Ptosis Correction on Asian Eyelids?

I am an adult Asian male with mild congenital ptosis of my right eyelid (about 1.5mm difference). I had consultations with two well-qualified oculoplastic surgeons. The first recommended Muller resection on the basis of good levator function and response to phenylephrine.

The second said he avoids performing that procedure on Asians due to increased propensity to swell and not heal so well, and instead recommended external levator advancement.

Why would swelling/healing be a stronger consideration for one procedure vs. the other? Do you agree with this supposed ethnicity-specific factor in deciding between the two procedures?

Doctor Answers 4

Asian eyelids don't swell more than Western eyes

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Dear Baldzac

I completely agree with Dr. Cohen. Asian eyelids don't swell more than Western eyes. The post surgical crease position is however very sensitive to swelling but this has nothing to do with the choice of ptosis surgery. For individuals who respond well to the neo-synephrine test, Muellerectomy can be an excellent choice. The Muellerectomy is significantly more predictable than the anterior levator. This surgery can also be combines with a small anterior skin resection as needed. Under the circumstances, you might consider getting some additional oculoplastic opinions until you find a surgeon who you are comfortable with.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Asian Eyelids respond well to properly designed upper lid surgery

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If successfully done, Asian eyelid surgery is a beautiful result. In Asian eyelids, we have the issues of eyelid crease position, eyelid fullness, and finally lid height and contour. Some surgeons find posterior approaches (Mueller resections) are useful in that they do not alter the crease or lid fullness that the Asians find so appealing and attractive.

In our experience, many Asians, however, want a more well defined crease especially in an eyelid with congenital ptosis. In these cases, we offer a bilateral upper eyelid crease fixation, blepharoplasty, and ptosis repair of the ptotic eyelid. This combination gives a more symmetrical appearance and generally results in an excellent result for the patient. I agree that it is unusual in our experience to anticipate Asians to have more swelling or other problems than the remainder of the population.

Good luck with your concerns.

J. Timothy Heffernan, MD
Seattle Oculoplastic Surgeon
4.6 out of 5 stars 12 reviews

Correcting eyelid ptosis (drooping of the upper eyelid)

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Hi Baldzac - The two procedures described are good for correcting ptosis, and the levator advancement can usually get a greater amount of lifting of the eyelid. As far as swelling is concerned, your eyelids should behave like everyone else's unless you have medical problems (diabetes) or you smoke. Levator advancement is a great procedure and I perform it frequently via an external eyelid incision. The recovery is pretty easy with minimal discomfort. Good luck!

Ptosis surgery for an Asian Eyelid

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I don't believe that Asian patients have more swelling than people with other ethnic backgrounds. Additionally, in my opinion, you are less likely to swell and bruise with a mullerectomy than with a levator resection. If you respond well to neo-synephrine, and you liked how it looked with the drop in, than a mullerectomy is the way to go. The only reason to consider a levator resection in that situation is if you wanted to modify your eyelid crease. That can be done with levator surgery but not with a mullerectomy alone. Hope this helps.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 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.