Would unilateral ptosis correction help me?

Question

I've been to two oculoplastic surgeons (one through insurance the other private) and both said my ptosis isn't bad enough to constitute surgery. However, I'm extremely bothered by the immense asymmetry of my eyes, and my eye with ptosis (picture right but In person it's on the left) also gives me eyebrow strain headaches. Would I benefit from a single eye ptosis repair? Would this correct my asymmetry? My ptosis eye also opens wider on the bottom lid, would ptosis repair fix that as well?

Kenneth D. Steinsapir, MD · Answer

My father, an internist from Brooklyn, liked to say: "If the butcher tells you the meat is bad, you should listen." Sometimes when a surgeon tells you that something can't be done or that you do not need it, what they are really telling you is that their work is not going to be satisfactory to your needs. Your upper eyelid ptosis profoundly affects your appearance. If warrants aesthetic ptosis surgery to properly address it. This is not the same as reconstructive ptosis surgery. That type of work will not be satisfactory for this situation. Most surgeons who offer reconstructive ptosis surgery are satisfied when the two eyelids are within 2 mm of each other. That will be total unsatisfactory for your situation because your left eyelid is only 1 mm lower than the right upper eyelid. Your issues include the upper eyelid ptosis that affects both upper eyelid (left worse than right) and the correspondingly asymmetric compensatory eyebrow elevation. As you shop round, it is important to understand that surgeons mostly only offer one type of ptosis repair: Mueller's muscle conjunctival resection ptosis repair. This is an extremely popular ptosis surgery, representing 80% of the ptosis surgery performed. The problem with this surgery is it will not work for the type of ptosis you have. You have a central levator disinsertion. That means that the levator is not in its correct anatomic position. The surgery works by creasing the levator tendon when it is in its proper anatomic position on the tarsus. Yours if off the tarsus or partially off the tarsus. The surgery will unpredictably correct your small amount of eyelid ptosis. Often this type of ptosis has an insufficient effect on correcting the eyelid so that the compensated eyebrow relaxes.  A detailed personal examination should explore what happens if just the left upper eyelid is elevated. This can be assessed with phenylephrine drops. If elevating the left eye causes the right upper eyelid (known as Herring's law ptosis) surgery on the right upper eyelid is needed. Since these are the principal reasons you would be having surgery, the muellerectomy is not your surgery. I also think you should be assessed for lateral canthal resuspension. This may only be needed on the left side. Your eyes can be your best feature.

A.J. Amadi, MD · Answer

Your eyebrows both seem slightly elevated, the left maybe more than the right. If this is happening, you are subconsciously elevating your eyebrows which elevated your eyelids, and hides the ptosis. You actually may be a candidate for bilateral upper eyelid ptosis. An in person evaluation is best.

Brent Moelleken, MD · Answer

You have pretty eyes and there are normal asymmetries between the two eyes, a very mild version of orbital dystopia.
Be careful of having surgery for things that aren't necessary.  Either the results will be so subtle that you'll be unhappy, or perhaps a real problem will ensue after the surgery.  This is especially likely if your perception of the problem is greater than the problem actually is.
I hope you won't join the ranks of patients who are unhappy with their barely necessary surgery!

Would unilateral ptosis correction help me?

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