Ptosis revision - what would you do as an oculoplastic surgeon? (Photos)

Question

I had congenital ptosis surgery in 2020 by an oculoplastic asorps surgeon in Houston. I had revisional surgery a year later. It has now been 1 year since the revision and my eyelid has multiple creases, bunched skin, and folds I never had before. My surgeon has said she can try and use a laser to tighten my skin. No skin removal so far. What would you do? I'm scared to trust my surgeon again but hate the swollen appearance of my eyelid. I can live with the height improvement I've achieved.

Kenneth D. Steinsapir, MD · Answer

The discussion that follows refers to your anatomic left and anatomic right assuming you have not flipped the images. Excess skin is not why you have a duplicated crease. Please understand that the effort to be made symmetric (perfect) is very challenging in anyone's hands. The closer the two eyelids are, the harder it is to get that last difference. The left crease is too high and needs to be lowered. The eyelid platform skin below the crease also needs to be controlled. The duplicate creases in the left upper eyelid are due adhesions between the levator aponeurosis and the skin. You so appear to have a compensatory retraction of the right upper eyelid (Herring's law related retraction). It is likely (but not certain) that correcting the left upper eyelid more should decrease the difference in the two sides. You need further anterior levator resection ptosis surgery with a crease lowering surgery. There is no substitute for a detailed in person assessment. Your eyes can be your best feature.

Bruce K. Smith, MD · Answer

Your ptosis repair was an absolute success. Congratulations to your surgeon. The asymmetries that are now noticeable are the asymmetries in the lengths of the lower lids and the rounded lateral canthus on the contralateral eye. The lower lid is more bowed or inferiorly distracted on that side as a result.  This could be addressed with horizontal shortening of the lower lid or a tarsal strip procedure.

Mark L. Mazow, MD, FACS · Answer

Thank you for your question and for your photos. It is difficult to answer your question without more information such as how the surgery was done. Was it posterior surgery? That only works in a very small subset of congenital ptosis patients. I actually published a paper about that. From your photos you still have some residual ptosis. An external approach with reformation of the lid crease would seem to make the most sense. I would get a second opinion from another ASOPRS surgeon. I’m not sure that I would offer you laser

Ptosis revision - what would you do as an oculoplastic surgeon? (Photos)

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Everything you need to know about Ptosis Surgery

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Ptosis revision - what would you do as an oculoplastic surgeon? (Photos)

Answers (3)

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Recommended reading

Everything you need to know about Ptosis Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.