Possible Ptosis After Upper/Lower Blepharoplasty?

Hi there

I would strongly suggest you give this some time as long as the eyelids open and close well.  While it can be hard to do in recovery -  patience is important.  Differential swelling is common. 

If after 2 months no change is ocurring then a more detailed look is needed.

As the orbicularis muscle is the muscle which closes the eyes, its normal weakness after surgery can cause assymetries in the aperture of the eye (especially when the muscle on one side is weaker than the other).  However, it is typically the mechanical effect of swelling which causes the ptosis, as orbicularis weakness can often lead to an eye which is too open (does not close well).

As was sated previously be another doctor - you should check your photos before surgery.  Was there ptosis present which was undetected.

When you are completely healed - a ptosis repair, if needed, can be performed simply and quickly so try to stay positive. 

I have certainly seen the same appearance before at only 12 days post-operatively.  In these cases what I have found is rather than any weakness in the orbicularis, which would actually make it more difficult for the eye to close, the problem is that due to swelling the levator muscle in the right upper lid cannot move normally.  As a result, the eyelid is droopy.  If this is indeed the case, the problem will resolve spontaneously over the next couple of weeks.  As difficult as it is, I would counsel patience.

Hi,

The eyelids are likely going change come more over next few days to weeks as all the swelling goes away and the muscles recover.  Regarding the ptosis, it is likely that you had latent ptosis before surgery (looking at old photos would help assess that).  I would let things heal up and then reassess the eyelid asymmetry. 

Mehryar (Ray) Taban, MD

I see your concern about the position of the right upper lid.  It sounds like you had more inflammation and swelling on the right post operatively.  In this instance it is most likely that the difference in lid position is related to swelling 12 days post op, which will even out.  I recommend continued close follow up with your surgeon to insure this resolves.

Possible Ptosis After Upper/Lower Blepharoplasty?  It is way too soon to worry about asymmetry and/or ptosis. listen to your doc, give it a chance. but to be clear cutting the orbicularis does not cause post op ptosis, I'm just sayin'.

Typically the muscle in the upper lid is not cut, but preserved to maintain fullness and prevent hollow in the upper lid, particularly in younger patients. Your photo does show a ptosis of the upper lid and time is needed to tell if the lid position will correct itself.
Best of luck,
peterejohnsonmd

Dear Niles,

  I can appreciate your concern from your photo.  The uneven lids are most likely a result of asymmetric swelling and should resolve as your swelling decreases.  Close follow up with your surgeon should identify any unforeseen issues.  If asymmetry persists after a month and if your concern is not shared by your surgeon,  then I would recommend being examined by another board certified plastic surgeon as a second opinion.  Good luck

If there has been significant swelling and you feel that the eyelid remains at the same level, it is possible that you may require enhancement. It is important you speak to your physician and discuss the possibility of having an enhancement procedure. In my practice when I perform ptosis surgery, I allow for swelling to resolve to the point where I am comfortable performing additional surgery. Swelling can be a factor in a surgeon’s ability to lift the eyelid in a predictable manner. The problem is that the amount of swelling is difficult to predict so until it subsides, you will have to wait until a valid reassessment can be made.

  It's not unusual for the upper eyelids to look uneven, wavy or asymmetric 12 days after an upper eyelid surgery.  Swelling, of the upper eyelid, will cause the eyelid to look fuller (ptosis-like) for several months.  I advise my eyelid surgery patients that it take about 3 months for the eyelids to fully heal.  Be patient and wait until then is your best course of action, IMHO.

Since you are just short of a few weeks post op I would not be to concerned at the exact symmetry at this time. The swelling is still very relevant to your current complaint and should subside in time. Keep in close contact with your surgeon and he/she should be able to set your mind at ease regarding your recovery. Best regards!