Ptosis Surgery Not a Success--or Something else Causing Eyelid Assymetry? (photo)

Help! I had ptosis surgery, but the lid was still too low, so the surgeon did revision surgery 20 days ago. While the lid is higher, I still detect a visible difference in the look of the eyes--the corrected eye still looks smaller. My surgeon is happy with the results but did point out during the last surgery that there was a visible difference in the lid shape. Was the 2nd surgery not a was success (still looks a bit lower)- or do I need another surgery to make the eyelids more symmetrical?

Doctor Answers 4

Eyelid Asymmetry after Ptosis Repair

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    Continuing to correct ptosis with very subtle differences in lid height is likely to produce very little improvement.  However, the possibility of making them worse is a factor to consider.

I Would Ensure You Understand The Risks Before Undergoing Additional Surgery

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   While reviewing your pictures, I agree that your right eyelid is slightly lower than your left.  In regards your results, I would qualify this is the acceptable result for ptosis surgery.  I believe that the different shape of your lower lid is accentuating the different sizes of the appearance of your eyes.  Your lower lid on the left is slightly lower than you right.  In combination with your right lid being slightly lower, it give the appearance of a smaller eye on the right.  


Revision or additional surgery on the right upper lid is possible, but every additional surgery becomes more complicated and the risks increase.  I would be cautious about having additional surgery on the right upper lid.  You might want to a procedure to raise the lower lid on the left to help increase the symmetry on both sides.  It is going to be very challenging and unlikely to get perfect symmetry between both eyes.  

Don't touch it, not yet at least

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sorry for your troubles. You really need to wait. It's also difficult to say with photographs over Internet but it may be that your orbit (eye socket) is a bit different or larger or lower on the right than the left. This will always show some sort of asymmetry between the two lies if the right eye is even 1 to 2 mm further back or below the left eye. I do see this in many of my patients whether it be for asymmetric eyelids or do just ptosis itself and I point that out to the patient's before surgery whenever possible. I would say that the position of the lid is pretty good. As an experienced ptosis surgeon I can tell you that "perfection" in ptosis surgery is certainly not an occurrence 100% of the time. Revision in ptosis surgery is actually somewhat common compared to standard eyelid surgery just because of the nature of the anatomical issues related to ptosis.

as frustrating as it can be you need to give it more time and get a few more opinions before doing anything else. But my general recommendations to you right now are to wait and wait a little bit more and get a few more opinions before doing anything. I would be somewhat cautious surgeons who make promises with regards to revision particularly in the context of ptosis because if they really have a lot of experience they know results can be variable.

Chase Lay, MD

facial plastic surgeon and eyelid specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

1-2 millimeter difference in eyelid height is natural and normal

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Having a revision after ptosis surgery is not uncommon. Even the most experienced oculoplastic surgeons have to do revisions. And doing this over 20 years, I never take for granted that things that look great during surgery may still require revisions, whether it’s from healing, swelling or other factors.

Most people or many people have subtle differences between the two eyes. It is normal for people to  have a 1-2 millimeter difference in eyelid height. Most of the time, no one ever notices that, so you must understand that a little bit of asymmetry is natural.

I can tell from your photos that the overall symmetry looks very good. The contour and the height looks good. To me, the surgery looks pretty successful. So as long as you’re within 2 millimeters, I think it is probably a more than acceptable result.


I would recommend that you keep in contact with your oculoplastic surgeon and certainly communicate with your doctor your concerns.  I hope that was helpful and thank you again for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

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