Name: Jordan R. Conger, MD
Rating: 5

Eyelid Surgery

Ptosis Surgery

Brow Lift

Chemical Peel

Botox

Good morning,
To answer your question directly, yes. With uneven eyebrows, application of botox or neurotoxin to the frontalis muscle in the forehead can help to drop the eyebrow on the higher side to match the lower side. However, this is not an exact science and asymmetries may still remain. 
An important question, however, is why do you have brow asymmetry. May times, one is lifting the eyebrow to try and compensate for eyelid ptosis (or droopy eyelids). Ptosis is when the eyelid position is low. Imagine taking a light and flashing it at your eyes. You will see a light reflex in the middle of your pupil. The distance between that light and the eyelid margin (area where eyelashes are coming out) is called the margin to reflex distance 1 (MRD1). When that distance is small (the eyelid margin is close to the center of the pupil), you have some degree of eyelid ptosis. Ptosis can be mild, moderate, or severe. If the eyelid ptosis or droop is bad enough, the eyelid can start to block the superior part of your vision in that eye. To try and prevent this, the body uses its forehead muscles to lift the droopy eyelids, but an unwanted side effect is lifting of the eyebrows. With all of this, there can be asymmetry. 
Now, back to the application of botox to improve symmetry. This can be done, but again there may still be asymmetries. One additional concern is that if you take away the forehead muscles, your brain cannot compensate for the droopy eyelids anymore and one may start to notice eyelid droop or ptosis and a blockage of the superior visual field. 
Sometimes, fixing eyelid ptosis is actually the right answer. As always, an in person consultation is best to determine what is the right intervention for you. 
I hope this helps.

I always had uneven eyebrows but I feel like they're worse than when I was a kid.(20yo female)

Can I fix my uneven eyebrows without surgery? (Photo)

Good morning, 
This is a great question, and one that I get asked about a lot. Ptosis is when the eyelid position is low. Imagine taking a light and flashing it at your eyes. You will see a light reflex in the middle of your pupil. The distance between that light and the eyelid margin (area where eyelashes are coming out) is called the margin to reflex distance 1 (MRD1). When that distance is small (the eyelid margin is close to the center of the pupil), you have some degree of eyelid ptosis. Ptosis can be mild, moderate, or severe, and the treatment options depend on the individual findings. Blepharoptosis levator resect surgery is a way to tighten the muscle inside the eyelid that is responsible for opening the eyelid (levator muscle) to raise the resting position of the eyelid margin (increase the distance between the center of the pupil and the eyelid margin, or increase MRD1). 
Separately, one can also have heavy upper eyelids. This can be from numerous causes, but most often I see excess skin on the upper eyelids contributing to the heaviness. Additionally, one can also have a degree of eyebrow ptosis. If the eyebrow position is low, this adds extra weight to the eyelids and further causes the heavy appearance. For the heavy eyelids, an upper eyelid blepharoplasty will excess the excess skin (and accumulating fat) to help sculpt and refresh the area. At the same time, doing a brow lift may be helpful to further remove any weight on the eyelids. 
Depending on your individual needs, a surgeon may recommend doing any combination of the above surgeries (blepharoplasty, levator muscle tightening surgery, or brow ptosis repair). Each intervention addresses a different component of the heavy eyelids. Of course, an in person evaluation is best to determine what is best for you.
I hope this helps.

Hello, I am a 57 year old female, interested in treatment options to repair my weighted eyelids. I’m trying to understand the difference between Blepharoplasty, and the repair of blepharoptosis levator resect. Are they one and the same or two separate procedures? From my research it would seem that they both do the same thing. Is it advisable to do one over the other, or is the levator resect part of a blepharoplasty procedure? Would the end results be equal? What would be my best option?

Upper eyelid surgery to repair heavy eyelids? (Photo)

Good morning,
I get this question a lot, and hopefully this information will be helpful for you. Under eye bags can become apparent as we get older because our anatomy continue to change as we age. The relative position of fat, skin, bones, cheeks, and ligaments all play a role in the appearance of under eye bags, and each person has a unique combination of these elements. 
There are both surgical and non surgical options to address under eye bags, but all interventions carry risks and these must be balanced with the possible benefits of the intervention. In general, non-surgical options include filler injections or fat transfer. These options work by helping to add volume to certain areas to help blend the transition between the lower eyelid and cheek. While these options have the benefit of being less invasive, they care risks including lumps/bumps, discoloration (blueish hue to the eyelid), and inflammation. They also may need to be repeated every few years for lasting results. 
A surgical option for lower eyelid bags is a lower eyelid blepharoplasty. Specifically, a transconjunctival approach, which is from inside the eyelid and is scarless. With this approach, fat can be subtracted or translocated to help address any hollows or excesses in fat. 
As always, an in person consultation would be best to address your individual concerns.
I hope this helps.

I’m 19 years old, average weight. I probably don’t get enough sleep but I do think I am hydrated.

