Need advice about unilateral or bilateral ptosis surgery (Photo)

Question

I had left upper eyelid ptosis surgery (internal) last year November. Now my eyes look asymmetrical cause right upper eyelid is droopy and feels heavy since surgery. I have used iopidine eyedrops to get symmetrical eyes BUT my left upper eyelid has dropped. This means that the herrings effect occurs on both sides. I need your advice. Do I need a bilateral or unilateral ptosis surgery (may internal)?

Kenneth D. Steinsapir, MD · Answer

My colleagues love this surgery because it is simple and only takes about 10 minutes to perform. Sadly it is not good for many patients. In many of these eyelids, there is separation of the anterior levator aponeurosis, the tendon of the levator palpebrae superioris muscle. When this occurs, and it is common, the tendon is not in position to benefit from the Muellerectomy (the surgery you had). There may be a small amount of elevation but the surgery is quite limited in this circumstance. There is a secondary issue that I see in these cases, which is that as the separation progresses, the improvement from surgery can disappear. I would not recommend repeating the Muellerectomy and definitely do not have full-thickness ptosis surgery, which is a disfiguring procedure. What I recommend in this circumstance is bilateral anterior levator resection ptosis surgery. Unlike the Muellerectomy, anterior elevator resection ptosis is highly adjustable at the time of surgery. You do not need much more lift but you do need symmetry. Ptosis is challenging surgery and you need a surgeon who can address your concerns. By the way, the Muellerectomy is not "scarless." There is a scar but it is behind the eyelid and it does complicate a future revision. There is no substitute for a detailed in person assessment. Your eyes can be your best feature.

Need advice about unilateral or bilateral ptosis surgery (Photo)

Answers (1)

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