Are my Eyes Permanently Messed Up? (photo)

Question

I had lid ptosis repair 12 days ago and I still can't close 1 eye entirely. The eyes now look completely different from each other and 1 eye has a fold over the crease (like Asian eyes) w/ skin drooping over the crease. Most swelling has gone, as I peaked 12 hours post op. The asymmetry and not being able to close 1 eye has not improved since early after surgery. My Dr said this will look just fine next week, but I can't imagine this will "even out" with the extreme difference in both eyes.

Kenneth D. Steinsapir, MD · Answer

However, you are going to need a cool head to keep from getting messed up.  Unfortunately ptosis sugery and eyelid aesthetics mix a bit like oil and water.  Our brains are way too sensitive compared to what is typically accomplished with ptosis surgery.  There are some surgeons in the world who are a bit more brilliant about mixing ptosis and aesthetic eyelid surgery.  A before photo would be helpful here before I start throwing bricks at your current surgeon.  What I do see is that both eyelids look to be supported at a single point with maximal flaring of the right upper eyelid contour between the lateral limbus and the pupil.  Lateral to this, the eyelashes look well supported but medial to this, the lashes point down.  This lack of uniformity of the lash direction contributes to and impression that the eyelid is less than orderly.  On the left side the lid is slightly peaked at the pupil. Lateral to this the eye lashes are better supported but no quite as well as seen on the right side.  Both eyebrows have compensatory hikes but the right is more than the left.  I think a careful in person examination might reveal more latent ptosis on the right side.  There is more platform exposure on the right side and more fold draping the eyelid platform on the left.

	You are 12 days out.  What you should do depends somewhat on who did your surgery.  If your surgeon is an ophthalmologist or oculoplastic surgeon, they will be able to monitor the health of the corneal surface while you heal and provide management if you are having trouble blinking your eye closed.  If your surgeon was a general plastic surgeon or a facial plastic surgeon, they lack the training, skill, knowledge, and equipment to manage the blink issue.  If you are not seeing an ophthalmologist, I recommend consulting an oculoplastic surgeon or cornea specialist just for dry eye management.  You should not have surgical intervention now for at least 6 months.  The reason is that you really do need to heal much more before it is clear what issues will simple resolve on their own and what will benefit from further corrective surgery.  The eye is not a car engine, getting lots of work on it does not make things better.

	To get out of trouble here, first determine if you need better dry eye management and then give yourself time to heal.

Peter E. Johnson, MD · Answer

I would be nice to know what the before was like, and how much lid function was to be corrected from your ptosis. Functional lid ptosis repair, when you cannot open the lid nomally requires a compromise as the muscle must be adjusted, and a lid lag is not uncommon.

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