Should I consider a third reconstructive ptosis surgery? (Photo)

Question

In 2012, I had failed ptosis surgery on my right eyelid, leaving an ugly scar. In 2015, a facial oculoplastic surgeon performed reconstructive surgery, but it also failed, creating multiple folds. In 2020, Dr. Parsa, a renowned oculoplastic surgeon, diagnosed me with blepharitis, not ptosis, and said I never needed surgery. He advised against further surgery. Now, I'm seeking feedback on whether surgery or non-invasive treatments could improve my condition.

Kenneth D. Steinsapir, MD · Answer

Ptosis surgery can be challenging. Sadly, even well known oculoplastic surgeons do not seem to know how to control both the upper eyelid position and the upper eyelid fold. However it is essential to do both. Your likelihood of having successful ptosis surgery very much depends on what is called levator function which is a measure of the ability of the levator palpebrae superioris muscle to move the upper eyelid margin. It is also important to evaluate how this muscle is attached to the eyelid skin because this is what makes the upper eyelid crease. Even though you have had prior unsuccessful prior ptosis surgery, that does not preclude you from having successful revisional eyelid ptosis surgery. On the other  hand, it takes a lot of experience and know how to successfully repair a previously operated on eyelid. Ultimately this will depend on what is left in the eyelid from the prior surgery. My experience in repairing many of these eyelids is that the prior surgeon often simply did not perform and adequate repair of the eyelid and the resources are often there to achieve a successful surgery. With regard to what you have been told, I am reminded of a saying my father would tell me: "If the butcher tells you the meat is bad, you should listen." The surgeon is telling you that they are not confident that they have the skill to perform the surgery. That does not mean it can't be done. Also the presence of blepharitis is not a reason to not perform eyelid surgery. I am attaching a paper of revising eyelid surgery and a video link that shows how this work is done. The video is graphic so if you don't like surgery videos be advised.

Should I consider a third reconstructive ptosis surgery? (Photo)

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