What kind of revision can be done for me to get the results I was hoping for?
I had upper bleph 2 weeks ago and I'm scared. I am hiding from friends & family. One eye
looks much smaller than before surgery & the other won't open over pupil yet that eye still
looks larger than other side! That side is also very blurry now. I suppose that will
be okay. I just want to know what can be done to make my eyes beautiful again? I had extra
skin I wanted removed. What revision will need to be done to make to make my eyes look
refreshed, revitalized & even?
Thank you for your question!
You submitted a question with photos stating that you had eyelid surgery about 2 weeks
ago and you asked about a revision due to your concern about the left lower eyelid looking
significantly lower than the right upper eyelid and your photo certainly reflect that appearance.
So based on your photos, you have what is commonly referred to as ptosis and ptosis
means that the upper eyelid is lower and closer to the pupil and it’s a general term but
when you talk about eyelids, it’s eyelid ptosis. Now, the question we have to ask first
is was this ptosis preexisting. In other words, during you evaluation, if you look at your
photos prior to surgery, was you eyelid on that side that low or was it a millimeter
higher and there was still asymmetry between the two eyes. It is certainly a possibility
in the absence of me not seeing your preoperative photos.
Now, if we assume that the eyes were equal and the upper eyelid were symmetric and high
just like the right upper eyelid then the question now is is this ptosis a result of
some type of injury during the surgery, is it due to a sequence of swelling and some
trauma. If that the case, then a lot of times, the ptosis can resolve on its own. We refer
to this, if there’s a lot of swelling, we call that traumatic ptosis. but if someone
has ptosis or is in the borderline, sometimes cosmetic blepharoplasty can uncover or manifest
the ptosis after surgery.
In a situation like yours, when people like you come to my practice, I’m a cosmetic
oculofacial plastic surgeon and ptosis is one of the most common procedures we do, ptosis
surgery, we will usually allow a little amount of time after the initial surgery to determine
if the eyelid height is stable. Now this time frame is based on observation during several
week gaps between visits to determine if the ptosis is any way improving during that timeframe.
If it is not improving during the first month to 2 months, then we can then move forward
with doing some time of revision surgery. What we try to do is avoid operating on tissue
that is swelling. But at the same time, having the asymmetry can be very distressing and
so we customize our approach for each individual patient and of course, we often will see when
patients come in for revision surgery from other doctors, they will often come with their
preoperative photos so we can actually make a comparison and determine what the situation
is.
So that being said, I think it is important to still communicate with your primary surgery,
the doctor who did your surgery originally. And review your photos and discuss with your
doctor what to anticipate and expect. No one knows your anatomy better than the original
operating surgeon. And if you feel that your doctor is comfortable and confident about
the ptosis and you can wait it out and waiting does not harm. Beyond the certain point, we
can probably conclude that the ptosis is not going to get better then ptosis repair will
be necessary.
Ptosis repair in our practice is performed under local anesthesia with LITE™ sedation
and what we do, we actually move the levator muscle the muscle that lifts the eyelid and
adjust it. We can actually sit the patient up during the surgery to maximize the symmetry
and make sure that gravity balances, the eyes look balanced with the gravitational aspect
being in place. It’s a more complex surgery than most general plastic surgeons are familiar
with. It’s very unique to oculoplastic or oculofacial plastic surgery. The point of
saying that is that you don’t want to rush a procedure like this. Every ptosis surgery
has a risk of needing more surgery. The eyelid can be too high, can be too low afterwards.
So, if this is a manifestation of swelling at the cellular level or at the level of the
tissue behind the eyelid from what you can see, then it can potentially get better on
its own. But I think within the first two months, you can pretty much make that determination
and again, there is no harm in waiting. You can wait much longer than that, 6 months or
longer and have the ptosis surgery performed. But seeing how much you are very concerned
and it’s been socially problematic for you, most likely, with the balance of swelling
and everything else, expediency maybe the best solution for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question!