What are ways to treat ptosis caused by blepharoplasty done a month ago? (photo)

Though uncommon, ptosis (droop in the upper eyelid) can arise after a blepharoplasty procedure.

Immediately after upper eyelid blepharoplasty it is common for patients to experience some degree of ptosis. This is due to the edema (swelling) or even haematoma that occurs as a result of the surgery. There can be swelling of both the eyelid skin or the elevator mechanism. If the levator mechanism (that opens the eyelid) was identified and preserved during the surgery, then there is no cause for alarm as the ptosis would be temporary and would resolve once the swelling subsides. This usually subsides within a week or two. In certain patients, the swelling may persist for longer but should resolve within a month.

The levator mechanism fuses with the orbital septum and this septum is usually opened to remove fat from the upper eyelid. During the surgery to remove the upper eyelid fat, there is a chance, though uncommon, that the levator may be damaged leading to ptosis. If this was observed during the surgery, it should be repaired. In cases where there is mild or moderate ptosis, there is a chance that it may resolve spontaneously without any intervention. I would usually wait for a period of 3 months before deciding on an exploration. Severe ptosis with the interference of the visual axis would require earlier exploration and repair of the levator mechanism.

Do speak with your surgeon first as he has the best knowledge on what transpired during the first surgery and would probably know the appropriate treatment.

Hope this helps and all the best to a speedy recovery!

Hi Regina, thanks for the question and the post-op photo.

There are several possible causes for ptosis that occur after upper blepharoplasty. I would start by comparing with the pre-op photo to see if there was any pre-existing ptosis and how much it has worsened.

The most common cause is usually swelling and internal bruising (blood clots) that may be affecting the function of the muscles that open the eye. If this is the case, then the ptosis will gradually resolve after 2-3 months. Occasionally scar tissue may form (adhesions) and this may require surgical correction.

Another possible cause is damage to the muscle or its attachments. If this is the case then the ptosis will not improve after a period of observation, and surgical correction is needed. A high crease (high skin-levator attachment) may sometimes interfere with levator muscle function and cause ptosis, this may require surgery to reset the fold lower.

To summarise, although there are many possible causes, it is important to wait until swelling has sufficiently subsided (at least 2-3 months), before deciding whether any surgical intervention is required.