Female: Desperately need to fix the problem. I have ptosis surgery to my right eye. In my first surgery, I only had the levator muscle elevated. I had revision surgery six months later to remove excess skin. In my opinion, my surgeon didn't remove enough. He also only did a partial incision with a laser on my old scar, so now I am left with pinched skin in the inner corner and a big thick white scar. Am I able to have blepharoplasty to fix this issue? If so, am I able to see a regular plastic surgeon? Or do I need to go to an oculoplastic surgeon?

Dr. Amiya Prasad: Thank you for your question. You've submitted some photos and you describe in your question that you had levator muscle surgery for ptosis and, after that procedure, you underwent a type of blepharoplasty to enhance further the appearance of the skin of the eyelid. And that in one photo with your eye looking down, you showed us the incision line, and you described the scar as being thick and another thing that you want to consider treatment. You've asked a question of whether or not to have the revision done by a plastic surgeon versus an oculoplastic surgeon. Well, first in reviewing your photos with your eyes open, it appears that the objective of making the eyelid elevated and getting relative symmetry, as well as shape and contour, appears to have been achieved. And that it is obvious that with your eyes looking down, that there is a difference in the appearance with your eyes closed.

Now the question that you have to, of course, first answer is why would you not go back to the original surgeon if the procedure has been accomplished to the point where the original issue of ptosis has been corrected? And when we measure success with ptosis, we're measuring height, contour, aesthetics, symmetry. And so, in the normal population, if the eyelids are within one to two millimeters of each other, it is considered to be normal and usually doesn't draw attention. So again, with your eyes open, it appears that you have achieved your objective. And I think that anyone who would look at your eyes would probably agree that the eyelid height, relative to the pupil, is where you would want it to be after ptosis surgery. Given that and the unique skills of an oculofacial plastic surgeon, I think that your best bet is really to continue communicating with your doctor who did the original surgery. If you are concerned about "excess skin," well, your original doctor really knows whether or not that's the case. Sometimes, the folds and the variability and appearance is not a function of excess skin, but rather a function of the skin being attached or folding in a certain way. An example is like non-incisional Asian eyelid surgery. This is a procedure where it may appear that there is overlap of skin, when actually there isn't extra skin, but rather the skin has to be attached in a way so that the eyelid crease can form. Variations of this procedure is something that is done for ptosis surgery, when appropriate.

So my first piece of advice would be is is communicate with your original oculofacial plastic surgeon. This is the doctor who knows your eye very, very well and I'm sure has reasons for doing the procedure the way that it was done. In choosing to consider revision procedures, you may also want to consider some procedures just to improve the scar quality. In our practice, we actually use a material call platelet-rich plasma, which is drawn from your own blood, to help people who have scars that are a little bit thick and we have found this to be very, very helpful in softening up scars.

Now, there was no clear indication from your question as to the timeframe. When we think of eyelid healing, whether it's skin or muscle, we have to think of six months to a year, and not just a few months. So especially in a revision surgery, an undesirable scar can change over the course of a year. So you may want to do more conservative options until considering another surgery. Again, my advise is meet with your original doctor and discuss your options, then consider second opinions if you don't feel as confident about the recommendations.

So I hope that was helpful, I wish you the best of luck, and thank you for your question.


Eyelid Ptosis Surgery Q&A

Dr. Amiya Prasad explains the factors of successful eyelid ptosis surgery, details the recovery process of upper eyelid surgery, and describes how eyelids are raised and folded surgically.