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Female Speaker: Upper eyelid swelling after ptosis surgery. Will the shape change after the swelling goes down? Four weeks ago, I had ptosis surgery on only my right eyelid. I wanted it to look like my left. I still have swelling on my eyelid, but my appears rounder and larger than the other. Will the shape change after swelling goes down to look symmetrical or will it stay the same?

Dr. Prasad: Thank you for your question. You submitted a single photo and described in your question that you had ptosis surgery approximately four weeks earlier and that the particular eye that was operated on appears larger and more round. Your question is naturally "Will that appearance change?" Will it become more symmetric or what to anticipate? So I think that this question is a question that really has to be directed to your surgeon.

Ptosis surgery is one of those types of surgery where the predictability is sometimes tricky. In our practice, when I perform ptosis surgery, during the surgery I'll actually allow the patient to be awake. And although they won't feel anything because the area is numb, I'll actually have the patient open and close their eyes. And I'll even sit them up during the surgery. When we do this, and a lot of my ocular plastic colleagues will do this, is that we want to do several things that are critical.

One is achieve the appropriate height, the contour, the symmetry, the aesthetics, and because this muscle is very sensitive and the eyelid backbone and tissue is so delicate and can easily affected by a variety of factors, we find that that is usually the best way to predict the outcome. Of course, with every ptosis operation there is a possibility of under-correction with the eye that it's too low or over-correction when the eyelid is too high.

Now only your doctor knows what the situation was like during surgery and sometimes you over-correct because you anticipate that with a little bit of time, the eyelid will come down. That's not an unusual situation. You see the things that we don't know from your question are the factors that impact on how the surgery is done. When we do ptosis evaluation we measure something called the levator muscle function. And the levator muscle function is reflective of how strong the muscle that lifts the eyelid is. It's like the word elevator, except without the letter E.

When the muscle is weaker we actually tend to... at least I do, over-correct a little bit more because the muscle is weak and there's a tendency for the eyelid to drop down a little bit. And the opposite is true when the person has a normal levator function, I usually try to aim to make the eyes relatively symmetric during the surgery because I expect that after healing there will be some stabilization.

In the normal human population there is always about a 1 to 2 millimeter difference between the two eyes, and so aesthetically as long as you're within that range, that's usually acceptable. So I can't tell you exactly what to anticipate without that information. But I think that most likely you will find your doctor will be able to guide you as to why you look the way you do and whether or not this is a case of someone who is over-corrected and may need some enhancement.

If that's the case, the timing is also something that your doctor will help you decide. I'll tell you, in my practice I usually wait for swelling to resolve to a reasonable level, so I can actually work on tissue that isn't as swollen, so it's more predictable. But I do my enhancements on a case-by-case basis. So I think that it is certainly valid and legitimate for you to ask the question. Clearly with this photo there is a difference between the two eyes. The right eye definitely does look more open and more round.

But in the absence of this other information, it is difficult to make a prediction. I think that communicating with your doctor and making sure that you feel that your questions are answered and you are comfortable, you'll be able to move forward and do whatever is necessary. Sometimes after ptosis surgery, one thing I didn't mention, is sometimes a little massage will actually help stretch the tissue out a little bit, enough to allow for a little bit of descent. But certainly I've had patients where initially they looked a little over-corrected and then with a little bit of time, a couple of months that is, it came down to a point where it was really spot on.

So again, it's a little bit of a tricky operation and I think that most likely you did your research and found the doctor that you felt confident with. So I think you should keep the faith and maintain communication with your doctor and work with the doctor ab

Eyelid Surgery Q&A: "Will the Shape of My Eye Change After Swelling Goes Down?"

Dr. Amiya Prasad discusses the possible reasons behind under- or overcorrection of the upper eyelid during ptosis surgery, surgical techniques to avoid them, and the proper time for ptosis surgery enhancement if needed.