A woman had incisional blepharoplasty plus ptosis repair. However, she is not satisfied with the results. She wants to know if she is having surgical complications.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, observed from the photos she submitted that her right eye appears to have several folds of skin on the upper eyelid and it appears that the right eye was the one which had ptosis surgery. He also observed that the right eye is more elevated compared to the previous photo.

Mueller’s Resection Surgery to elevate the eyelid is a standard operation done for ptosis. Its advantage is avoiding the anterior approach to elevate the eyelid approximately 2 millimeters. The removal of a thin strip of skin may have been adequate at the time of surgery, but sometimes the connection between the eyelid skin and levator muscle necessary to create an eyelid crease loosens or separates. This results in multiple folds in the eyelid.

Ptosis surgery is very sensitive to factors that occur intra-operatively and post-operatively than can result in some variability. In his practice, Dr. Prasad makes the best efforts to maximize the predictability. When Dr. Prasad does ptosis surgery, he actually lets his patients open and close their eyes during the surgery. They don’t feel anything but they can cooperate so he can adjust the eyelid height and contour precisely. He also lets the patient sit up during the surgery to make sure that he can get maximal symmetry. As a general rule of thumb, if the eyelid height is within 2 millimeters of symmetry between the two eyes, aesthetically it doesn’t make much of a difference. Depending on the time frame since her surgery, this woman may want to consider observation because sometimes swelling can have an impact on the eyelid height.

As far as the multiple eyelid creases are concerned, Dr. Prasad has successfully been able to restore the crease using a non-incisional method. If the eyes are closed, a person can actually assess if there is excess skin. Most of the time, the multiple folds are not because of excess skin. To recreate a crease using the non-incisional technique, Dr. Prasad makes some fixed entry points from the outside and connecting skin and orbicularis muscle to the levator muscle. He has been able to help a lot of his patients to get that ideal crease even if the crease wasn’t well defined during excisional surgery.

Dr. Prasad suggests that this woman maintain some faith and communication with her doctor. As long as this doctor was open and communicating with her, revision surgery may ultimately be best performed by her surgeon. She can certainly get additional opinions, but in general, it’s always good to have the first surgeon who’s a specialist in this area do the revision surgery. The original surgeon knows your anatomy and what they were dealing with from the first surgery.

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