Thank you for your question.
You submitted several photos with your question a close up review of your eyes with varying
degrees of the eyes being open as well as with one photo looking down.
You’re describing your question that you underwent blepharoplasty and you’re not
fully satisfied with the results.
According to what you described, your doctor has noticed there’s a 1.5 millimeter difference
between the two eyes and he suggested a Muller’s muscle resection of the right upper eyelid
to lower it down to achieve better symmetry.
You’re asking if it’s dangerous.
Well I can certainly give you some perspective from my experience.
I’m a Board-certified cosmetic surgeon.
I’m fellowship trained oculo-facial plastic and reconstructive surgeon practicing in Manhattan,
Long Island for over 20 years.
The procedure you described Muller’s muscle resection is a procedure that I’ve performed
a lot in my practice particularly for Thyroid Eye Disease or Grave’s Disease.
Just for clarification and understanding anatomy and then to address the question about safety.
We’ll go over some of the basic anatomic issues.
When somebody has Thyroid Eye Disease, the muscles that move the eye called the extraocular
muscles can become inflamed and become tight.
Amongst those muscles it’s been observed that there are – with the upper – as far
as the eyelid is concerned, there are two major muscles.
One is called the levator muscle like the word elevator and the other is Muller’s
muscle which is right behind the levator muscle.
Levator muscle accounts the majority of the movement of the eyelid but the Muller’s
muscle does account for about two millimeters of elevation.
Now it has been well known in oculoplastic surgery that Muller’s muscle when it’s
affected by Thyroid Eye Disease can actually cause tightening and an elevation.
One of the strategies is to actually evert the eyelid and excise and remove Muller’s
muscle to get the eyelid to come downward.
As far as the procedure is concerned, I think in the hands of a trained oculoplastic surgeon
most likely the risk if relatively low.
That in terms of the – when you say dangerous is it dangerous for the integrity of the eye
itself?
Is it dangerous in terms of the ability to heal or the problems with functionality of
the eyelid?
I would say in both cases it’s relatively safe.
Because it’s done on the inside of the eyelid, there is no external incision.
The area is very well vascularize so it should heal fine, the only issue sometimes is with
the foreign body feeling from the sutures et cetera that are used to close or repair
the conjunctiva or just to deal with the healing process behind the eye after this procedure
is performed.
Now, the only issue that maybe is that it may not work or it may not work completely.
You may still have retraction of the eyelid and you may not get the full correction that
you want at which point then you may need to do another procedure such as levator muscle
recession or something called a levator muscle myotomy and there are different procedures
for that purpose.
I think that you really need to have a discussion with your doctor, a detailed discussion about
the risks and benefits.
Understanding that within the normal population, a small amount of asymmetry is normal but
if this symmetry’s bothersome to you and it shows up in pictures and you just – it
really draws to your attention then – and there is the history of a thyroid related
issue, then the Muller’s muscle resection is the first line type of treatment to help
address this issue.
Sometimes when I have these consultations with patients, I’ll tell them that we can
have a plan A and we can have a plan B so that when we do the procedure, what I’ll
do is I’ll have the patient open their eyes during the procedure.
I’ll sit them up and have them look to see how symmetric they are.
If the Muller’s muscle resection does and fully accomplished that, I’ll explain to
the patient what I would probably suggest we do at the same time to maybe achieve that
certain height to try to minimize the need of a second operation.
The reality is that when it comes to eyelid position as supposed to eyelid skin you are
dealing with a lot of variables that have to do with the swelling, the anesthetic and
the healing that can affect the position that supplies for eye lever traction.
It applies to eyelid ptosis.
You always have to be prepared for some type of revision procedure if that – a need arises.
Again, meet with your doctor, get more details and see what you’re able to tolerate as
far as this procedure’s concerned.
I hope that was helpful.
I wish you the best of luck.
Thank you for your question.