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

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

Christopher L. Hess, MD · Answer

When extensive work is done on the lids there tends to be extensive swelling. This includes swelling of the muscles as well as the skin and surrounding tissues. This and the work can cause a temporary decrease in function of the muscle. It's not unexpected. Since you're very early out from surgery give it some time. If there's still an issue after 6 months then it should be addressed.

Steven Wallach, MD · Answer

Your concerns are something that should be evaluated by your surgeon. Yes, you may have a levator injury or you may be swollen or the muscle is contused. You may also have had some element of ptosis prior to your blepharoplasty that was brought out during the surgery. Raise scars are a concern as well and should be evaluated by your surgeon

Keith Denkler, MD · Answer

Your Levator muscle (upper eyelid lifter) may have been injured, partially torn, or stretched in and around surgery/recovery.
Please recheck with your doctor.
It could get better with time, but may need some tightening on the weakened side.
Your doctor will examine you and come up with a plan.
Good luck.

Jonathan Hoenig, MD · Answer

I'm sorry to hear of the problems you're having after your eyelid surgery. It is possible that the muscle was damaged.
Unfortunately, it's hard to say what's going on without seeing you. Perhaps your right eye was droopy before surgery but you didn't notice it before?
The raised scars should settle down over the next few weeks. If you have concerns about the eyelid ptosis, I suggest you consult with an oculoplastic surgeon who is specially trained to deal with issues in eyelid plastic surgery. You can find one near you by going to www.asoprs.org.

Brooke R. Seckel, MD, FACS (retired) · 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.

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