Post ptosis surgery question about how to revise a high incision and extra eyelid fold. Should I get a second opinion? (Photo)

I had ptosis surgery a little over 3 weeks ago. I know it still needs to heal, but I believe the incision is too high and is causing an extra fold, making my eyes appear very asymmetrical despite my eye opening more now. My dr said it could be fixed in-office by removing more skin but I would like to be sure before agreeing to that solution. Could there be a need to tighten the levator more? Or is there another way to address the fact that my eye crease is not really sliding back properly?

Doctor Answers 3

Let's call this what it is-a ptosis surgery fail.

Seventy percent of my practice is fixing the work of other eyelid surgeons so I am an expert in this subject.

Your upper eyelid is now worse after ptosis surgery than it was before ptosis surgery.  This can happen in the best of hands but it is quite rare.  

At three weeks your surgeon is not being honest with you when they tell you that this eyelid needs to heal more.  This eyelid is never getting to where it needs to be.  I am also troubled by your surgeon's statement that you need a little office procedure to remove the fold of skin.  Do they actually believe that or are they simply telling you that and plan to actually correct the ptosis when they have your eyelid open?  If the plan is to simply remove the extra fold of skin, this is a big mistake.  You have that because the ptosis surgery worsened the upper eyelid ptosis.  Now the levator aponeurosis and associated orbital fat are further retracted into the orbit.  Snipping this extra fold of skin will not fix the now even heavier upper eyelid.  Instead it will only make the hollowness and long right upper eyelid platform more obvious.  What you need is a definitive repair of the right upper eyelid ptosis with an appropriately performed anterior levator resection ptosis repair.  The anterior orbital fat needs to be released into the upper eyelid fold.  The right upper eyelid crease can be lowered at the same time. Any spare skin will be needed to accomplish this.

I would be much more comfortable with your current surgeon if they told you the truth that the surgery is a fail for whatever reason and the eyelid needs to be revised. While it is best to wait many months, an early repair after 8 weeks could be consider for social reasons.  I strongly recommend that you find another surgeon for this work.  You need a very experienced individual for this and it is worth your while to travel for this type of work.


Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Wait for 3 months after eyelid surgery

The right upper eyelid still seems a bit droopy, not incision related. It is early in the healing process. Best to wait about 3 months and then re-evaluate. Revision ptosis surgery is possible. See link below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 62 reviews

Post ptosis surgery question about how to revise a high incision and extra eyelid fold. Should I get a second opinion? (Photo)

It never hurts to get a second opinion.  I agree that it is still too early to be sure what would be the best treatment, if necessary, to do to make your eyes appear more symmetric.  It is possible that the lid fold could be adjusted surgically.  But it is also possible that further levator tightening will be required.  Don't despair please.  I think that, if necessary, this can be fixed.  Good luck!

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 116 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.