Page 218 - Read Online

Farber et al. Plast Aesthet Res 2020;7:20 I http://dx.doi.org/10.20517/2347-9264.2020.05 Page 19 of 23

Figure 27. An elderly patient demonstrates bilateral ptosis with a high lid crease on the left shown before and after tarsolevator
advancement

Postoperative management
Patients should be instructed to sleep with their head elevated and to apply cold compresses. Lubricating
eye drops or ointment should be prescribed and used liberally. Most surgeons also prescribe a topical
ointment containing antibiotics or steroids to be applied to the lid incision. Sutures are normally removed
within one week postoperatively.

OUTCOMES
Postoperative results
Although there are no randomized controlled comparison studies on ptosis repair techniques, there are
studies reviewing the revision rates of individual techniques for involutional ptosis repair [Figures 26-31].
[8]
The outcomes and techniques in these studies are highly variable . However, one consistent finding was
[14]
the higher rate of revisions in patients with more severe preoperative ptosis and fibrosis . Therefore,
patients with more severe ptosis should be counseled about this risk preoperatively. The most important
consideration is ultimately which technique is most reliable in each surgeon’s own hands.

Complications
Overcorrection or undercorrection
Rates of overcorrection and undercorrection vary on the basis of repair technique. Undercorrection is
best treated with surgical revision if the degree of asymmetry or ptosis is sufficient to warrant operative
intervention. The timing of surgical revision should allow for adequate resolution of acute postoperative
swelling, but should also occur prior to the formation of significant scarring that would make identification
of anatomic planes difficult.

If the eyelid is slightly overcorrected, as evidenced by incomplete lid closure or scleral show, this finding
can oftentimes be corrected by stretching the lid downward [Figure 32]. Traction stretching can be
performed while the patient is awake and should be initiated within the first postoperative week. If this