Perhaps 80% of ptosis surgery is performed by Mullerectomy. It is popular because the anatomy is simple and a competent surgeon can perform bilateral Mullerectomy (Muller's muscle conjunctival resection ptosis surgery) in about 8 minutes. It is important to understand that surgeons are so in love with these characteristics that ignore the short comings of the surgery. You have a profound upper eyelid anterior levator central disinsertion. While a neo-synephrine drop test is often used as a marketing tool to demonstrate the effect of surgery to the patient, a successful response to the drop does not necessarily mean surgery will be successful. The Mullerectomy works by folding or plicating the anterior levator aponeurosis to accomplish the surgical effect. When the tendon is not properly attached to the tarsus, as will be the case in your eyelid, surgery is not effective. It might raise the eyelid a small amount but it does not have the power to repair the attachment of the tendon to the tarsus. The lack of power of this surgery means that you will still have a compensatory eye brow elevation, a hollow sulcus, and still a lack of an upper eyelid fold. I would not perform a Mullerectomy in this situation. You need a strong repair of the disinserted anterior levator aponeurosis, a lower upper eyelid crease, repositioning of the pre-apnoneurotic fat. Don't talk yourself into a surgery that is still a surgery that will not accomplish what you need. Your eyes can be your best feature.
