Eyelid Surgery & Injectable Fillers with Myasthenia Gravis

Question

I have had Myasthenia Gravis for about 15yrs and have not been on any medication for over 3yrs. Back then I did have some eyelid drooping, facial slackness & limb weakness. Symptoms now mild & just some limb weakness.

	I am 42 & interested in eyelid surgery and fillers but wondered about risks. My MG doctor is a bit vague (am the only MG patient he has!) so I wanted to get a surgeon's perspective. thanks :)

Mehryar (Ray) Taban, MD, FACS · Answer

The short answer to your question is that it is safe to do proceed with eyelid surgery, but it depends on what kind of eyelid surgery and how aggressive it needs to be.  It appears you have a stable form of ocular MG so it should be safe.  Fillers are especially safe.  You need to consult an oculoplastic surgeon to assess the current status of your eye/eyelids and periocular area and discuss possible treatment options.

	Dr Taban

Kenneth D. Steinsapir, MD · Answer

MG can affect the strength of muscles including the small muscles that help open and close the eyes.  Eyelid surgery can also weaken these muscles.  Add it any tendency for a dry eye and you are a set up for eyelid complications.  If you must have eyelid surgery, you should be very carefully evaluated by and oculoplastic surgeon.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their website (ASOPRS.org) that can help you identify a high qualified oculoplastic surgeon.

	BOTOX is contraindicated (fancy medical term for not a good idea) in individuals with MG.

	FIllers however could be an excellent option for you.

Sam Goldberger, MD · Answer

Myasthenia Gravis causes eyelid drooping so it is common for Oculoplastic surgeons to repair ptosis in patients with MG.  Go to an Oculoplastic surgeon to see if your findings warrant surgery.

Francis R. Palmer, III, MD (retired) · Answer

IMHO, fillers carry no risk but becasue MG weakens muscles, the eyelid surgey places you at increased risk of lower eyelid malposition and upper eyelid ptosis. I'd be very conservative in the eyelid surgery and only after you've had fillers that would hopefully make you happy enough to forgo the eyelid surgery. I would assume that you want fillers to the face.

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