Irregular Ptosis in my right eye (worse in the evenings). Had an upper and lower bleph several years ago. (photos)
Doctor Answers 4
This is levator dehiscence ptosis.
It may not have been caused by your blepharoplasty but it often is the cause. I have developed a surgery to address this type of post-surgical changes. The key is lowering the upper eyelid crease, recreating the upper eyelid fold, identifying the disinserted elevator aponeurosis, the tendon in the upper eyelid, and reattaching it into the upper eyelid platform. The eyelid platform skin is snugged to the new upper eyelid crease and orbital fat is mobilized to fill the upper eyelid fold. Study the attached video to see this how this is done.
Eyelid ptosis not related to blepharoplasty
Eyelid ptosis (droopy upper eyelid) relates to weakened upper eyelid levator muscle which is responsible for lifting the upper eyelid. It hasn't nothing to do with upper eyelid skin and/or upper blepharoplasty. Eyelid ptosis is always worse when tired. See an oculoplastic specialist for evaluation and possible eyelid ptosis surgery.
Based on the photograph, there is a notable difference between morning and evening. It is hard to fully assess because only the eyes are visible, and head/chin position can affect the appearance too. I also cannot tell how much brow use, if any, is present. If the ptosis is truly fluctuating so much between morning and evening, you may need a careful evaluation to ensure there are not other underlying causes such as thyroid or neuromuscular conditions. Assuming those are absent, it is hard to treat fluctuating eyelid position. If there is a certain baseline level of drooping, it could be addressed. I would suggest seeing an oculoplastic surgeon for an evaluation.
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It appears that you have mild ptosis more on the right than the left. Ptosis may be surgically corrected - and yes, it is worth it if it bothers you. For evaluation and repair of ptosis, you should see an oculoplastic surgeon who has the most experience with the levator muscle. Timing of repair is not an issue - this is considered elective surgery - so you have time for gathering opinions. Best wishes with your decision.
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