I am going to see an eye surgeon in two weeks but I wanted to have an idea what to ask before I go. I am 26, I was told by my mother that my right eye drooped when I was younger. Now it appears to be my left eye, but when I pull the right eye down a bit and it folds over the eye brow, it appears to be lower then the left eye. Is my problem a ptosis or extra skin? Should I mention this to my doctor or see what he says first? It is more noticeable when I am tired.
Eyelid Ptosis or Extra Skin?
Doctor Answers 18
Ptosis of the Eye
I agree, your left eye does appear to be ptotic. It is best to see an occuloplastic surgeon to have this evaluated and treated. Ptosis surgery can be tricky so make sure your surgeon does this operation frequently.
Asymmetric eyes - orbital dystopia
Often, asymmetry of the eyes is not due to ptosis, but due to orbital dystopia. That is a different "set" of the eyeball within the bone. One eyeball is literally deeper in the bone than the other.
In your case, it appears that the right eye "bulges" more. This causes a chain reaction. Often lower eyelid fat is more visible, there is more white showing below the pigmented portion of the eye, and the eye appears "bigger". The lid creases also appear different, since there is a different shaped eyeball pushing on them from behind.
This circumstance cannot, under most circumstances be corrected. It can only be camouflaged, or be made to appear less prominent.
I personally do not believe you have ptosis alone, but definitely appear to have one eye that is deeper set than the other.
There are many methods for camouflaging eye asymmetry, from asymmetric eyelid lifts to ptosis repairs to asymmetric browlifts to an asymmetrically performed superficial cheeklift, minimal incision (USIC).
A patient must first understand that these are all not curative procedures, but designed to camouflage the orbital dystopia.
The attached paper shows three patients who had deliberate alteration of eye shape to reduce (camouflage) the appearance of a prominent globe.
Asymmetry is the answer
Looking at your picture, I see several interesting things.
First both lower lids are a bit droopy, but right more so than left. Note increased scleral (the white of the eye), especially laterally. Consideration to a lower lid tightening and repositioning procedure should be entertained.
Next, the upper lids seem about equal, but the left side has a deeper fold, and it may be due to your brows (there is asymmetry present).
I would also agree with the other doctors.
So what to ask? Ask for a complete exam and recommendations. Tell him your concerns and goals.
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The higher position of your left upper eyelid crease is very suggestive of ptosis. One of the most common findings in ptosis is elevation of the lid crease. In many cases, ptosis is bilateral. If the left eye alone is corrected, there is potential for the ptosis in the right eye to be unmasked. I would recommend an ASOPRS trained occuloplastic surgeon.
Ptosis vs Extra Skin vs Orbital Asymetry
Asymmetry of Underlying Facial Bones
Your pictures suggest that your primary problem is related to asymmetry of your underlying facial bones. In your case, you’re right superior orbital rim sets at a lower level than the opposite side. This is commonly referred to as “orbital dystopia”. When this occurs, the eyelid soft tissue is secondarily effected with resultant eyelid asymmetry.
I would not recommend treatment for this type of mild deformity because of the risk benefit ratio. When the potential for improvement relative to the complication rate is minimal this is not a risk worth taking.
There are a variety of causes of orbital asymmetry. It may be related to the boney orbit, the eyelid or the eyebrow. In most cases of mild asymmetry there’s some asymmetry of the bones surrounding the eye. This cannot be treated without major surgery. If you continue to have concerns about your asymmetry it’s appropriate to consult a board certified plastic surgeon.
Eyelid asymmetry is actually a very hard judgement to make without doing sophisticated measurements. Even eyelid ptosis and drooping of the eyelid can be hard to diagnose without accurate measurements. At a glance the left eyelid seems normal and the right eyelid seems to have a slight excess of upper eyelid skin and a tendency towards lateral bowing in the outer lower 1/3 of the lower eyelid. I do not see any obvious ptosis of the upper eyelids.
If the right eyebrow was lifted ever so slightly I think both upper eyelids would look symmetrical and the creases would be at the same level.
Eyelid Ptosis or Extra Skin
If one has eyelid ptosis, one has drooping of eyelids below the limbus of the eyelid normally within 2mm. If you have true eyelid ptosis which droops down to your upper or middle then you should have both of them corrected simultaneously for an optimal result. These are completely different operative procedures.
You may have ptosis of the right eyebrow
From looking at your picture, it seems to me that you may have asymmetry of your upper eyelids due to unilateral ptosis of the right eyebrow. I do see drooping of the right upper eyelid compared to the left. However, if you should lift the right eyebrow, and look again, both upper eyelids may look more symmetrical. That is something that you should ask your doctor.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.