Over correction retraction repair...do I need revision or work on other eyelid? (photo)

Question

I had upper left eyelid retraction repair appx 7 wks ago. (Have Graves) From the getgo my eyelid looked like it was set too low. Still have some swelling. I see my surgeon in a week but from what he told me after sending him pics he may want to go in & lower the right eyelid. I was under the understanding that it's better to over correct since it's easier to go in & lift the eyelid than lowering it. What would you recommend lowering my right eyelid or try raising the over corrected left eyelid?

Kenneth D. Steinsapir, MD · Answer

Upper eyelid retraction surgery is an extraordinarily difficult, non-cosmetic procedure. At best it is accurate plus or minus 2 mm.  That means that it is realistic to expect the eyelid to heal within a 4 mm range.  That is a very unhappy reality.  You state that it is better to over correct the left eyelid because in can be lowered after the fact.  The reality is the opposite.  Fixing a droopy lid after recessing the levator aponeurosis is very tricky business.  It is not standard ptosis surgery.  I would much rather go back into an eyelid and do more recessing of the levator.  Surgeons have have different opinions about this.  You do not indicate if the right upper eyelid was retracted this much before the left upper eyelid procedure 7 weeks ago.  If it was not, this is Herrings law retraction.  If it was, then like the left side, retraction is due to thyroid eye disease.  I think you and your surgeon are premature in messing with the right side.  Provided the right eye is tolerating the lid position in terms of corneal health and comfort, I would recommend being patient and giving the left eyelid another 4 months to heal.  At that point the right upper eyelid can be more accurately adjusted to the position of the left eyelid.  Again the accuracy of that surgery will be plus or minus 2 mm.In the meantime, I suggest that your surgeon inject the left upper eyelid pre tarsal orbiculularis is a tiny dose of botulinum toxin.  This method is described by Steve Fagien.  Done correctly, it will provide approximately 1 mm of lift for the left upper eyelid.

Kamran Khoobehi, MD · Answer

The pictures shows that your left ptosis repair is not adequate and your right eye is compensating. Your eyebrow is compensating for the left eye ptosis and causing brow asymmetry. Please send  before surgery pictures for better evaluation.

Gregory Park, MD - Account Suspended · Answer

Your left upper eyelid margin is now in good position in relation to your iris. Rather than trying to elevate the left eyelid to match the right, the appearance and symmetry between both of your eyelids would be improved by correcting the proptosis of your right eye. Thank you for sharing your photos and questions. Best wishes.

Over correction retraction repair...do I need revision or work on other eyelid? (photo)

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