8 yrs post op Eyelid Surgery, I have a raised scar, hollowed eyelid, and high crease. Should I have revision for ptosis? (photo)

In 2006, I had upper eyelid surgery and as a result, ended up with a raised scar in the medial canthal area, hollowed eyelid and high crease on the left upper eyelid. I had fat grafting to the left upper eyelid and ended up with ptosis. After ptosis surgery, the eyelid became tighter and the eyelid does not stay closed; I again tried fat grafting by injections and restylane injections to the left upper eyelid after an oculoplastic consult, eyelid does not stay closed and the ptosis remains.

Doctor Answers 1

Continued Ptosis after Eyelid Surgery

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Correction of eyelid ptosis after repeated eyelid surgery can be very difficult to get perfect.  It is difficult to determine from your pictures when these were taken, but I'm gathering that after the ptosis surgery in 2006, you are having difficulty in complete closure of the eye (i.e. lagophthalmos).  The important thing to understand is just what type of ptosis surgery you had performed.  Was it performed inside the eyelid (i.e. a muellerectomy procedure)? or was it performed externally (i.e. a tarsolevator advancement)? Muellerectomies can lead to excessive scarring and residual lagophthalmos.  It appears from the last pic that your repair is slightly over-corrected.  If that is the case, a revisional tarsolevator procedure may be required.  This can reset the resting position of your eye into a lower position. 

In order to correct the high eyelid crease, fat transfer is usually the gold standard.  In my experience, trying to inject fat into the lid after multiple procedures does not take very well because of all the scar tissue.  In these instances, I prefer to release all of the scar tissue during the tarsolevator procedure.  After this, fat can be directly and gently positioned in the upper eyelid prior to closing the incision.  This is often very successful and looks very good.  I would personally recommend avoiding any injectable filler or synthetic material in this region.  This can lead to unpredictable scarring, and may actually worsen your lagophthalmos.

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