Ptosis repair, blethroplasty, and one-sided browlift

I have been to see two Oculo-plastic surgeons in...

I have been to see two Oculo-plastic surgeons in the Virginia area about treating congenital ptosis in my right eye and right brow. Until now, it's been tolerable, but I am aging, and it's getting worse. It's impacting me in many ways.

One doctor, Dr. Rostami, recommends levator advancement and blepharoplasty (cut on the outside of the eye) and a hairline brow lift on the side that is falling. The other, Dr. Cytryn, recommends what I understand is a levator resection (no incision. This is done from inside the eye lid - which he says is statistically more likely to produce a more pleasing and exact result ) with an external incision in the crease to move fat, and a brow/forehead lift, both sides. He says will give me the lift I need from eyebrow to crease without a bletho ... and give me an improved contour.

Cost with Dr. Rostami - $7,000 (in her in-office surgical suite)

Cost with Dr. Cytryn - $3,200 surgical fee, $1,500 or $1,600 surgical suite fee (in Maryland), $500 or $600 "tines fee" (for the forehead lift)... This is from memory... I think I need to ask for more information because I'm not sure if this includes anesthesia or the ptosis portion of the surgery; for now we'll call it $5,200, and be aware that it could be higher. Impacting this will be the eyelid ptosis situation...

About the eyelid ptosis situation ...

Dr. Rostami says my visual field test show that I do have vision impairment, but not enough to qualify for insurance coverage, so this will all be out of pocket for me... my very small pocket.

Dr. Cytryn says the photos clearly show this is medical, and he believes insurance will pay for it.

I obviously need to get a better understanding.

I am going to get a third consultation, and make a final decision.

I'll share as I go through this process (surgeon selection, surgery experience, and before, healing, and after shots). As for you, dear reader, if you are in the DC, Maryland, or Northern Virginia area and have anything to share... about these doctors, other great doctors, questions I should ask, or your own experience, I would be grateful to hear your story.

Thank you!

Stressful search for truth

I went to see a new doctor today, a plastic surgeon ranked in the top 1% in the country. He basically parroted Dr. Rostami's recommendation. He side-stepped the question of levator repair technique because it's outside his specialty, but agreed a blepharoplasty and one-sided brow lift would be the best approach.

Different than Rostami, he thought I should have the levator repair as a stand-alone surgery, and let it heal. Then, he recommended I do the bleph and brow lift as a second surgery. This seems out of sync with all of the other physicians here who say the ptosis repair and bleph are often done together, and it's best done this way...

The doctor did offer, without prompting, that he would let the Dysport in my brows wear off before I do my brow. This would allow the doctor to see and work with everything is in it's natural resting position. I queried the Real Self Docs to see what they have to say.

It is done

Yesterday I went for my lymph drainage massage. Today, I had the procedure! My before is below. It's a little flattering to be honest, but I couldn't find one that really showed the state of my eyes and brow, but it will give you a general idea. Right eye and eye brow have ptosis. Correction, had ptosis :)

I'll back up a minute and tell you the a little bit about the last steps of my decision making process... First, I spent some time on the phone with my insurance company and became convinced that they were not going to cover my surgery with any doctor. I simply didn't have enough vision loss (30% or more) for them to consider it medically necessary. I decided to go through with the procedures even though it required going in debt. I simply couldn't look forward to years of waiting for my sight to decline as I became more and more ... well, unattractive.

As mentioned previously, I also saw three doctors. Dr. Rostami said she believed I should have levator advancement, upper bleth, and one-sided brow lift. Cytryn recommended a total brow lift and a levator surgery using a different method. He believed he could get the levator portion covered by insurance. (But the insurance company convinced me he would not be able to achieve this.) The third doctor, the head of plastic surgery at George Washington University, sided with Dr. Rostami, saying he felt I'd benefit from levator muscle repair and an upper bleth. He thought afull brow lift would be too much... His suggestion was a little different than Rostami's though... He wanted me to see an oculofacial surgeon in his building to get the levator repair done and then have a second surgery with him for the upper bleth. Two surgeries, more scaring, more time off work... The answer to all of this was no.

In the end, it broke out like this. Rostami offered a sound treatment plan. Cytryn's might have been fine, but two out of three doctors recommended another course, and he was not going to get my surgery covered. GWU doctor was out because he couldn't take care of all of this in one shot.

So, I booked with Soheila Rostami, MD, FAAO, FABCS. She was the best choice for me overall. Oh, BTW, about the Dysport, she reassured me several times it wouldn't impact the brow lift. I guess everything is based on the bone, so it doesn't so much matter where the brow is as where it's going to end up... I think that's it. I'm not a doctor, but the doctor really thought it wouldn't be a problem, and I trust her.

