Can the Crease/Sulcus Area Be Revised for Sharpness, Height and Depth Upper Eyelid Surgery? (photo)

Hi Dr's, 2 years ago I had a left eye mullers muscle resection w/ bilateral upper bleph (4 mm skin only) to correct mild left eye congenital ptosis. Before, my eyes were similar to 1st pic: deep sulcus, sharp / high creases (but I had assymetry unlike the example). After, they are the style of 2nd pic: hooded / low creases, also my creases are not sharp and the sulcus rolls out and hoods over them, aging me and making my eyes looks small. I have a strong preference for before style. Any ideas?

Doctor Answers 4

Your own photos

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Honestly, it would be best to post your own photos, both with eyes open and also with your eyes in downgaze. Short of an in person consultation, that's the best way to assess your concerns.

Though, crease reformation is usually not done with mullerectomy ptosis repair, the eyelid crease will pull in deeper to the superior sulcus and the fold will be more prominent, IF YOU ALREADY have a crease to begin with. If you don't, the crease can be strengthened through the blepharoplasty incision. This is a discussion that you should have had with your surgeon before hand.

Again, no good recommendation can be given without your own photos. In the photos you have shown, the after photo is a more anatomically normal photo. The before photo shows someone with mild ptosis that is elevating their brows to compensate, thus showing more tarsal platform. I have posted a before and after of a patient with similar anatomy: she had mild ptosis which she felt made her look more tired. I performed a mullertectomy ptosis repair WITHOUT blepharoplasty [no skin removal]. This made her appear more alert, but as you can see, her fold is more prominent which hides the crease. This happens because not only does the ptosis repair tuck the eyelid in deeper to the sulcus allowing for the skin to drape more heavily, but also because the patient's subconscious drive to elevate the eyebrows is now diminished and the brows settle and provide more eyelid skin to drape as well. 

This is a very important phenomenon that needs to be discussed with patients so that their preoperative expectations are properly set. It may be that since you've had your ptosis repaired, that your brow has settled, and a browlift may achieve what you are desiring.

Looking forward to seeing YOUR photos.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Upper eyelid crease

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Upper eyelid crease can be lowered and raised within reason with expertly performed eyelid surgery.  Ptosis surgery can change the appearance of upper lid and,   indirectly, the position of the eyebrow.  This can result in more fullness in upper lid.  In your particular case a through examination by an eyelid expert is the only way to determine if your wishes can be translated to a surgical result.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.8 out of 5 stars 62 reviews

Crowded upper eyelids/brows

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Ptosis surgery elevates the upper eyelids. It can allow the brow to relax/drop (since droopy eyelids forces the forehead to work harder to lift the eyelids). My guess that's what has happened but need your own photos to assess.  See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Photos of other people really don't help us with your issues.

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The big problem with the conjunctival muellerectomy combined with an upper blepharoplasty is the generally inability to perform anchor blepharoplasty.  Generally what is done is simple skin or skin/muscle excision.  This means that the eyelid platform skin is not controlled (think of snugging a bedsheet on a bed).  Also the crease will often be poorly defined.  To control the crease, there is no substitute for exposing the levator aponeurosis and directly attaching the platform skin to the levator.  It also sounds like you have more skin left in the eyelid than is ideal.  Bottom line, these can be successfully revised.  Unfortunately very few surgeons, including oculoplastic surgeons, really understand how to control the upper eyelid crease.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.