Ptosis repair, blethroplasty, and one-sided browlift

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!

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.

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 :)