Upper eyelid swelling after ptosis surgery. Will the shape change after the swelling goes down? (Photo)

Question

4 weeks ago I had ptosis surgery on only my right eyelid. I wanted it to look like my left. I still have swelling on my eyelid, but my eye appears rounder and larger than the other. Will the shape change after swelling goes down to look symmetrical or will it stay the same?

Kenneth D. Steinsapir, MD · Answer

You are having an issue no doubt.  At 4 weeks after surgery the right upper eyelid appears over corrected.  However, without all the data, it is hard to come to an opinion regarding your best options.  Depending on the nature of the surgery you had, it is sometimes possible to massage the over elevated eyelid to improve the situation.  This really needs to be done under the supervision of a surgeon.  The other possibility is that your right eye was lifted enough that there was a secondary fall in the left eye so that taken together the right upper eyelid looks too high and the let too low.  Due to precisely this type of situation I will often measure the effects of a potential ptosis surgery at two separate preoperative visits.  The first visit, I may do the neosynephrine test in the  heavier eye and record what happens to the upper eyelid positions for both upper eyelids.  On the second visit, I will typically then instill neosynephrine drops into both eyelids and measure the effects.  Based on this information, one gets a better idea of the interaction of the two eyelids and this can help guide planning for surgery.  Regarding your current situation, I recommend you talk with your current surgeon and decide if he or she have a plan to address the current situation.  If not, you might consider getting second opinions.

Mehryar (Ray) Taban, MD, FACS · Answer

As swelling resolves, the eyelid is likely either remain in same position or move higher, not lower. Recommend waiting about 3 months after surgery for full healing and then re-evaluating the position of the eyelid and comparison to the other side. Revisional surgery is possible.

Curtis Wong, MD · Answer

Perfect symmetry is nearly impossible to achieve when doing ptosis surgery and if a surgeon tells you they can, get it writing with a guarantee.  You should be relaying your concerns to your surgeon so your surgeon can direct you with maneuvers to help improve your symmetry.   I think your early results look quite good and would anticipate improvement but still best to keep your surgeon in the loop to allow your surgeon the opportunity help you achieve the best result possible.

Amiya Prasad, MD - Account Suspended · Answer

Ptosis surgery is a
type of surgery where predictability is tricky. As an oculoplastic surgeon, we
want to achieve the appropriate height, contour, symmetry and the aesthetics of
the eyelid. When I perform ptosis surgery, I allow the patient to be awake
during the surgery. Although they won’t feel anything because the area is numb,
I’ll let them open and close their eyes and I’ll even sit them up during the
surgery.  This is the best way to predict
the outcome because the muscle is very sensitive, and the eyelid backbone and
tissue are so delicate they can be easily affected by a variety of factors.

In every ptosis
operation, there is a possibility of under-correction when the eyelid is too
low, or overcorrection when the eyelid is too high. Only your doctor knows what
happened during the surgery. Sometimes the surgeon will overcorrect because they
anticipate the eyelid will come down after some time.

When I do a ptosis
evaluation, I measure the levator muscle function to assess the strength of the
muscle that lifts the eyelid. When the muscle is weaker, I sometimes
over-correct because the muscle is weak and there’s a tendency for the eyelid
to drop down a bit. When a person has normal levator function, I try to make
the eyes relatively symmetric during the surgery because I expect after healing
there’ll be some stabilization.

In the normal human
population, there is always a 1-2mm difference of eyelid height between the two
eyes. As long as you are within that range, that’s acceptable. In your case,
your doctor will be able to guide you as to why you look the way you do and
whether or not this is a case of someone who is overcorrected. If that’s the
case, the timing  for an enhancement is something
that your doctor will help you decide. In my practice, I usually wait for
swelling to resolve to a reasonable level so that I can work on tissue that
isn’t swollen. I do my enhancements on a case-by-case basis. Clearly with this
photo, there is a difference between the two eyes - the right eye definitely
does look more open and round, but without other information it is difficult to
make a prediction. I think that communicating with your doctor will help you
move forward to do whatever is necessary.

Sometime after
ptosis surgery, a little massage will help stretch the tissue out and allow for
a some of decent. I’ve had patients who initially looked overcorrected, but
with some time it came down to a point where it looked appropriate. I think
that you should keep the faith and maintain communication with your doctor. Work
with the doctor about moving forward with any other adjustments that may be
required later on. I hope that was helpful, I wish you the best of luck, and
thank you for your question.

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Brooke R. Seckel, MD, FACS (retired) · Answer

The quick answer to your question is yes the swelling will go down and the eyelid shape should be much more symmetrical with the opposite side.  4 weeks is still early and I would expect another month before you can truly assess your results.

Upper eyelid swelling after ptosis surgery. Will the shape change after the swelling goes down? (Photo)

Answers (5)

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