Thank you for your question.
You are asking a question what is adequate time for swelling to be a contributing factor
in terms of postoperative ptosis surgery as it relates to the eyelid position.
And you’re concerned about the level of your eyelid as well as some blurred vision
and light sensitivity after undergoing ptosis surgery.
And you’re concerned that you haven’t had any improvement.
And certainly, it’s a very common concern after this type of surgery.
Of course, in the absence of more detail about the surgery and physical exam, I can share
with you my experience as a specialist.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Ptosis surgery has been a very big part of my practice.
And I have certainly a lot of experience with primary and revision ptosis surgery.
And I’ll review with you a little bit of the principles that were probably discussed
with you with your surgeon.
Now assuming you had this procedure with an oculoplastic or oculofacial plastic and reconstructive
surgeon, I’m certainly sure that you had someone who did this with great skill and
knowledge and competence.
But it is important to understand some guiding principles when we do ptosis surgery and what
the challenges are to get predictable outcomes.
Unfortunately, the eyelid muscle, the muscle called the levator muscle like the word elevator
is a muscle that is affected and is the reason for the approach to most ptosis surgeries.
Essentially, this muscle is graded as relatively weak or moderately strong or very strong.
Essentially, we have our own technical terms.
That’s how we grade the muscle.
And then we look at the level of the eyelid whether it’s mild ptosis or moderate or
severe ptosis.
Now that being said, the surgery itself, very often, I think is the situation in your case
is either an advancement of that muscle or a shortening of that muscle so that the eyelid
can be pulled upward.
Now if the eyelid is relatively weak, then swelling can push that eyelid downward because
the muscle isn’t that strong to pull the eyelid up.
Now to try to maximize the predictability of this type of surgery, we typically do this
surgery under local anesthesia essentially mostly with the patient awake.
We may give a little sedation for the local anesthetic so that they’re a little more
comfortable during that point but afterwards, we’ll actually have the patient open their
eyes during surgery.
We’ll actually sit them up and look at them to see how they look.
We try to do it quickly because swelling can quickly impact the performance of the muscle
and the level of the eyelid.
So in terms of swelling after eyelid surgery and in particular ptosis surgery, you’re
looking at several months before the swelling has resolved adequately to impact and have
an effect on the eyelid.
A lot of times, we just have to allow time to go by because the swelling between the
eyelid crease and the margin can linger.
Now certainly, there can be some evidence of improvement early on in the first few weeks
such that little subtleties can certainly change over the course of time but I’m sure
that this is a discussion you had with your doctor.
As far as the light sensitivity and blurred vision, you should speak to your doctor about
this.
The reason why I’m saying that is that even though you may not have it currently, the
optimal appearance that you’re hoping for, if that muscle is shortened then it’s possible
that your eyelid isn’t closing fully when you sleep.
And if that’s the case, then you may be dealing with some irritation or exposure.
There are other possible causes but that requires a proper examination by your doctor to see
if there’s any issue with the cornea.
The cornea is a clear part of the eye and if it gets dry or if it gets scratched, you
can have these symptoms.
So it’s very important that you see your doctor about these symptoms sooner rather
than later and not delay any more than is necessary.
So discuss your concerns with your doctor.
No one more than your doctor understands your situation preoperatively and intraoperatively.
And so, they can probably give you the best understanding of what transpired during the
surgery and if you have recollection of being asked to open or close your eyes during surgery,
then that’s also certainly helpful.
If you had the surgery under different circumstances where you’re deeply sedated or under general
anesthesia well that’s probably not relevant.
But certainly, discuss these concerns with your doctor.
I always tell my patients that the ptosis surgery, no matter how much experience and
how much we are able to try to get this ideal result during surgery, there’s always a
possibility of some overcorrection, undercorrection requiring revision so I’m sure you’ve
had that discussion as well with your doctor.
So I hope that was helpful, I wish you the best of luck and thank you for your question.