You asked:
Upper eyelid swelling after ptosis surgery.
Will the shape change after the swelling goes down?
4 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 eye appears rounder and larger than the other.
Will the shape change after the swelling goes down to look symmetrical or will it stay the
same?
Thank you for your question.
You submitted a single photo and describing your question that you had ptosis surgery
approximately 4 weeks earlier and that this particular eye that was operated on appear
larger and more round.
And 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 were the predictability are 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.
And when we do this and a lot of my oculoplastic colleagues will do this, is that we wanted
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 are so delicate
and can easily be affected by a variety of factors.
We find that that is usually the best way to predict the outcome.
And of course with every ptosis operation there is a possibility of under-correction
when the eyelid is too low or over-correction when the eyelid is too high.
Now, only your doctor knows what situation was like during the 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’s reflective of how strong the muscle that lifts the eyelid.
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’s weak and there’s a tendency for the eyelid to drop down a little
bit.
And the opposite is true, when a 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’ll be some stabilization.
In the normal human population there is always about a 1-2mm 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 that 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 those other information it is difficult
to make a prediction.
I think that communicating with your doctor and making sure that your questions will be
answered and that you are comfortable you’ll be able to move forward and do whatever is
necessary.
Sometime after ptosis surgery, one thing I didn’t mention is sometimes a little bit
massage will actually help stretch the tissue out a little bit enough to allow for a little
bit of decent.
But certainly I’ve had patients were initially they looked 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 that you should keep the faith and maintain communication with your doctor
and work with the doctor about moving forward with any other adjustments that may be required
later on.
So I hope that was helpful.
I wish you the best of luck and thank you for your question.