Mullerectomy to lower eyelid crease? (Photo)

Question

Dear doctors, first thank you for the kind responses to my prior message. I saw an oculoplastic surgeon to ask how I can lower my eyelid crease and fix the slight ptosis. She recommended the Mullerectomy and the 10% phenylephrine drop did improve the crease (see photo). She would not do an anterior approach because of risk of overcorrection. My questions: 1) How certain can I be that my Mullerectomy result would look like the drop test result? 2) The drop test overcorrected my lid, what then?

Kenneth D. Steinsapir, MD · Answer

The vast majority of ptosis surgery performed in the United States in the posterior approach ptosis surgery that is also called Mueller's muscle conjunctival resection ptosis surgery. Surgeons love this surgery because it takes about 8 minutes to perform the surgery. In many cases, the surgeon is simply not practiced or even adequately trained to perform anterior levator resection ptosis surgery. You do not have ptosis. Performing a ptosis surgery will not accomplish what she is proposing. You have pathology in the attachment of the central levator aponeurosis. In this circumstance, Muellerectomy will not accomplish what is suggested by the phenylephrine test. Also there is a substantial risk you will end up with upper eyelid retraction. The Muellectomy is an underpowered ptosis surgery and it seldom is adequate to address the compensatory eyebrow elevation seen in your images. Crease lowering requires a new crease to be made at a lower level. The edge of the anterior levator needs to be repositioned at the level of the new crease. In your case, the levator may need to be extended using rotation of the distal septum to avoid the risk of causing upper eyelid retraction. The preaponeurotic fat must also be positioned at the level of the new crease to make a fold that extends to the new crease. There is no substitute for an in person assessment. Your eyes can be your best feature. Don't get the wrong surgery. Stay out of trouble.

Mullerectomy to lower eyelid crease? (Photo)

Answers (1)

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