Ptosis surgery for mild case?

Question

Ever since I was young (maybe even born) my left eye has had mild ptosis and I believe that lead to an astigmatism in that eye (in pictures it's the right eye). I've seen two different doctors who both say it's so mild I shouldn't get it fixed but it feels very dramatic in photos and that bothers me. Is this really so mild I shouldn't fix it? Also, would I benefit from upper eyelid and tear trough filler?

Melanie Ho Erb, MD · Answer

You have mild congenital ptosis and astigmatism often accompanies it. Your ptosis can be improved with a surgery. Or there are eyedrops that can temporarily improve mild ptosis for about 6 hours that you could use before you take photos. In order to determine if you are a good candidate for surgery you need a full evaluation by an Oculoplastic Surgeon. My personal best,Dr Melanie Erb

Kenneth D. Steinsapir, MD · Answer

My father, an internist from Brooklyn, liked to say: "If the butcher tells you the meat is bad, you should listen." Sometimes when a surgeon tells you that something can't be done or that you do not need it, what they are really telling you is that their work is not going to be satisfactory to your needs. Your upper eyelid ptosis profoundly affects your appearance. If warrants aesthetic ptosis surgery to properly address it. Not that this is not the same as reconstructive ptosis surgery. That type of work will not be satisfactory for this situation. Most surgeons who offer reconstructive ptosis surgery are satisfied when the two eyelids are within 2 mm of each other. That will be total unsatisfactory for your situation because your left eyelid is only 1 mm lower than the right upper eyelid. Your issues include the upper eyelid ptosis that affects both upper eyelid (left worse than right) and the correspondingly asymmetric compensatory eyebrow elevation. As you shop round, it is important to understand that surgeons mostly only offer one type of ptosis repair: Mueller's muscle conjunctival resection ptosis repair. This is an extremely popular ptosis surgery, representing 80% of the ptosis surgery performed. The problem with this surgery is it will not work for the type of ptosis you have. You have a central levator disinsertion. That means that the levator is not in its correct anatomic position. The surgery works by creasing the levator tendon when it is in its proper anatomic position on the tarsus. Yours if off the tarsus. The surgery will under correct your eyelid ptosis. That means that your eyelid will not open as much as needed and your compensatory eyebrow elevation will not relax as much as would be ideal. Since these are the principal reasons you would be having surgery, the muellerectomy is not your surgery. You need an anterior levator resection ptosis surgery with an anchor blepharoplasty to strengthen the upper eyelid fold and control the crease position. It is highly likely that both eyelids are going to need surgery. Yes, you could also benefit from a small amount of under eye, tear trough filler. This should be Restylane. The low G prime fillers are not good for this location, such as Belotero, Juvederm, etc. There is no substitute for a detailed personal assessment. Your eyes can be your best feature.

A.J. Amadi, MD · Answer

You definitely have eyelid ptosis, left worse than right. On your left side, you are actually compensating by lifting your eyebrow. Generally, most plastic surgeons will and should leave this alone as they do not have expertise and/or experience to deal with cosmetic ptosis. This is subtle surgery and can sometimes lead to  unpredictable results. 
However, Oculofacial Plastic Surgeons (Oculoplastic surgeons),  address these problems commonly. There are two different techniques that can be used to fix this problem: an internal approach with no skin incisions, and an external approach that does utilize a well hidden incision. They both have their pros and cons. In general, I usually use internal approach for mild to moderate ptosis without any skin or crease issues. It is less invasive and has a quicker recovery. However for more severe ptosis, or ptosis that presents with additional skin or eyelash problems, the external approach is more versatile and can achieve more. It does have a longer recovery however.
Choose a surgeon that is experienced in both techniques so together, you can decide what is right for you. Virtual consultations are available.

Mehryar (Ray) Taban, MD, FACS · Answer

Cosmetic ptosis surgery is possible using scarless internal technique. Need more detailed evaluation to determine accurately. See an oculoplastics specialist.

Ptosis surgery for mild case?

Answers (4)

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