3 sort of failed Ptosis surgeries. Thoughts? (Photos)

Question

I have congenital ptosis in my left eyelid. In 2016 I got the muscle tightened and it did nothing at all, made it worse. In June 2020 the same surgeon did the same surgery and made eye droopier than ever before. Found a new surgeon and had the surgery again in December of 2020 (6 months later) and eye looks best it has, but still droopier than right eye and different shape. I had a consultation with new doc in California and he says last option is full thickness method. Im scared. Thoughts?

Kenneth D. Steinsapir, MD · Answer

First, I am so sorry you have had three unsuccessful ptosis surgeries. There is no reason that you can't have successful ptosis surgery. However, these are fussy procedures. I suspect that one or two of your surgeries were Mueller's muscle conjunctival resections. These often fail. Perhaps your third surgery was performed as an anterior levator resection ptosis surgery. These are details we do go through carefully to prepare to fix a multireoperated eyelid.

There are very few surgeons who perform full thickness upper eyelid ptosis surgery. It is an outlier surgery  that the now deceased Henry Balyis, MD. would occasionally perform. In my opinion, this is a destructive surgery that has a high failure rate. It is almost impossible to further revise the upper eyelid when the surgery is unsuccessful. I routinely see patients who have had several failed prior upper eyelid ptosis procedures some including full thickness ptosis surgery. In each case, the full thickness ptosis surgery was performed by the same surgeon. It would be highly inappropriate to identify this surgeon but they do practice in California. I am not here to pick on this particular surgeon and do not ask if this is the same surgeon who you consulted. Please remember that I only see problem cases. No one with a successful outcome would be coming to see me.  I am sharing my opinions and experiences.

Full thickness ptosis surgery attempts to directly cut out full thickness eyelid and stitch the remaining parts together. Theoretically this will lift the eyelid. It spares the surgeon of a very fussy and time consuming surgical dissection throughout anatomic planes that must be separated to perform standard anterior levator resection ptosis surgery but are scarred together due to prior surgeries. When full thickness ptosis surgery  is unsuccessful, this dissection is made 100 times harder.

How many successful full thickness ptosis surgeries have I seen? It is a fair question. Honestly, I have never seen a successful full thickness ptosis surgery. Further the unsatisfactory full thickness ptosis surgeries patients I have seen recently have shared with me that when they discussed with their surgeon that they are unhappy with the outcome of full thickness ptosis surgery, they were advised that there was nothing further that could be done for them. Surgeons sometimes say that when they are personally out of ideas or no longer desire to further help their patient.

What do I recommend? Do not rely on a "Skype" or "Zoom" conference as an eyelid examination. These eyelids need to be carefully assessed in person. My typical eyelid consultation for these types of issues can run up to two hours. There is a great deal of information that needs to be gathered and a great deal of information that needs to be discussed. You have an excellent eyelid contour and upper eyelid fold. That usually means that the eyelid can be successfully repaired using a standard anterior levator resection ptosis repair. However it is essential to carefully dissect between the scarred levator aponeurosis and the superior tarsal muscle in order to accomplish this. This is a fussy scar dissection, which I routinely perform. Ptosis surgery needs to be performed under light intravenous sedation in an accredited surgery center. It is critically that you are completely comfortable and cooperative. These type of surgeries take time. I usually schedule them for 3 hours. You can study my videos to understand how this work is performed.

Your eyes can be your best feature.

Nelson Lee Novick, MD · Answer

Before embarking on any additional surgeries, you may wish to consult with a board certified cosmetic dermatologist about the recently FDA approved topical prescription eye drops specifically for treating eyelid ptosis. Hope this helps and best of luck.

3 sort of failed Ptosis surgeries. Thoughts? (Photos)

Answers (2)

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