Had ptosis surgery 6 months ago, eyelid is much worse. My surgeon said it can't be fixed. What do you think? (Photo)

The most important factor in fixing an upper eyelid is the excursion of the eyelid, which is called levator function. It is a simple measurement of the difference in the position of the upper eyelid looking all the way down to looking all the way up with the brow held in place with the thumb. This isolates the activity of the levator palpebrae superioris muscle. When the excursion is above 12 mm, the likelihood of improving the eyelid with more surgery is very good. Then the excursion is less than 8 mm, the likelihood is poor. I need to know more about your ptosis, your ptosis surgery, and have the benefit of personally examining you. Was your surgeon a fellowship trained oculofacial surgeon or were they a facial or general plastic surgeons, or some other type of specialist? Oculofacial plastic surgeon do the vast bulk of ptosis surgery. Other specialists, including general ophthalmologists, do only a tiny percentage of these surgeries. Experience matters. The most popular form of ptosis surgery is posterior approach ptosis, also known as a Mueller's muscle conjunctival resection. These often fail. The good news is that at 6 month, your eyelid is ready for the revisional. When a surgeons says that you can't be fixed, they often mean that they can't fix you. You need a second opinion.

This is a complex problem that needs evaluation in consultation. Revision ptosis surgery is possible but the exact technique would depend on the strength of the eyelid muscle and other factors. Underlying facial orbit asymmetry is also a factor.

Thank you for your very interesting post and multiple photos. I am sorry you are unhappy with your prior surgery 6 months ago. Did your surgeon offer any explanation for why it did not turn out as you had hoped? Did your surgeon explain why she felt "it can't be fixed?" You also have some significant brow asymmetry so this needs to be analyzed as well. Did you have Ptosis from birth? -  since a key issues is when did your Ptosis develop? More than anything you need a real expert at this point.Ptosis ("toe-sis") is a drooping of the eyelid due to a weakness of the eyelid muscle. Ptosis surgery is very technical and requires great precision to have a natural, beautiful outcome.  Few surgeons are masters at this condition. Even in the best hands this surgery can be quite tough to achieve symmetry. You need an in-person consultation with a board-certified, fellowship-trained Oculofacial Plastic Surgeon with extensive experience in ptosis repair and eyelid surgery.  Many patients travel great distances to see me for this sort of expertise. I have seen and treated many prior failed Ptosis surgeries. You must avoid any doctors that perform ptosis or eyelid surgery part time, they cannot help you. Mild ptosis like yours is not a medically covered procedure -- it is considered cosmetic plastic surgery by insurance companies.Best of luck to you.
Damon B. Chandler, MD
Harvard-Penn Trained Oculofacial Plastic Surgeon

Seek someone who does revision ptosis surgery and has lots of experience doing it. Whether it can or how much it can be improved depends on lots of factors that only an exam can provide.If the surgeon thinks the muscle is damaged or can't be fixed without making the lid not close... all hope isn't lost. I've used donor pericardium grafts with success to extend a shorted or surgically damaged muscle. It the levator doesn't work at all, there are some other techniques to help but perfection is a stretch in that situation.

Your problem appears to be asymmetry in your brows. I would address this with your surgeon or get a second opinion. Best of luck