Ptosis in Left Eye After Canthopexy

I had a left eye orbital fracture 5 years ago. I had that repaired and then about 5 months ago I had a scar revision, fat graft for upper cheek hollowness, and a canthopexy procedure to fix mild lower eyelid sag. After the canthopexy I feel like my left eye aperture is smaller compared to my right eye either by over correction or by ptosis or by both. Is ptosis correction surgery correct for me? It doesn't affect my vision but does bother me aesthetically. I'm a 30 YO male. Thank you.

Doctor Answers 8

Ptosis in Left Eye After Canthopexy

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It certainly does seem from the picture that you posted that you do have ptosis, however the cause of the ptosis needs to be ascertained.  If you are bothered by the ptosis, it certainly is reasonable to seek out treatment.  You should consult a surgeon who can identify the cause of your ptosis and the best way to treat it.

Beverly Hills Oculoplastic Surgeon

You look good so maybe don't mess around with more surgery

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It is very possible that your mild ptosis is related to the old orbit fracture and you had perhaps unrecognized enophthalmous (eye sunken in) which is very common with a lot of orbital floor fractures. Correcting some of the other problems now leaves this to be observed as a stand alone issue?

I can't see how a canthopexy could give you ptosis but it could make the opening a bit smaller if your bottom eye lid was lower before the surgery.

Harlow Hollis, MD
Victoria Plastic Surgeon

Ptosis or pseudoptosis

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First, you need to find out what's causing the ptosis.  It may be through ptosis, for which ptosis surgery (using posterior approach in your case given small amount of ptosis) would be the answer.  However, you may have pseudoptosis, from sunken eye secondary to your old fracture. I recommend consult with an oculoplastic surgeon.

Dr Taban

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

This is not a functional issue, it is an aesthetic issue.

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Dear Lover

The upper eyelid is tethered to the lateral canthal angle.  When a canthoplasty is performed, generally to some degree, the upper eyelid in its lateral aspect (and sometimes across its width) will be pulled down with the lateral canthal angle.  That is what is going on with your left eyelids.  Yes you do have about 1 mm of left upper eyelid ptosis.  This is a small degree of upper eyelid ptosis.  As you can tell, some surgeons are not comfortable in addressing such a small amount of ptosis.  However, this is a common difference that can bother the individual and if it does, it is reasonable to seek help to adjust the ptosis.  A detailed personal consultation is needed to determine precisely what approach is needed to address this situation.

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

You do not need ptosis repair

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You have great result since your left eye looks very normal. Your let eye brow is higher than right side and this can be congenital or your eye brow compensating for mild left eye ptosis. Leave your eye alone ...

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Ptosis in Left Eye After Canthopexy

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More often than not, patient discover certain pre-existing asymmetry in their facial structures that they did not notice before the operation. This is usually due the existing facial asymmetry that exist in every person but it may be minimal and not noticeable or it may be very obvious. Looking at your picture, it seems that you are no exception.The right side of your face is basically smaller than the right side. Your right eyebrow is lower than the left and you have wider upper eyelid crease than the left. Now, if this was present before the operation, then that may be the cause of what you have noticed. You had canthopexy and not canthoplasty. The former is basically tightening of the lower eyelid without disruption of the lateral canthal tendon and therefore, it may have less affect on your upper eyelid position. The canthpexy appears to have not totally corrected your left lower eyelid downward pull which I suspect is secondary to scarring after your orbital fracture surgery. All these contribute to what you perceive as ptosis.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Ptosis or pseudoptosis?

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Your current symptoms likely relate to either what you describe as an orbital fracture, or to a zygomatic fracture.  If this was associated with a contour change in the cheek, then you more likely sustained a zygomatic fracture.  This may result in endopthalmos, pseudoptosis, and lower lid malposition.  Any subsequent soft tissue surgery represents camouflage for what is essentially a problem with the bony orbit.  I would be wary of treating the minimal ptosis that you have, given the fact that this likely represents pseudoptosis.

Glynn Bolitho, PhD, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Eyelid Asymmetry After Orbital Fracture Repair

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It is difficult to evaluate your case without an examination and with just one photo.  Often after orbital fractures, the eye can sink into the socket, causing eyelid asymmetry.  This could be your underlying problem.  The large light reflexes on your pupils make it somewhat difficult to determine if you have ptosis of your left upper lid, but if there is any ptosis it is very minor.  I think that you have relatively more skin in the left upper lid and that a cosmetic left upper blepharoplasty to remove excess skin would improve your eyelid symmetry.

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon

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.