Failed external ptosis surgery, will an internal approach help? (Photos)

Question

i got external ptosis surgery back in september but it failed. my dr told me that my levator muscle just simply did not work and recommended an internal approach. she was very honest in telling me that my eyes will never be 100% symmetrical but i'm wondering if the surgery is even worth it.

Kenneth D. Steinsapir, MD · Answer

I do a lot of aesthetic revisional ptosis surgery. I am a fellowship trained oculofacial surgeon and a board certified ophthalmologist. So your photos are very helpful. There is truly no substitute for a detailed in person assessment. Perhaps the most important indicator for the potential for success with ptosis surgery is the measurement of eyelid excursion, which is called levator function. It is measured by fixing the eyebrow position with the examiners finger so the eyebrow can't move and then having the person being examined look all the way down and all the way up. The measurement of that excursion is called levator function. To form a well defined crease like you have on the right side, assuming you did not flip your photos, one needs to things: levator function of 12 or more millimeters and an adhesion between the skin, orbicularis oculi muscle, and the underlying leavator aponeurosis tendon. I question if your prior eyelid surgeon made a new hard crease in your droopy eyelid. I suspect they simply cut the eyelid where they thought you had an existing crease was. That is not always ideal. In my  paper on the Post Upper Blepharoplasty Syndrome which I am attaching, the most common cause for persistent ptosis after ptosis surgery is that the surgeons simply failed to advance the levator aponeurosis enough. Having a posterior approach ptosis surgery is not the answer. It will not fix your issues. You need a revision anterior levator resection ptosis surgery, crease lowering, and an anchor blepharoplasty to help make the droopy eye look like the better eye. The goal should be to make you look as symmetric as possible and a posterior approach Müllerectomy will not achieve that. I strongly advise doing that. There is no substitute for a detailed, in person assessment, That would be your next step.

Failed external ptosis surgery, will an internal approach help? (Photos)

Answers (1)

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