As for the surgery, it happened today and it went great. There was a kindness about Dr. Rostami that I previously missed. She was as gentle as she could be. She involved me in the process making sure we were on the same page. And I could tell she legitimately loves what she does! Plus, I just like her.

Tonight I'm home. I took one dose of Vicodon and have switched to Extra Strength Tylenol. We will see how I hold out, but I do have high hopes for a great result. Stitches out next Tuesday :)

Hard not to freak out!

You know, a lot is on the line for me. This is all very high stakes.

That is very likely why I'm freaking out this morning. I'm looking at photos of others who have had this kind of surgery, and it seems like those whose surgery achieved great symmetry achieved it nearly instantly and those who didn't ... didn't. Now, this isn't true in every case. I see some beautiful eyes that healed into beautiful symmetry over time (like Tremson), but not all of them. I have to ask ... Will I be one of the lucky ones? Please, God, I hope so.

Why does this feel frightening? Well, I have played my only card. I've invested all I have ... and some I didn't. So, whether this works or doesn't, the situation for me is permanent. I'll have to live with it. There are simply no big pots of cash around for "revisional" anything...

So, this morning I let myself have a good cry... Well, I didn't let myself, it just happened. It actually happened even as I tried to stifle it back. Why did I try to stifle it? I was worried about giving myself some kind of infection! Then, rather schizophrenically, I thought... Hey, good news, my tear ducts still work! Rollercoaster, please stop.

I'm sure I'm not the only person who has ever experienced this... Who has over extended themselves to fix a lifelong problem that is difficult to fix by any standard, and then waited around for the "mirror, mirror on the wall" to finally say, "You are fairest of them all," or at least "Hey, nice symmetry!"

I know. I know. Too soon to tell. I know. I know. Don't worry. But that would be you talking rational sense, and I'm in an emotional place today.

Pictures

Ceasing and desisting with the freaking out

Talked to the doctor. Her response was rather amusing... along the line of ... You just had surgery 2 days ago. Oh. my. gawd. You can't tell anything at this point! You are losing your head!!

At which point I think to myself that she is making a grand assumption that there was anything in my head to start with ;)

Her casualness does make a panicked, emotional person feel... well, a little stupid ... but also a little secure. It is clear she does not see any problem whatsoever. zero. nada. And I am breathing deeply again.

Surgery Weds. - pics Saturday morning

I guess we'll call these pics day 3 post op... I'm actually feeling pretty good about everything... It appears the bruising has peaked, and it's not bad at all. The doctor provided a lymph massage before the surgery and a healing kit with pills and gel that seem to really be working.
Eyes seem less swollen and more even today, but maybe it's just me? What do you think? Also, I think the brow will probably settle in. Except when I'm bathing or applying meds its wrapped tight in a bandage, so it's got a way to go to heal.

5 days post op

stitches out tomorrow

Things that might be helpful to know

If you are considering eyelid surgery, I offer you a few nuggets gleaned on my journey so far:

1.) Upper Blepharoplasty, for me, seems to be a breeze. Here is what I mean . . . on my left side where I've received ONLY upper blepharoplasty surgery (5 days ago, no levator repair done), there is a nice shape to the lid and beneath the brow (fat sculpting rocks, who knew?), very minimal bruising, minimal swelling, zero pain, and a super clean and neat-looking line of stitches. Seriously, I was very afraid, but I'm here to tell you, you don't need to be afraid of this procedure. Just make sure you find a qualified, board certified surgeon, like Dr. Rostami. Do your research and buy the very best you can afford. Don't be sorry.

2.) Itching may occur... Yesterday, I felt like fleas were attacking my eyelids. I texted my Doc and - thinking it was an allergic reaction and because an alternate medication wasn't possible because of allergies - I took Benadryl to try to tap down the itching response. Well, I'm not sure if it was the Benadryl that took care of the itching/reaction or if it just knocked me out so I wasn't bothered, BUT it got me through the day and then the night. Today, no Benadryl and much less itching. Maybe the itching is just a part of healing? Dunno, but I sure am glad that I had Benadryl to get me to the other side, and I'm going to keep it handy through the rest of this journey.
3.) A word about healing... from reading around, it seems that lots of ptosis repair patients get very concerned with their post-surgical results, and by results I mean the appearance of under correction of their ptosis affected eye (if only one involved) after levator advancement... But it turns out the initial appearance of under correction can be good news! Why? Well, it seems that eyes swell from the surgery, so a newly "fixed" eye will likely appear under corrected because swelling weight is holding it down. As the swelling disappears over weeks and months, the lash line will rise. So, it isn't instant, and it's going to get better.

Anyway, that's all for now. Just a bit of insight from a non-medical expert patient for the sake of other non-medical expert patients. I hope it helps someone... I am sure helped by others here who share their stories and tips.

BTW, I see my Doc to get the stitches out tomorrow ... maybe. I'll let you all know how it goes.

