I recently encountered a young Asian woman in the office with severe congenital ptosis. The upper eyelids drooped severely, no matter how hard the patient tried to lift them. This is because the muscles were malformed at birth. She underwent a prior surgery some number of years ago elsewhere to attempt to correct this problem. A preoperative photo is displayed below:
This photo demonstrates a few specific findings:
The eyebrows are elevated as high as possible.
They eyelids are still so low that the pupils are barely visible.
The upper eyelids are featureless, e.g. they don’t have a skin fold, which is the most important feature of the Asian upper eyelid.
Given the severity of the eyelid dysfunction, coupled with the excellent brow function, a frontalis suspension surgery was proposed. In this surgery, a silicone rod is secured to the upper lid, and passed through the deep tissue up into the brow. The brow then is responsible for the lifting of the eyelid. (In fact, the brow is already responsible for any lift that this patient has; this surgery just makes the brow more efficient at it!)
When positioning the silicone rod in the lid, I pay attention to reformatting the upper lid crease. And I absolutely did not remove any tissue, because I wanted to recreate a skin fold for her.
A postoperative photo (two month postoperative) is depicted below:
As one can tell:
She has elevated eyelids (with more than 50% of the pupil visible).
She has a lid fold.
Although not depicted, she can also close her eyes normally.
The broad smile that she displayed leaving the office that day.