Mild Ptosis More Complicated to Fix?

Nelly

While it is absolutely true that ptosis surgery is a bread and butter procedure for board certified ophthalmologists who are fellowship trained in oculoplastic surgery and admitted to the American Society for Ophthalmic Plastic and Reconstructive surgery, mild ptosis repair is not easy particularly in an Asian eyelid.  

It is important to understand that there can be a degree of inaccuracy with any ptosis surgery even when performed by the most experienced surgeons.  When performing surgery on larger amounts of ptosis, small differences in the eyelids are much more likely to be tolerated.  This can include mild under and overcorrects, mild asymmetries in the eyelid folds, differences in crease height placement.  DIfferences in how much skin is left on the eyelid platform and asymmetry in crease formation with fixation to the levator affects the degree to which the two eyelid platforms skin will hold makeup and the degree to which the upper eyelid lashes are supported are less of an issue in functional ptosis surgery cases compared to cosmetic ptosis cases.  Finally, ptosis surgery can affect the upper eyelid contour.  

When we perform surgery for a small amount of ptosis, all of these factors must be considered because they all influence the perceived success of surgery.  You will notice all of these things.  Additionally, repairing ptosis surgery in an Asian eyelid will affect the amount of eyelid platform exposed after surgery.  It is generally necessary to also remove just the right amount of skin in order to have a symmetric amount of upper eyelid platform exposed after surgery.  An experienced eyelid surgeon will consider and discuss with you all of these factors and others such as the fact that it appears that your two eyes sit a different heights in your face.  This will have a direct bearing on your perception of your eyelids and if it is not discussed before surgery, you might even think that the surgery caused this difference.  So I agree with your caution.  I would recommend that you get a number of opinions and don't rush into surgery.

Mild ptosis is not uncommon in Asians.  It is important first to recognize the condition prior to performing eyelid surgery so that it can be corrected.  Levator advancement during the procedure is an effective manuever performed symmetrically to best address the ptosis.   A conservative amount of skin excision may also be necessary depending upon the amount of levator advancement to avoid the "fat lid" look.   Make sure your surgeon performs Asian eyelid surgery on a consistent basis and understands Asian aesthetics.  Good luck!

There have been some very insightful comments made. I think we are all in agreement that Asian Eyelids can be challenging cases, especially when the ptosis is subtle. Oculoplastics Surgeons [synonymous with Ophthalmic Plastic or Oculofacial Plastic Surgeons] have the most amount of experience in this type of surgery. But make sure you find a surgeon that is experienced in both external and internal approaches to ptosis repair, as the different techniques can offer different benefits.

Internal techniques do not require a skin excision and will not affect the position of the crease. However any change in eyelid position will change the degree of fold over the crease.

Good luck