I have these weird indent bags under my eyes that won’t seem to go away. What do you suggest? (Photo)

Good morning,
This is a great question, and one that I get asked about a lot. Ptosis is when the eyelid position is low. Imagine taking a light and flashing it at your eyes. You will see a light reflex in the middle of your pupil. The distance between that light and the eyelid margin (area where eyelashes are coming out) is called the margin to reflex distance 1 (MRD1). When that distance is small (the eyelid margin is close to the center of the pupil), you have some degree of eyelid ptosis. Ptosis can be mild, moderate, or severe, and the treatment options depend on the individual findings. 
Alternatively, you can also have eyelid asymmetry from other things such as excess skin on the surface of the eye, differences in fat distribution in the eyelid causing relative differences in hollows, or you can have differences in the way the eyelid skin folds. The treatment options depend on a case by case basis. An in person consultation is always best to determine what is the right treatment.
I hope this helps.

I’ll be 31 years old in a month and I was wondering if I have Ptosis ? I also can see triple eyelid since the beginning of the year.

I can see triple eyelid - Do I have ptosis? (photos)

Good morning,
I hear this a lot with patients who are concerned about the appearance of lower eyelid skin. The location of the lines can determine which treatment option is best for you. If the lines are on the outside area of the lower eyelid/lateral canthus, then botox or neurotoxin may be able to relax the orbicularis muscle that is causing the dynamic wrinkles. However, if the lines are more central or towards the tear trough area, then a chemical peel (such as TCA) or a laser (CO2 resurfacing) may address your concerns. Finally, one other option to consider is surgery, which would include a transconjunctival lower eyelid blepharoplasty with a skin pinch to address any fat malposition in the eyelid and the excess skin on the anterior surface of the eyelid. As always, an in person consultation would be best to address your individual concerns. 
I hope this helps.

Hi I have lines under the lower eyes can chemical peel help? I have silikon under the eyes. I'm not interested in thread lift. I had juvederm yesterday in the tear trough but she only injected the lower part which isn't much of an improvement she fill in little bit. Then told me to massage the area so it could go on evenly. Not interested with microneedling neither. Had it done and it was shortlived paid too much for only 4 months Can fat transfer improve?

Lines under the eyes - can a chemical peel help?

Good morning,
I can understand your concern, however, remember that most people are asymmetric. If your goal is to improve symmetry, you can consider a surgical option called a lower eyelid blepharoplasty via a transconjunctival approach (scarless, inside your eyelid). This can remove some of the excess fat or reposition fat to help improve symmetry. As always, an in person consultation is the best way to address your particular concerns. 
I hope this helps.

Female, age 28. Uneven eye bags, puffy on right, sunken on left. Options? (photos)

Good morning!
It is possible to continue to get botox or dysport treatments while on blood thinners. One would carry an extra risk of bruising and swelling. Fillers are more invasive and again will likely lead to more bruising and swelling and therefore are higher risk. 
I hope this helps.

Is it possible to continue to get Botox and dysport treatments if you are required to take prescription blood thinners that can’t be stopped prior to treatment? What about fillers while on blood thinners? Thank you.

Botox and blood thinners

Good morning and happy holidays!
I can understand how this can be a frustrating situation. There are different options for you in terms of improving symmetry and reducing the appearance of the puffiness in the lower eyelids. As you want a permanent solution, a surgical option may give you the longest lasting results. Your concerns may be addressed by performing a transconjunctival (scarless) lower eyelid blepharoplasty to excise or reposition the lower eyelid fat. There are other non surgical options including filler, but these may not be as long lasting and also carry other complications. 
I hope this helps!

I've had uneven under eye bag/lines since I was young. I've noticed them to be more pronounced in my late twenties. I have always been self conscious of how they look when I smile and would like to improve the appearance of them permanently.

30 yr old with asymmetrical under eye bags (Photo)

Good morning,
Ptosis repair can be tricky, especially if it is your 3rd+ surgery. Every time you do surgery it can create more scar tissue and make subsequent surgery more challenging. That being said, doing surgery to correct the above is still possible, but it is important to have an expectation that thing still might not be perfect/completely symmetrical. You may want to consider seeing an oculoplastic surgeon for future repairs given the complexity of the situation. 
I hope this helps!

I have had 2 failed surgeries in the last 2 years. The first surgery was feb of 2021 in which the surgery was performed on the anterior side of my right eyelid with little to no success, so I had my second surgery January of 2022 but this time on the inside of my eyelid and had no success. I got a second opinion, but would it be wise to get another surgery in 2023 opinion to correct the asymmetry.

Should I do a 3rd ptosis surgery to correct the asymmetry? (photos)

Good morning! 
As you can probably understand, this is not a straight forward issue to correct, but not impossible. I see two issues, one being asymmetry in eyelid position and the second being asymmetric upper eyelid sulcus hollow (area between eyelid and eyebrow). The first may be able to be addressed with more ptosis repair, the second by either filler or bringing your orbital fat forward to address the sulcus hollow on the left. 
As always, in person evaluation is best.
I hope this helps!

I am 48 years old. I had internal ptosis repair to my right eye about eight years ago. I had an external ptosis repair to my left eye and blephoraplasty to both eyes one year ago. Since the left ptosis repair, I’ve had two corrective surgeries to my left eye and one corrective repair to my right eye (all within the last year). I’m still assymetrical and wonder if it’s possible to fix the original misshaping of my right eye by the original surgeon or if I have any other options.

Ptosis Repair Symmetry Questions (Photo)

Jordan R. Conger, MD

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Jordan R. Conger, MD

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