Excess skin - Can this be fixed with just excised skin? (photos)

Question

I had a consult and was dx with ptosis and Dermatochalasis of both upper eyelids. The procedure indicates Bilateral upper lids levator resection (skin + levator + crease). Would skin excised from my eyelids take care of the excess tissue or would they need to also perform an upper blepharoplasty? My left eyelid definitely has ptosis but I feel like my right eyelid is more pushed down due to excess tissue.

C. Blake Perry, MD · Answer

Ptosis refers to the position of the lid without regard to skin excess. Often when one lid is too low (your left upper lid) the other lid may need to be raised at the same time due to Herring’s law. Removing skin does not affect the true lid position-it only removes the weight that pushes the lid down. You need an in person exam to determine the best surgery option. Judging from your pictures, you would likely need a bilateral upper lid blepharoplasty, left upper lid ptosis repair, and possible right upper lid ptosis repair. Best to see an eyelid expert.

A.J. Amadi, MD · Answer

Technically, removal of extra skin and re-creating a crease is called and "anchor blepharoplasty". Some patients may also need fat excision as part of their blepharoplasty, though we tend to be very conservative with fat excision to preserve volume. 
The levator resection (or advancement) is the ptosis repair part of your surgical plan. 
So if you surgeon is planning on skin excision, with levator advancement ptosis repair, plus crease reformation, then you are having both an anchor blepharoplasty AND ptosis repair.

Kenneth D. Steinsapir, MD · Answer

The only reason this might not be handled at the same time is health insurance. Surgeons are often not paid very much by health insurance. They are anxious to separate insurance covered ptosis surgery from blepharoplasty because if they do both steps together, they do not get paid of the work. So they play the game. Only perform the ptosis surgery. Then if the blepharoplasty is medically necessary it is done as a second stage of surgery at a later date. In my practice, I do not participate with health insurance, we simply do what patients need. You need both ptosis surgery and a cosmetically performed upper blepharoplasty to get the best possible result. Your eyes can be your best feature.

Mats Hagstrom, MD (license on probation) · Answer

Bilateral upper eyelid blepharoplasty with ptosis correction with leavator (L more than R) resection seems like an appropriate recommendation.
Unilateral ptosis repair is a bit tricky. It really helps if you find surgeons who have extensive experience doing these procedures.
Try to get confirmation of how many unilateral ptosis corrections your provider has done. Hopefully they had an extensive collection of before and after pictures to show you.
Blepharoplasty by itself, will raise the eyelids slightly, but in your case, correcting your blocked vision appears indicated with a little more than just skin removal.
It’s not a bad idea to consult with a few providers before scheduling surgery.
This type of work can be done by plastic surgeons, facial plastic surgeons, or oculoplastic surgeons. 
Best,
Mats Hagstrom, MD

Excess skin - Can this be fixed with just excised skin? (photos)

Answers (4)

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