I was born with congenital ptosis and had an upper bleph on my right eye 3 weeks ago. I am pleased with the results looking straightforward but worry about looking downwards. My operated eyelid does not cover the top portion of my eye as the other one does and my eye is exposed instead of being hooded by the lid. When I tilt my head back, my eye grows bigger (more white shows) while the other lid comes down naturally. Will this improve with time or does this mean too much skin was removed?
Possible Overcorrection or Too Early to Tell?
Doctor Answers 5
Congenital ptosis repair
Your operated eyelid is swollen from the ptosis surgery that increases the depth of the upper eyelid crease. This should relax over the following 3 months.
Congenital ptosis and downgaze.
Congenital ptosis results from a weakness of the muscle that elevates the eyelid. With congenital ptosis this muscle is scarred and does not fully relax or stretch. Since the eyelid must relax or stretch to cover the eye when looking down, the scarred muscle prevents complete relaxation. The"hang up" of the eyelid in down gaze can also be related to shortening of the muscle during ptosis repair- a necessary procedure to correct ptosis.
With this said, I would allow the healing process to continue and discuss your concerns with your surgeon.
Based on your photos, the surgeon did a wonderful job on your blepharoplasty as did the ptosis surgeon (if you did have a ptosis correction).
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No congenital ptosis surgery is perfect.
It is important to understand that the muscle in the eyelid that raises the eyelid is defective in congential ptosis. This means that at best virtually all congential ptosis surgeries represent so type of compromise. In order to have the eyelid sit at the right place, the tendon is shortened. This accounts for the difference in the two side in down gaze. However, in straight ahead gaze, you look good. I would advise you to relax, let yourself heal, and discuss your concerns with your surgeon.
Blepharoplasty and ptosis
By the fact that you were born with congenital ptosis, there is a very limited amount of up/down movement your eyelid can actually perform. The goal of the surgery should have been to give your eye the most normal looking appearance in straight ahead gaze, which it appears you do have. The over exposed look in downgaze is to be expected as well. I'm not sure if you had your ptosis repaired at the same time of the blepharoplasty so that I would need more info. from you on. Other than the extra crease you have in the upper eyelid on the right, which you may want to get touched-up, or removed, I think your results are satisfactory. The 'eye growing bigger' issue will not improve too much with time, as this should have been discussed with you/expected in a congenital ptosis.