Releasing Eye Tension After Incisional Ptosis Correction

It has been a while since my last post.

Today’s topic is

Releasing Eye Tension After Ptosis Correction

This is a patient case study.

This patient visited us after undergoing incisional ptosis correction at another clinic, suffering from severe asymmetry and a pulling sensation (eye tension). Therefore, we decided to proceed with early revision.

If you look at the patient’s right eye (the left side of the photo), the inner corner is peaked like a mountain. In the left eye (the right side of the photo), the line at the inner corner appears kinked.

During the initial consultation at our clinic before the patient chose the other hospital, I suggested that ptosis correction was unnecessary and recommended only double eyelid surgery. Unfortunately, the patient underwent ptosis correction elsewhere. Since aesthetic judgment is subjective, diagnoses can vary between surgeons.

This is the view when the eyes are closed. There is severe sunken scarring, particularly in the inner corner (near the nose), suggesting that a significant amount of tissue was removed during the previous surgery.

Early revision is typically performed between 1 to 3 weeks post-op.

When there is eye tension due to asymmetry, correcting the line asymmetry is difficult because the original designs differ, meaning some line asymmetry may remain. Line asymmetry may require further revision later.

The goal of early revision is focused on making the pupils appear symmetrical. While one could wait 6 months, that would require a more complex procedure called ‘retraction surgery,’ which makes the process much more involved.

The purpose of early ptosis revision is to properly release the areas where the ptosis correction was performed.

This is the appearance 1 week after the early revision. The pupil symmetry looks good, doesn’t it? However, because the underlying designs are different, there is still a difference in the inner corners.

These are photos taken 3 months after the surgery.

At the 3-month mark, the pulling sensation from the ptosis correction has been alleviated, and the double eyelid asymmetry has improved. Although the designs differ when the eyes are closed, they appear similar because the fixation was changed to a weaker setting.

This is the view with eyes closed at 3 months. Patients don’t usually visit at the 3-month mark, but this patient came in because a suture used for fixation became exposed and needed removal.

Occasionally, the sutures used to create the double eyelid can become exposed. Some individuals have a constitution that pushes out foreign substances. Removing them is not a major issue; usually, medical-grade sutures are left in for life if there are no problems. Removing an exposed suture does not cause the double eyelid to unravel. The arrow points to the small area where the suture was exposed.

Since a lot of tissue had already been removed, it was difficult to make the fixation very weak, but by pulling in as much surrounding tissue as possible to flatten the area, the scars seem to be fading gradually.

In double eyelid surgery, scar improvement is possible if there is enough existing tissue left. In revision cases where tissue is lacking, improvement is often limited. Whether a scar improves after revision depends heavily on the first surgery and the surgery immediately preceding it.

In most cases, if there is a pulling sensation after ptosis correction, releasing it immediately brings relief. however, relief from tension symptoms is not 100% guaranteed. This is because if the nerves or tissues were irritated during the initial ptosis surgery, symptoms can sometimes persist for a long time.

Frequently Asked Questions

When is the best time for early correction of eyelid retraction after ptosis correction?

It is generally recommended to perform it between 1 to 3 weeks after the surgery. During this period, early correction focuses on releasing the pulled part from the ptosis correction and aligning the pupils symmetrically. If delayed beyond 6 months, an additional surgery called retraction surgery may be required, complicating the process.

Does early correction completely fix asymmetry in the double eyelid line?

No, line asymmetry may remain. Since the design of the previous surgery itself was different, early correction alone will leave line asymmetry, and a separate revision surgery will be needed later to completely correct it. The main purpose of early correction is to make the pupils appear similar.

What should I do if the fixed thread after double eyelid surgery is exposed?

You should visit the hospital to have the exposed thread removed. Occasionally, if you have a body type that pushes out foreign objects, the thread may become exposed, but removing it will not cause the double eyelid to loosen, so you don't need to worry too much.

Does revision surgery always improve existing double eyelid scars?

No, it depends on how much of the original tissue remains. If too much tissue was removed during the first surgery or the immediately preceding surgery, and there is insufficient remaining tissue, scar improvement may be difficult even with revision surgery.

Does releasing ptosis correction completely eliminate eyelid retraction symptoms?

Most cases improve, but it cannot be 100% guaranteed. If nerves or tissues were stimulated during the original ptosis correction surgery, symptoms may occasionally persist for quite a long time even if the pulled part is immediately released.