Upper Eyelid Hollowness After Ptosis Repair

Question

Hi, I am 32 years old Asian female. Apr 2011, I had a surgery to repair ptosis. However, my left upper eyelid became too hollow, stiff and sunken. I am frustrated that my eyelid are hugely assymetrical. I am fearful of another surgery as it may damage muscle function. I've read that fillers don't work and the only solution is fat grafting. I'm looking up fat grafting to correct this, and I'd like to know, are oculoplastic surgeons or plastic surgeon better at this procedure?

Charles S. Lee, MD, FACS · Answer

The left eyelid ptosis should be addressed, and unfortunately you will need further surgery on the levator muscle. The high crease, hollowness, etc. are by-products of the ptosis. Fat grafting, double eyelid surgery, etc., will not improve the situation. Because ptosis appears to be more common in Asians (my personal observation), surgeons that perform Asian eyelid surgeries, whether plastic surgeons or oculoplastic surgeons, will usually be experienced in ptosis repair.

Steve Laverson, MD, FACS · Answer

You must have returned to the original surgeon, have you not? In your narrative, it would be helpful to know whether your initial ptosis was unilateral (one side only) or bilateral, and what your pre-surgical appearance was. Your MRD (marginal reflex distance, between pupil and upper lid margin) is ZERO on the left side. This is the primary asymmetry, and needs to be the focus of any procedure to restore symmetry and left upper lid function. Fat grafting is NOT part of the initial solution, and should not, in my opinion, be a part of the operative plan at this time.

Michael Law, MD · Answer

When a hollow upper eyelid is the result of an overly-aggressive upper blepharoplasty, fat grafting of the brow-upper lid junction can rejuvenate the eye area in a manner that is simply impossible by means of standard blepharoplasty techniques. A word of caution: this is a delicate surgery that requires a fair amount of experience with fat grafting, and meticulous surgical technique.  In experienced hands a smooth, youthful and aesthetically ideal brow-upper lid contour can be achieved.  Make sure your surgeon can show you numerous photographic examples of brow-upper lid junction fat grafting.View many, many photos to be certain the surgeon you select has extensive experience and expertise with this procedure.

Chase Lay, MD · Answer

I have seen this issue time and again after a surgeon has attempted a ptosis repair on an Asian patient. You have quite a bit of scar tissue and a crease position that is far too high at least taste on this photo. I would not say that you require fat grafting but it may be needed. One variability that cannot be accounted for until the time of surgery is the quality of your levator tendon. So much of the success of your revision depends upon the quality of this anatomical structure and the function of the levator muscle. I would get several consultations and hold off on any fat grafting or filler. And when I referred to fat grafting I did not mean injecting fat although that may be an alternative.

	Chase Lay, MD

	double board certified facial plastic surgeon and Asian eyelid surgery specialist

Eric In Choe, MD · Answer

In general, I don't recommend using filers for upper lid hollowness and rarely use fat grafting except in severely deformed cases because of its associated risks and unpredictability.

	In your case, your main problem is ptosis of the left upper eyelid causing severe asymmetry and accentuating the hollowness. 

	Ptosis repair is one of the most challenging procedures, even for skilled surgeons, thus you need to find a surgeon who has a lot of experience in ptosis repair on Asians. Don't be afraid to ask doctors how many ptosis repair they have performed and what their success and revision rates are.

Jeffrey Schiller, MD · Answer

Levator advancement surgery to correct your ptosis will definitely bring the crease down and may correct the hollow area. If it is still hollow then a filler or fat transfer could be discussed. Find someone who does a LOT of ptosis repair (usually an oculoplastic surgeon) and who operates on a good number of Asian eyes.

	Good luck!

Bobby S. Korn, MD, PhD · Answer

Hi, sorry to hear about your eyelid asymmetry. First, it appears that you have a levator dehiscence ptosis of the left upper eyelid as well as volume loss of the upper eyelid (superior sulcus) as evidenced by the eyelid position MRD1 1.0 and elevated eyelid crease. What did you left eye look prior to any surgery? Was the crease as high or indistinct? Were there multiple folds? Is there an element of congenital ptosis (present since birth?) A good history and review of old photographs would help to determine a treatment plan. What kind of ptosis repair did you have - anterior/posterior? Filler or fat would not be my first choice but rather a repair of the levator dehiscence. Best of luck in your care.

Upper Eyelid Hollowness After Ptosis Repair

Answers (7)