Do my eyes continue to look droopy after the orbital decompression surgery and mid-face lift that I had done? (Photo)

Question

I had the orbital decompression surgery done in 2008 and a mid-face lift done in 2011. I've attached a current picture of how my eyes look like now. I still believe my eyes have a tired and droopy look to them and feel like I would benefit with a brow lift possibly or maybe a surgery to fix the droopy eyelid.

Christian Subbio, MD · Answer

It appears as though you have some recurrence of the downward malposition of your lower lids.  This can be addressed with a lower lid tightening procedure.  As well, your upper lids have a slight degree of ptosis or drooping and as well may benefit from a lid margin reshaping.  This can be addressed with a ptosis repair procedure by a very skilled oculoplastic surgeon who is comfortable with the very nuanced and meticulous maneuvers needed to lift the upper eyelid and at the same time reshape it.  The key here is visiting with someone who specializes in eyelid surgery and who has done hundreds, if not thousands of these procedures.  In California you should have no trouble finding such a provider.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Gerald Minniti, MD, FACS · Answer

Hello,Your result was not sustained, and you have a recurrence of your natural lid malposition. A procedure that directly tightens the lid ligament would be best for you. Best of luck!

Johnny Mao, MD, FACS · Answer

First of all, the results from the first surgery look decent, I am not sure why the right lower eyelid had more "rounding" at the lateral end.  However, as time progressed, lower eyelids have descended, but still pretty good.  The upper eyelids appear droopy which contribute to a tired look and can be improved with ptosis repair under twilight, or semi-awake, so you can respond to commands to ensure symmetry.  I would also want to see the previous surgeon's OP note to see what was done with the midface lift and lower eyelids before deciding how to approach the lower eyelids.  I don't think a browlift will lift the eyelids enough to give you the aesthetics that you desire.  You need a formal upper eyelid ptosis repair.

Arnold Almonte, DO · Answer

What you have is called "ptosis" of the upper eyelids. Consult with a qualified surgeon who is experienced in "ptosis repair". This is surgery of the upper eyelids, and can possibly involve the brow as well. Good luck!

John L. Burns Jr., MD · Answer

You have upper eyelid ptosis and I would suggest consultation with a Board Certified Plastic Surgeon or Oculoplastic Surgeon with experience treating ptosis which can be difficult to accurately correct.

Sam P. Most, MD · Answer

I would suggest you see an experienced oculoplastic surgeon, given that you may need revision surgery on your upper and or lower lids.

William Marshall Guy, MD · Answer

Hello Kariam7,Your picture shows that your upper eyelids are ptotic (droopy) likely as a result of the orbit being displaced backwards after the decompression.  In addition, the right lower eyelid is malpositioned on the outside aspect of the lid.  There are treatment options but these are best undertaken by an oculoplastic surgeon.  I hope this helps and good luck.

John B. Lazor, MD, MBA, FACS · Answer

If your orbital decompression was for Graves Disease, it is not uncommon to have related eyelid problems. See your oculoplastic surgeon for evaluation and ptosis repair

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. I understand that you underwent orbital decompression in 2008 and a mid-facelift in 2011, and now you’re concerned about your eyes looking droopy. You’d like to know if a brow lift would be of any benefit or if you should also consider an eyelid lift.To give you a bit of info about myself — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I’ve had significant experience with orbital decompression and thyroid eye disease as it is a large part of my practice, so I can certainly assist you with your concern.Looking at the photos you submitted, it’s clear to me that the decompression and mid-facelifting surgery has been very successful for you overall. Your eyes are at a good position, and considering your history, I’m impressed that the left upper eyelid did not require any additional surgery beyond the decompression.You feel that if your brows are elevated more via a brow lift, that your upper eyelids will look more open. This is a common thought among patients, but from my own perspective, I think your eyebrows are already at a good place and I don’t think a brow lifting procedure would be of benefit to you.With regard to the upper eyelid position, based on your photos, it does seem like the upper eyelids are a little bit low relative to the pupil. In the absence of a full and proper examination, I can say that it is not unusual for someone who had surgery for thyroid eye disease to go from eyelid retraction to ptosis. I suggest that you discuss this with the original surgeon who did your orbital decompression surgery, as they would be most familiar with your anatomy. Discuss your options in lifting the eyelids and get an understanding of the reasons and pros and cons.Before surgery, I always tell my patients in cases wherein I wasn’t the original surgeon, that we need to have a plan A and a plan B, because a lot relies on what kind of anatomy I will encounter once I’m already doing the surgery.I would suspect that your doctor may be concerned about the predictability of the lifting of the eyelid. When you have ptosis surgery or an eyelid retraction surgery, the eyelid can always be too open or too low — that’s just the reality of doing this type of surgery. In such cases, you’ll need additional surgery. However, if you have an attainable ideal in mind, then it is worth discussing and considering ptosis surgery for, even though you once had eyelid retraction. I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Mark Loury, MD, FACS (retired) · Answer

With orbital decompression the globes move backward (I assume it was done for Graves orbitopathy). As a result the upper eyelids drop (proptosis). There is also some drop of the right lower lid. Graves can also cause some swelling of the lids. You could benefit from upper and lower lid surgery to refresh your eye appearance.  Because of the added complexity from the decompression I suggest consulting with an oculoplastic surgeon experienced with this condition. Best wishes

Do my eyes continue to look droopy after the orbital decompression surgery and mid-face lift that I had done? (Photo)

Answers (10)

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