During my oculoplastics training, one of my mentors once told me that if I wanted perfect ptosis results, I should never take on eyelid ptosis cases. It sounded a bit extreme at the time, but with experience, I have learned that there was wisdom in his statement.
Ptosis surgery is, without a doubt, the most unpredictable operation we perform as oculoplastic surgeons. Although it is not the most challenging technically, the results, at times, can be pretty frustrating. As a surgeon, I may operate flawlessly and feel very satisfied with the result at the end of the procedure, only to see the eyelid droop a week later.
The main issue with ptosis repair is the many factors influencing the final outcome. The cause of the ptosis, patient’s age, amount of postoperative swelling, and tissue response to the surgical trauma are just a few factors determining whether the surgery will be successful. Additionally, the type of approach (anterior vs. posterior) and the kind of anesthesia utilized can also influence the outcome. You can understand why ptosis repair is challenging for the oculoplastic surgeon.
Expect one surgery but prepare for two.
With all this said, it is clear that ptosis surgery is not a perfect science. It brings to mind another word of advice my mentor offered me: Why promise your patients one surgery (referring to ptosis) if they may need two? He meant that ptosis surgery is the oculoplastic procedure that most commonly requires a touchup. Touchups are relatively infrequent in my practice but, when necessary, most are for ptosis surgery patients. The touchup rate for ptosis patients is close to 10%, which is relatively high for an oculoplastic procedure. Therefore, although I aim for perfection on the first operation, I find it wise always to prepare my ptosis patients for a second intervention.
What happens if I need a touchup after droopy eyelid surgery?
First, waiting at least three months from the first ptosis operation is wise before proceeding with the touchup intervention. I say this because I have seen eyelids raise five weeks after the procedure when I had thought a touchup unavoidable. Therefore, the first rule is to wait for swelling to go down before deciding on a second operation.
If the eyelid position is undesirable three months after the surgery, the patient will require a touchup. My policy regarding reintervention for ptosis repair is not to charge my patients the surgeon fee. They must, however, be responsible for the facility and anesthesia fee (if done under sedation). I usually charge a surgeon fee if the eyelid droops a year after the first operation.
If my patient is happy, I am happy.
Whether one operation is sufficient or a reintervention is necessary, I am there for my patients until they are satisfied with the outcome. Ptosis surgery is challenging, but it is also quite rewarding. Achieving a good result improves the patient’s vision and self-esteem. I continue to strive for perfection in my ptosis patients because if my patients are happy, then I am happy.
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