Looks like I still have ptosis.
What can be done or should anything be done?
I had conjunctival muellerectomy performed by an oculoplastic surgeon exactly 2 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 still are 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 sty in my upper right eyelid.
Is it possible that this affected the appearance of my left eyelid?
Doctor:
Thank you for your question!
You submitted a question with a photo and you described in your question that you had
a conjunctival muellerectomy or Mueller muscle resection actually that was to address ptosis
performed by an oculoplastic surgeon two months prior.
And your question of course is if will there be an improvement or do you need additional
surgery.
I’m going to discuss a little bit about what the factors with ptosis surgery that
make sit challenging and I’m going to explain to you a little bit about what we do in our
practice and it should be similar to what your doctor ultimately choose to do for you.
I’ve been a practicing oculofacial plastic surgeon for 20 years and certainly I have
done a lot of ptosis surgery and 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 sugery.
There’s a muscle in the eyelid called the levator muscle and behind that muscle is a
muscle called Mueller’s muscle.
Both muscles contribute to the lifting of the eyelid.
Your doctor did a Mueller’s muscle shortening or resection or brought the two tissues.
In our practice, what we routinely during surgery is we actually have the patient open
and close their eyes both in the laying and seated position.
We 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.
This muscels are very sensitive and trying to get the ideal contour and height and symmetric
result make it uniquely challenging.
I think it is safe to assume that your doctor did something similar to that during your
surgery and was satisfied with the result.
At this point, with the photo you submitted, the left eye looks like it’s drooping like
it ptotic or drooping.
Now that being said, if someone has drooping of the eyelid after surgery, certain factors
such as swelling can contribute to that position.
Now looking at the photo you submitted, in the absence of the physical exam, there doesn’t
appear to have significant swelling at this point.
So in my practice, if someone didn’t have the optimal result whether the eyelid is too
low or too high after the surgery, if I’m comfortable with the degree of swelling not
being significant, then I’ll go back and make an enhancement or a different procedure.
In a situation like yours, I may or I would probably do a levator muscle enhancement to
try to make sure that the levator muscle which is like the word elevator to lift the eyelid,
we actually advance it to 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 an enhanced or maybe a different procedure performed in order to achieve that result.
Sometimes after a procedure, the suture, the tissue, they just separate and the eyelid
droops again.
So this isn’t in any way a judgment to the skills of your doctor.
If your doctor is an oculofacial plastic surgeon, someone who has long history of doing this
type of procedure and has appropriate training etc., there’s no one who doesn’t deal
with ptosis surgery where they need to do revision.
So I think that you need to meet with your doctor again.
I think that 3-4 month period, most of the significant swelling that would affect the
surgery is typically resolved and you can probably safely have this procedure done and
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.
I wish you the best of luck, I hope that was helpful and thank you for your question!