Concerned about ptosis after upper and lower blepharoplasty - Advice? (photo)

Question

9 days post op upper and lower blepharoplasty. I am not happy with appearance so far. I think too much skin and fat was removed from upper, but my main concern is that both my upper lids feel very tight when I look up or to either side. I have discussed my concerns with the surgeon but he is adamant that I am healing great and he is confident that I do not have ptosis and with time I will be able to open my eyes more freely. Please tell me your thoughts. Thank you

Jonathan Kulbersh, MD · Answer

Thanks for including photos with your question. Based on the images, it does appear you are experiencing a typical recovery after blepharoplasty. Swelling will make the eyes feel tight at this point - this side effect can last for at least a couple of weeks and interfere with your ability to see your outcome right away. I recommend keeping your post-op appointments with your surgeon in order to monitor your progress and follow all instructions you are given to support the healing process. I think within the next couple of months, you should start to see a very positive improvement from your procedure. Best wishes for a good recovery and results!

Kenneth D. Steinsapir, MD · Answer

Having said that, I am not as optimistic that you will have resolution of the upper eyelid ptosis. In particular, you now have upper eyelid lash ptosis that you did not have before surgery. That suggests that you have lost some of the internal support for the upper eyelid that you had before surgery. You did have mild upper eyelid ptosis before surgery and it would have been ideal if your eyelid surgery had addressed that issue. It is helpful to have a preoperative discussion regarding how much eyelid platform show to expose with surgery. It is helpful to have a preoperative discussion regarding where the upper eyelid crease should be placed. In my opinion, your upper eyelid crease was placed high, performed without an anchor blepharoplasty, and with correcting the existing upper eyelid ptosis. You need to heal from this surgery before any revision can be performed. It is possible to fix the upper eyelid ptosis, lower the upper eyelid crease, and repair the upper eyelid lash ptosis. Generally it is best to let the eyes heal a full 6 months before doing this. An in person examination is necessary to plan surgery. That consultation can productively performed once you have healed about 4 months. The tightness you are feeling may be related to dry eye which can happen after surgery. I recommend seeing your general ophthalmologist to be assessed for dry eye. Measures such as frequently artificial tears and night time ointment can be helpful. Often this dryness is at its worse in the first 6 to 8 weeks after surgery.

John J. Martin, Jr., MD · Answer

You had ptosis in the before photos.  When the lid height is low pre-op a decision can be made to tighten the levator muscle to correct the ptosis when the blepharoplasty is performed.  Some patients do not want to alter the lid height as they say that they have always had that appearance.It looks like your lid height is improving as the swelling resolves, so I would expect that eventually you will have a lid height similar to the pre-op, but without all the extra skin.    If you don't like the ptosis you can have that repaired in the future.

Gilbert Lee, MD · Answer

Thank you for your question and photos. You are very early in the recovery process. It takes a few weeks of healing before the results start to settle out. I recommend that you stay in close contact with your surgeon and make sure that you understand what to expect during the recovery process. They will be able to help you through and to achieve the best possible result. Good luck!

Mark L. Mazow, MD, FACS · Answer

Thank you for your question. Firstly, you are only little more than a week post op. You are healing appropriately, but you still have a normal amount of post operative swelling and bruising. In the upper lids this can give the impression of ptosis. Your pre op photos do show a small amount of ptosis. Your post op photos show the lid position improving as time goes by as would be expected. I always tell my patients that they can expect about 50% of the swelling and bruising to resolve at two weeks, 90% resolution at month and several months for the remaining 10% to resolve. If you still think your lids are ptotic at month post op your surgeon can re-evaluate you. In my own practice I would observe a patient such as yourself for at least  three month post op if not longer to allow the edema to completely resolve before making any decisions.

Darab Hormozi, MD · Answer

At 10 days post surgery, it looks perfectly normal to have tightness and heavy feeling in the upper lids. These feelings can continue for weeks before you return to normal. According to the photos you look as expected for 10 days after surgery. The heavy feeling and droopiness that you feel In the upper lid will gradually go away. Good recovery

Concerned about ptosis after upper and lower blepharoplasty - Advice? (photo)

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