Why is scarless (inside eyelid) usually not preferred for ptosis repair?

I favor internal ptosis surgery for mild to moderate eyelid ptosis because it gives better, more predictable result, not just that it avoids a scar. See following video. There are some surgeons who still only do external ptosis surgery. You can visit asoprs.org.  You are welcome to do skype consultation too.

BBLdoll2015 thank you for your question. An in person consultation is necessary to determine your best course of action.   First of all it is very important to understand neither internal ( inside ) or external ( outside ) is scarless.  Internal does have a scar on the inside , conjunctiva and surrounding tissue; external has the scar hidden in the normal eyelid crease. This internal scar can cause irritation and  contour irregularities. While  the majority of my patients have an external approach, an internal approach has  its calling. I may utilize an internal approach:young childrenno excess skinminimal amount of ptosisnever had eyelid surgery External approachexcess skin to be removedprior eyelid surgeryimproved contour and height adjustment ( in my hands)contouring excess fat simultaneouslyLook for an Ocular Plastic surgeon who will be familiar with all the techniques.

Both the internal and external approaches work well.  If someone has no extra skin, and just ptosis, it is usually done internally to avoid any scar.  If you have extra skin to come off - you can do an internal ptosis repair and external skin excision, or just do everything from  the outside.  So the main issue here is whether or not you have skin to be removed.  If you do, you will have an external incision. 

Thank you for your question.  I favor an internal approach for mild to moderate ptosis repair.  However, each surgeon has there preferred method, and many have great reproducible success using the external approach.  Best wishes.  

There is some debate among surgeons regarding the proper approach for Ptosis repair -- there is no debate for me, however.  I believe that external ptosis repair is superior and is the only form of this surgery i perform.  You mention external scarring but there is scarring and alteration of the internal structures of the eyelid with the "scarless" method, or mullerectomy.  Others may disagree, but my results for almost 10 years speak for my opinion.  No matter what method is chosen, Ptosis surgery is challenging in every single patient, and it is extremely difficult to achieve perfect symmetry so I am hopeful you will have realistic expectations. Best of luck to you.

Muellerectomy ptosis repair (inside the eyelid) approach does not work on everyone. It is not simply a matter of what the doctor prefers. Based on testing in the office (sometimes with a drop), it can be seen if that technique would work. If the patient is not a candidate, the external (skin) method is used. As you can see, it is not based on who wants to do it but more so on whether it would work with you.