Asymmetrical eyelids - is full thickness or mullerectomy ptosis surgery better? (Photo)

Question

Update to my previous Q: I have asymmetrical eyelids after two Asian blepharoplasty surgeries, where the levator was also shortened 4-5mm both sides, to no effect. Last surgery was 2.5 years ago. I hope to lower my left eyelid crease to match my right. I’ve seen 3 doctors who all had different recommendations. Doctor A: left eye full thickness ptosis repair. Doctor B: Mullerectomy for both eyes, plus lower the left eyelid crease. Doctor C: leave it alone. Which option is best for me? Thx!

Hugo Higa, MD · Answer

Yaya,You should consider a ptosis repair of the left upper eyelid with crease revision.  The ptosis repair tends to lower the crease. With a lower incision, the skin should fold over the new crease and look more even.  I wouldn't recommend skin removal however, since you may end up in the same boat - only with a higher eyelid.  Hope this helps.Cheers,Hugo

Kenneth D. Steinsapir, MD · Answer

You need an anterior levator advancement ptosis surgery with an anchor blepharoplasty.  Surgeons do not like to do them because they are very fussy.  I specialize in them because so many upper eyelid issues can only be fixed with this approach.  I see patients from all over the country and the world who come to me for this work.  Study the attached video which demonstrates how I perform this method.  The video is for a Western eyelid but the approach is basically the same for the Asian eyelid with some important differences: Lower crease, less platform show.  The Mullerectomy will not fix your ptosis because your levator tendon is not in the correct position.  Most eyelid surgeons do not understand this.  The neosynephrine test may work to open the eyes in the office but the surgery will be a failure. The Mullerectomy effectively internally folds the levator but the levator needs to normally insert onto the tarsus.  That is not your situation. Surgeons love the Mullerectomy because the surgery is very straight forward and can be done in 15 minutes.  Do not have full thickness ptosis.  This is a garbage technique that destroys the upper eyelid.  It is still taught in the Los Angeles oculoplastic fellowships but it is an awful technique that is used foolishly in my opinion.  It is embraced by a few surgeons and the results are just terrible in my opinion.  Finally, the doctor who tells you not to do anything is making an honest statement that they are not able to do your surgery.  My father had an expression: "When the butcher tells you the meat is bad, you should listen."  You have probably avoided seeing me because my office does charge an initial consultation visit fee that can be applied to surgery.  However that consultation will be 1 to 2 hours in length and is essential to provide the detailed information needed to design as surgery that will restore your eyelids.

Mark L. Mazow, MD, FACS · Answer

Thank you for your update. I would still not  change  my thoughts. I would still like to see how your lids respond to Neosynepherine drops. I don't think that anyone on this forum cam give your specific advice about your case more than the three doctors who have already examined you in person. You should consult with them again or seek yet another opinion. There are always many ways to address an issue.

Asymmetrical eyelids - is full thickness or mullerectomy ptosis surgery better? (Photo)

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Asymmetrical eyelids - is full thickness or mullerectomy ptosis surgery better? (Photo)

Answers (3)

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Recommended reading

Everything you need to know about Ptosis Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.