Man: Looks like I still have ptosis. What can be done, or should anything be done? I had conjunctival Müllerectomy performed by an ocular plastic surgeon exactly two months ago on my left eyelid. He said that I had acquired ptosis from years of wearing contact lenses. I was expecting my eyelids to be symmetrical by now, but they are still not.

Were my expectations too high? Am I healing well so far? Will it continue to improve in the coming months? I currently have a Stye on my upper right eyelid. Is it possible that this effected the appearance of my left eyelid?

Dr. Prasad: Thank you for your question. You submitted a question with a photo. You have described in your question that you had a conjunctival Müllerectomy, or Müller's muscle resection, actually, that was to address ptosis, performed by an ocular plastic surgeon two months prior.

Your question, of course, is, will there be any improvement or do you need addition surgery?

Well, I'm gonna discuss a little bit about what the factors are with ptosis surgery that makes it challenging. I will explain to you a little bit about what we do in our practice and it should be probably similar to what your doctor would ultimately choose to do for you.

I have been a practicing cosmetic ocular facial plastic surgeon for 20 years, and certainly I have done a lot of ptosis surgery. I can tell you that there are challenges with ptosis surgery that make it unique, which is why most plastic surgeons do not ever do ptosis surgery.

There's a muscle in the eyelid called the levator muscle, and behind that muscle is the muscle called Müller's muscle. Both muscles contribute to the lifting of the eyelid.

Your doctor performed a Müller's muscle shortening or resection and then brought the tissue together, and I'll tell you. In our practice, what we do routinely during surgery is, we actually have the patient open and close their eyes both in a laying and seated position. We'll actually sit the patient up. They never feel any pain or discomfort, but it gives us an opportunity to try to real time adjust the height of the eyelid.

These muscles are very sensitive and trying to get the goal of the ideal contour and height, and of course symmetry and aesthetic result, makes it uniquely challenging.

I think it's fair to assume your doctor did something similar to that during your surgery and was satisfied with the result. At this point, with the photo you submitted, that the left eye looks like it's ptotic or drooping.

That being said, when someone has a drooping of the eyelid after surgery certain factors, such as swelling, can contribute to that position. Now, looking at the photo that you submitted, and this is the absence of a physical exam, there doesn't appear to be significant swelling at this point.

So in my practice, if someone were not to get the optimal result, whether their eyelid is too low or too high after the surgery... If I'm comfortable with the degree of swelling not being significant, then I will go back and I will do an enhancement or a different procedure.

In a situation like yours, I would elect to probably do something called a levator muscle advancement to try to make sure that the muscle, the other muscle other than the Müller's muscle, the levator muscle, which is like the work elevator, to lift your eyelid, would actually advance it and try to get that eyelid contour and shape to be more symmetric with the other eye.

So I think that most likely your doctor will agree with you that the left eye does deserve to be enhanced and to have maybe a different procedure performed in order to achieve that result. Sometimes after a procedure the sutures, the tissue, they just separate and the eyelid droops again.

This isn't in any way a judgment as to the skills of your doctor. If your doctor is an ocular facial plastic surgeon, someone who has a long history of doing this type of surgery and has appropriate training, etc., there's no one who doesn't deal with ptosis surgery where they need to do revisions.

So I think you need to meet wit your doctor again. I think at the three to four month period most of significant swelling that would effect the surgery is typically resolved and you can probably safely has this procedure done.

Of course, this is in the absence of a proper physical examination. But I think that meeting with your doctor and discussing that option is something that's appropriate at this time.

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

My Eye Is Still Drooping After Ptosis Surgery: When To Consider a Revision

Dr. Amiya Prasad details the two muscles responsible for lifting the eyelid that are addressed in ptosis surgery and describes how to know when a ptosis revision is necessary.