Ptosis Surgery Story: Correcting Severe Eye Asymmetry

"I had a weird dream that my double eyelids had come undone"

Hello, I’m Park Sung-hyuk, the chief director of Noon Noon Plastic Surgery.

Usually, when people say "sleepy eyes," they mean eyes that simply look tired. But in some cases, the ability to open the eyes is so significantly reduced that it makes everyday life difficult.

The story I’m introducing today is the recovery story of a ptosis surgery patient in their 60s, a Korean American who came to a plastic surgery clinic in Gangnam from California. This patient decided on surgery after only a video consultation with me, and even through the screen, the ptosis in the left eye looked very severe. I strongly emphasized,

"It’s hard to guarantee symmetry, and we need to consider the possibility of revision surgery, so you’ll need to stay in Korea for at least two weeks."

This is the story of a patient who wanted not just to look prettier, but to change the world they see through eye correction surgery.

Severe asymmetry, and an extreme functional difference in levator function: 10mm vs 14mm

When I actually met the patient after they arrived in Korea, the condition was even more serious than expected. The right pupil was about 50% visible, but the left was less than 40% visible, making the field of vision very uncomfortable.

The patient’s appearance with severe asymmetry (before surgery)

But even more serious than that was the very large difference in the strength of the eyelid-opening muscles on the left and right sides.

The strength of eyelid opening can be assessed by measuring how far the eyelashes move when looking alternately up and down.

The appearance of a test for upper eyelid levator muscle function

In plastic surgery textbooks, this test is called the "Levator function test" or "Berke's method."

• Right (Rt): 14mm (the lower limit of the normal range)

• Left (Lt): 8mm (markedly below normal)

These numbers were the results of the patient’s eyelid-opening strength test. When the functional difference between the left and right sides is this large, symmetry is hard to guarantee. Even though they had come from far away, I gave the patient an honest diagnosis rather than false hope.

"I can’t guarantee symmetry. You should consider it a success if about 60% of the black part of the eye is visible.

Would you still like to proceed with the surgery?"

The patient was deeply disappointed, but still trusted me and decided to go ahead with the surgery regardless of the ptosis surgery cost.

A patient in their 60s whose field of vision is blocked by sleepy eyes and severe ptosis (eyes open and eyes closed)

High-difficulty eye correction surgery, and results beyond expectations and a miracle

There is always tension in the operating room. Especially in this kind of asymmetric eye correction with a large difference in function between both sides, it becomes a matter of 0.5mm.

The patient had asymmetry even when younger, but said the difference between the left and right sides increased with age. Thinking about that, I could picture age-related or degenerative ptosis, where the muscles that open the eyes loosen as they detach from the tarsal plate.

When the connection between the levator muscle and the tarsal plate loosens with age (the white dotted area), the eyes become sleepy

(Source: link)

And I imagine that the left upper eyelid levator muscle may have undergone more fatty degeneration than the right.

Image training while imagining the patient’s condition helps improve surgical success

But something surprising happened during surgery. After carefully dissecting the left levator muscle, which I had thought would have almost no function, and releasing the adhesions that were restricting movement, the muscle function turned out to be better than expected.

"At this rate, we can raise it more!"

While showing the patient a mirror during surgery and discussing it together, I raised the target. Beyond the original goal of 60% pupil exposure, I precisely completed the eye correction with a final target of 80% pupil exposure.

Another example of checking eye symmetry during surgery while performing eye correction

In fact, eye correction surgery at Gangnam plastic surgery clinics is known for sitting the patient up during surgery, having them open their eyes, and then checking the shape and discussing it with the doctor. When I mentioned this while exchanging ideas with an American colleague, he shook his head and said,

"You guys are crazy"

"I had a nightmare that my double eyelids had come undone" - an episode after ptosis surgery

From the very first video consultation, I strongly told the patient to keep at least two weeks open in their schedule in case an early revision might be needed. But the result was so successful that revision surgery was unnecessary. Thanks to that, they were able to enjoy Korea fully, meeting relatives and traveling around after a long time.

Before-and-after treatment of sleepy eyes with severe asymmetry

What stayed with me was what the patient said with a smile when they came for the final check before leaving the country.

"Director, last night I had a weird dream that all my double eyelids had come undone.

When I looked in the mirror, it turned out so well that I guess I was nervous it might go back to how it was."

That must have shown how desperately they wanted to escape the asymmetry. After two weeks of tension, the patient returned to the United States with a bright smile.

In difficult cases, 'experience' matters

If you are worried about severe ptosis or eye asymmetry, you will probably visit several clinics for consultations. Sweet words like "it will definitely look beautiful" may sound nice, but medicine is never a field that can guarantee 100% results.

That is why, more than hearing confident promises you want to hear, it is more important during the preparation process for surgery to carefully examine how much your eye function (Levator function) is objectively reduced, and which eye is the dominant eye. You should also look for a clinic with experience handling the many anatomical variations and physical variables that can arise during surgery.

The more difficult the case, the more honest diagnosis and dedicated surgery create a patient’s smile.