your photos. You are still very early in the healing phase. Swelling can take up to several months to completely resolve. Your surgeon is wise not to suggest revision until at least three months. Often these cases will be observed for up to six months or more if improvement is noted. Your photos do show some improvement from the pre-op photos. I would advise you to be patient and follow your surgeon's  wise advice. 

Mark L. Mazow, MD, FACS
Dallas Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

What type of surgeon did you see?

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Was it a general plastic surgeon or a more specialized oculoplastic surgeon?  It makes a difference.  How detailed was your examination with the surgeon?  Was levator function measured?  Levator function is a measure of excursion.  I find the remark that in 3 months, you should come back and have a sling if the eyes don't open, makes me wonder if your surgeon really knows what they are doing.  If you have enough levator function, you don't need a sling which is honestly a disaster of a surgery and is only performed with levator function is less than about 8 mm.  Presumably you had an anterior levator resection ptosis surgery.  You may have had a supermaximal levator resection but your actually details and operative reports need to be studied. Very few general plastic surgeons ( and unfortunately not all oculoplastic surgeons) understand this anatomy.  Because a sling surgery is so deforming, I encourage you to seek second options with other oculoplastic surgeons.  I don't recommend a sling procedure.  In you before photos, you have an upper eyelid crease which suggests to me that you have some levator function.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Ptosis surgery

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Thank you for your question.  Ptosis surgery takes time to show full effect.  Cautiously waiting is appropiate to see final results, usually around three months.  If at three months the eyelid is still low, then it may need to be revised.  If you surgeon is not experienced in revision surgery, it is appropiate to seek a second opinion.  In general, slings are reserved for patients that have little or no function of their eyelid muscle, a trained oculoplastic surgeon will be able to test for this very easily.

Best of luck!

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.