Eyelid still drooping after ptosis surgery and revision - can this be fixed? (Photos)

Question

Hi doctors, I had ptosis surgery on one eyelid and later a revision, but the eyelid still drops back down. The other eye lifted well, so they look uneven now. I’m 24 and otherwise healthy. I’d really like to know what options might exist to improve the eyelid at this point. Thank you.

Kenneth D. Steinsapir, MD · Answer

I did respond to you a couple of weeks ago. I am in the business of fixing eyelids after failed surgery. I am sorry you are in this situation. It is very common to feel hopeless and lose faith in your initial surgeon. I do not recommend that you go back to that surgeon. Assuming  you have not flipped these images, your left eye (on the right side of the picture) is heavier than the left but both eyelids are relatively heavy. You have a high crease and no upper eyelid fold. You have bilateral eyebrow compensation, meaning your forehead is lifting the eyebrows in response to the ptosis. There is slight more eyebrow compensation on the left side with the heavier eyelid which is expected. Likely your initial upper eyelid surgery was a Müllerectomy and possible this same surgery was performed when your eyelid was revised. This is the most common form of ptosis surgery. However, as I stated in my previously response to you, These situations require anterior levator ptosis surgery to repair. The most important thing here is to assess levator function. That is the excursion of the upper eyelid margin when the eyebrow is fixed. It is measured from the upper eyelid position looking all the way down to looking all the way up, The other important element is to assess how much preaponeurotic fat you have in the eyelid. This fat volume helps fill out the reconstructed upper eyelid fold. It is highly likely that you have a central levator disinsertion that was not adequately repaired by the prior ptosis surgery. The repair is performed by making a new lower crease, finding the disinserted levator aponeurosis, advancing it to the new crease in such a way the eye is opened to the desired height, mobilizing available pre-aponeurotic fat so it can contribute to the upper eyelid fold. When the internal tendon is strengthened, it often provides the signal needed for the eyebrows to relax to a more natural position. In my opinion, it is highly likely that both of the eyelid will need to be addressed even though the right is somewhat more open than the left. There is no substitute for a detailed in person assessment. Do not let well meaning surgeons fill the eyelid with filler or grafted fat. Understand who you are seeing what what they are proposing.

Eyelid still drooping after ptosis surgery and revision - can this be fixed? (Photos)

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