Possible Levator Muscle Injury from Eyelid Surgery?

Question

I had upper eyelid surgery on both eyes on June 25th of this year. My right eyelid is not opening all the way when I look up or out to the side. When I raise my eyebrows, my entire right eye pulls up. The left eye is not having any of these problems. Also, I have raised scars on the outside of both of my eyes.Could my doctor have injured the levator muscle in my right eye, or possibly extracted too much fat, causing a ptosis effect?

Charles K. Lee, MD, FACS · Answer

You are now 2 weeks out from the surgery and by this time, you eyelids should have accomodated to each other.  If you still have signficant ptosis at this point, it is likely that the levator muscle or attachment to the tarsus is not functioning fully and will likely not resolve with further waiting.   In other words, the transient effects of medication, brusing, swelling, etc, should have mainly dissipated.
There are a number of possibilities that are causing your eyelid asymmetry at this time, but removing too much fat is likely not one of them. My advice is for your to wait and be patient a while longer (minimum of 3-4 weeks).  If you require further treatment, the levator may be explored, tightened, or "advanced."  By this time, you will also see that the scars on the lateral incision will have healed much further.

Sam Speron, MD, FACS · Answer

Hi,
Thank you for your question!
It is possible that your muscle was damaged during the surgery. It is difficult to say without examining you. It could be several things. It would be a good idea to go back to your doctor or consult a plastic surgeon that specializes in this area. 
As for your scars, they should heal up over the next few weeks and not be as raised.
Best regards,
Dr. Speron

Brooke R. Seckel, MD, FACS · Answer

Your history sounds as though you may have a levator injury. However, there is a big difference between an injury and an actual cut of the levator muscle. The lid droop you mention is called ptosis.
Sometimes the levator muscle is stretched or injured but not cut, and the levator is weak for 4-6 weeks after surgery, causing a temporary ptosis. This usually resolves in 4-6 weeks-hopefully this is your situation.
If the levator was cut or disinserted (pulled out) form the tarsal plate, then a surgical repair will be necessary.
Be sure to see your surgeon soon-he /she should be able to diagnose the problem.
From your description of your scars, you might consider a second opinion by an expert in eyelid surgery-a board certified plastic surgeon who specializes in eyelid surgery or an occuloplastic surgeon.
Levator repair is a very technically sophisticated procedure that requires an experienced skilled eyelid surgeon to successfully restore normal levator function. if you need a repair you need to see an expert, in my opinion.

Kenneth D. Steinsapir, MD · Answer

Dear Anonymous
You are relatively early from you surgery.  It is quite possible that heaviness in the eyelid that you are describing is due to swelling and will resolve with time.  On the other hand, it is possible for the tendon of the upper eyelid to become disinserted or loose.  This can be the direct but unintended result of the eyelid surgery or in someone who is predisposed, swelling in the eyelid associated with the surgery can contribute to this.  It is my impression that the levator aponeurosis, the tendon that connects the upper eyelid to the muscle that opens the eye, gets injured during eyelid surgery much more commonly than we realize.
It is appropriate to address your concerns to your surgeon and hear what that person has to say.  Recognize that not all sugeons who do eyelid surgery are formally trained in oculoplastic surgery.  They may only know how to perform a basic cosmetic blepharoplasty and not much else.  If your eye does not open and the lid margin blocks the pupil, this might prompt your surgeon to explore the involved eyelid under local anesthetic in the office or in an operating room.  If your surgeon does not provide a response that makes you comfortable, you might consider a consultation with an eye plastic surgeon.  If you have a good relationship with your surgeon, you might ask them to recommend and eye plastic surgeon for a second opinion.  It can be very helpful to have such an opinion.

Trevor M. Born, MD · Answer

Dear Anonymous,
i am sorry that you are having issues with healing.
You should  return to your surgeon for review  and if they are not familiar with your condition then they should refer you for a consult with a surgeon who can deal with your problem.
With Warm Regards,
Trevor M Born MD

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Possible Levator Muscle Injury from Eyelid Surgery?

Answers (9)

Answer: Levator muscle and repair in upper lid blepharoplasty

Answer: Levator muscle and repair in upper lid blepharoplasty

Answer: It is possible

Answer: It is possible

Answer: You may have a levator muscle injury after blepharoplasty

Answer: You may have a levator muscle injury after blepharoplasty

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Our mission is to create a world where every investment in modern beauty is Worth It.