Lateral flare post bilateral ptosis repair. Will it relax/drop over time? (Photo)

Question

I underwent bilateral levator aponeurosis advancement and upper blepharoplasty in early August 2023. I believe it was overcorrected as my outer upper lids appear retracted and I look like I’m staring/glaring. It feels “tight” but I don’t have any issues with closing my eyes, however I question if they slightly open while I sleep because I wake up with a lot of dried eye discharge in the morning. What is your professional opinion on undergoing correction? Will it possibly relax/drop overtime?

Kenneth D. Steinsapir, MD · Answer

You have included two eyestrip pictures. Once showing a lateral tethering with definite lateral eyelid contour peaking. In the other eyestrip, the eyelid contours look normal with one eye a bit heavier than the other. The first question is the appearance of over correction only present when you make extra effort to open the eyes or are you always seeing it? If they are mostly normal, revising the eyes may not be worth the effort. If the retraction is always present, then you are going to need to revise the eyelid position. I correct these by revising the anterior levator insertion. I find this is much more reliable than doing a so-called levator recession. This also creates the opportunity to lower eye upper eyelid crease and address internal eyelid adhesions.  Your lateral canthal angles are too high in my opinion. There is no substitute for an in person assessment.

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