2 failed ptosis surgeries. What are some options now? (Photos)

Question

I had my first ptosis surgery in Feb. 2015, done internally. I had a correction surgery performed by a different surgeon in June 2017, done externally this time. I feel as though this one has failed also. Not sure what my options are at this point. I had a difficult time with recovery both times. I’ve tried the Upneeq drops as well, they are okay but seems to open both top and bottom lid and make my eye look overcorrected. I also have noticeable dryness with the drops. Insight much appreciated!

Kenneth D. Steinsapir, MD · Answer

I am in the business of aesthetically fixing eyelids that other have not been able to fix. The fact that you have had two failed ptosis surgeries is very common. The Müllerectomy, your first ptosis surgery commonly fails. Surgeons persist with this surgery because it is so easy, not because it is good. When you have central levator disinsertion, the Müllerectomy is relatively ineffective because the central levator is out of place. Revision with an anterior levator resection ptosis surgery is generally performed by reconstructive surgeons. They often quote an accuracy for this surgery of plus or minus 1 mm. That is 2 millimeters! That is not sufficiently accurate for the aesthetic result you need. Also need crease lowering and advancement of the anterior orbital fat to help recreate the left upper eyelid fold to match the right upper eyelid fold. With sufficient correction of the ptosis, the left eyebrow will relax down improving symmetry with the right side. The key with this work is what resources are left in the eyelid. Under no circumstances, do not get talked into having full thickness ptosis surgery. There are a few eyelid surgeons out there who offer this destructive surgery. It is very hard, possibly impossible to fix eyelids after this procedure. The critical measure for these eyelids is their range of excursion, called levator function. If you have an eyelid excursion greater that 10 mm it is possible to help the eyelid but it is much better if the levator function is greater than 12 mm. There is simply not substitute for a detailed in person assessment.

Ayse Dolar Bilge, MD · Answer

HelloYou also have superior sulcus deformity so you will benefit from upper eyelid filler with surgery.Hope it helpsBest regards

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