Stitches out! More antibiotics

Dr. Rostami removed all of my stitches today. As my brow incision is red, she asked me to continue putting antibiotic ointment on it and prescribed another 7 days of oral antibiotics (Cipro, 500 mg, 2x day). I have picked them up from the pharmacy and will start tonight.

She is really liking the brow shape, and I am. I think it will settle in really nicely.

As for my eyes, she did say my right eye (the ptosis affected one) has dropped. She isn't sure if it's just swelling or if more will have to be done to the muscle. If more needs to be done, she says the surgery is very simple. It could be done in her office on a Friday, and I could return to work on Monday, and it won't cost me any more money. Wow. Isn't it wonderful that I managed to find a doctor who is committed to a great outcome? I am blessed.

As for next steps, we just won't know for six more weeks. I have an appointment the second week of January. Until then ... we wait. Tick tock. I'll keep posting pictures, so you can see how things look as the days and weeks roll on.

After stitches out

I got my stitches out yesterday, so here is what I look like 7 days out, no stitches.
-bruising is really clearing fast and well. I continue to use the Auriderm products provided by my doctor - arnica Montana tablets 2xs daily and the post-op gel. For outings, cover up is key.
-the forehead incision is looking better than it did yesterday. The stitches are out, and I'm using antibiotics internally and externally.
-little eye continues in its rebellion but it will join the team sooner or later - whether that means time or treatment.
For all you in the US, Happy Pre-Thankgiving, and happy day to all of you elsewhere :)
Melissa

8 days post op

Thankgiving morning. Cover up over bruise.

Dog ears gone

So I had these little clumps of skin in the corners of my eyes as of yesterday morning. As of yesterday evening, they totally smoothed out. Sometimes healing is slow and sometimes it takes the turnpike! Itching of eyelids is a little annoying, but I am treating and tolerating it as part of the healing process.

Picture update

Steady as she blows.

Day 10

The healing of the brow incision continues at a pretty good clip, I think. Eyes still itchy, so the cause was definitely not the antibiotic ointment. It's just plain old healing. My eyes are still asymmetrical. Daily, I pray and think positive thoughts. Come on healing! So long swelling!

Post op Day 11

I was so hoping to be celebrating by now. Im not freaking out this morning, but I can't help but feel sad about the persistent assemetry. I know I need to wait for the swelling to go down, but I am admitting that I find myself in a daily slow dance with a persistent suitor - fear - and his arms are like ice.

Post op day 12

Back at work today. Thank you, Lord. Who knew how I would miss the routine of it all. "Normal" is so really very under rated, my friends.
Pics below represent Day 12 Post Op. My only noticible bruise is beneath my right eye. It is the one that had more work, ptosis repair, so it makes sense the bruise would linger here and not elsewhere. I am mostly able to cover it with makeup, as you will see in the pics. The lines from my stitches are also fading, and the brow level is holding up.

Post op day 13

Drinking lots of water and exercising patience ... Or trying to exercise patience and occasionally succeeding:) I've taken the last of my oral antibiotics so I'm prescription free again. Forehead incision is looking great.

Post op day 14

Two week anniversary!

Brow incision continues its healing. It looks good I think! Bruise continues fading. Patient - that's me - is continuing to practice good self care. Drinking lots of water, eating healthy food, and getting good rest. Still taking Benadryl at night to tap back itching. Ibuprofen during the day also seems to help. (You aren't supposed to take it for 2 weeks before or 1 week after surgery, but I'm past all that.)

Still celebrating the wonderful goodness of normal living! Being in isolation for a week binge watching Netflicks sounds great in theory. In practice, life in the big outside world is way more wonderful!

Things change daily

Yesterday, I was excited. Today, it looks like I took a step back. Other bloggers have noted that during the healing process, your eyes will look different every day. As such, I think this is just part of the process. I am also experiencing different sensations in my eyes... A little more tightness, some warmth... A very occasional pain... I think I'm just walking into and through different aspects of healing.

Post op Day 16

I woke up in the middle of the night with a splitting headache and a dry mouth and eyes. I drank some water, added drops to my dry eyes, and heated a neck wrap, which I placed under my neck for support. I was able to go back to sleep, but I wasn't excited to go to work. This may or may not have anything to do with anything.

Generally, the sensations in my eyes vary. Sometimes I feel tightness and sometimes heaviness. For example, I felt like I had a quarter or two taped to my Ptosis eyelid earlier today. I just think it's all about healing... Still waiting to see equalness between my eyes. It'll come right? Please, God. Amen.

Day 17 post op

Same.

More blue ... Maybe?

My eyes are dry these days. I read someplace that Omega-3s may help with dry eyes as well as inflammation. So I bought a bottle of burp less fish oil and took a dose last night. I also took some ibuprofen, moistened my eyes with eye drops, and slept with my head elevated.

I think there might be more blue visible on the ptosis side this morning... But maybe it's wishful thinking? (Note, I am no longer under any kind of vitamin or prescription limitations. Omegas and ibuprofen aren't allowed 2 weeks before or 1 week after surgery, because they cause bleeding and bruising, but this isn't a problem for me now.)

Day 20 post op

And the lid is down again! Discouraging :( Also, they are dilated differently. My two eyes have two minds.

Last night, I took just Fish oil. I tried cutting out everything else. I don't want to get to the point I can't sleep without Benadryl. Net result of fish oil alone = not great.

Day 21

Three weeks. The healing continues.

Keep the moisrIre coming

Hello friends. See pic from post op day 22. Keeping my eyes ever-moist is helping healing. So upshot, girls, get out those eye drops!

Day before compared to 22 days after

a genuine before after

Post op day 23

The sensations I'm experiencing continue to be interesting. This morning, it was tightness. I also had a (very likely unrelated) headache. I don't think ive hit " ideal" just yet as there is still some lingering unevenness, but I think things are moving in the right direction:
I like the eyebrow work.
I like my eye shape.
I like the contours.
I just need Ptosis eye to open a little bit more. Come on little eye. Like the little engine, I know you can!

Tonight, I have a party - post op day 24

so I put on a little makeup. Having a lash line and no hooding is wonderful. I'm going to have to learn to do my makeup in a whole new way since I can now shade! Yeah!! And, what about the brows? I like 'em a lot.

Still waiting for better eye symmetry, but, it will come. I've definitely decided :)

Post op day 25

Are we tired of talking about my peepers, yet? Well, that is what we do here :)

Had a great weekend. Tried to just enjoy life and to test drive my new eyes a little bit in terms of makeup. When I'm completely done with healing, I'm heading to the makeup counter for a makeover. I want to learn to make the most of these inset sapphires :)

Just kept up Mercury free, burp less fish oil by Nature Made, lunricating eyedrops, and allergy meds. Healing keeps on coming.

Hope your weekend went well :)

Day 26 post op

Just a quick snap.

Day 26 and 27 Post op

and so it goes ....

Day 28 post op

4 weeks after surgery.. What do you think?

Day 29 Post Op

Next week, I will see family. I wonder what they'll say... Last week I posted a new photo to social media and noted how many and how quickly it was liked. No one said, wow, look at your eyes! Or what did you do!!! More, nice quiet nods of general approval. Hopefully that's a good sign...

Post op day 30

A picture speaks a thousand words. Very frustrating ups and downs. Very disappointing to be arranging my hair to cover my ptosis eye, still. This is like having a deviated septum and getting nose surgery and finding things look aittle better but you still can't breath. My primary concern was always symmetry, and in spite of spending $7,000 and a month recovering, it's just not there, and today nothing else matters.

There is always make-up

Day 30 post op with makeup. I took advantage of my new brows to create a little more drama.

Post op day 31

photo update

Post op day 34

photo update

Post op day 35

Merry Christmas Eve, all. Photo update with and without makeup.

Post op 5 weeks and one day

Christmas Eve with lots of makeup. I'm experimenting.

A few thoughts...

Final analysis (unless something else happens) ... I am pleased with the results of my blethroplasty. Funny, since I didn't set out to have an eye lift at all! It just turned out that I needed one to help fix my eye unevenness, caused by my congenital eyelid ptosis and eyebrow ptosis. Nonetheless, I now have a crease and lovely shape to work with. This makes makeup fun! Also, I am pleased with my one-sided brow lift. I don't hurt anymore! Before the surgery, I always had tension in my forehead, and my muscles between my eyes felt like they were in a tight fist. No more of that! Now that the muscles on my sinking side have been "pinned up," they don't seem to need to work so hard to jack up my brow and lid and such. As a result, I have fewer headaches and less pain. This is a definite win. As far as the ptosis repair, my eyes are not entirely symmetrical, but I console myself with the fact that my vision is 100% again, and I still look much, much better than I used to (and due to the aforementioned makeup, I am able to do a pretty good job of disguising the unevenness that remains). This means I'm not afraid anymore that my face will cause me to lose career or personal opportunities, which was definitely on my mind before. In closing, I give this self improvement project an 85%. I do wish it wasn't so expensive and debt inducing, but I wouldn't have selected a lesser doctor, so it is what it is... In short, I'm glad I did it, and I'd do it again. It was with it. My best to you!

One more thing ...

I would change my rating to "Worth It," but I can't figure out how! To my doctor, I'm sorry about that! To readers, it was worth it :) My best to you.
McLean Oculoplastic Surgeon

Dr. Rostami is a capable and qualified professional. I am overall pleased with the work she did for me, and I would recommend her to others in need of a safe provider of eye-related services.

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