Would ptosis or eyelid surgery help correct this? (Photos)

Question

I have symmetric eyes and I am wondering if this is ptosis? My eyes appear asymmetric in pictures, with my left eye sometimes appearing smaller when I smile, and it has begun to really annoy me. I think the issue is with the lower lid of one of my eyes, as my tear ducts don't seem to align (left duct looks higher). Is this ptosis? If not, what could it be? Would ptosis or eyelid surgery help correct this? I do wear contacts, if that helps.

Kenneth D. Steinsapir, MD · Answer

Your left face and right face are slightly different. Consequently, the left eye socket including the cheek is a little higher than the right side. That means that your left eye is a little higher than the right eye. Do not get talked into having a plastic floor sled placed on the right side to raise the right eye. Yes there are doctors who may offer this but it will be a terrible mistake. I have seen many patients after these well meaning surgeries. They are never right. I fix them by removing the implant. You do have a small left upper eyelid ptosis. Most ptosis surgeons operate on larger amounts of ptosis and tell patients that surgery is accurate plus or minus 1 mm. Plus or minus 1 mm is 2 mm. That level of accuracy means that you will never be happy with that result. I am in the business of doing cosmetic eyelid surgery and often address 1/2 mm of ptosis. It can be done but very few surgeons offer this level of work. A detailed personal assessment is needed. Don't accept a Skype consultation. That means the surgeon does not put their hands on your eyelids which is critical to assess what is going on.

Jeffrey Joseph, MD, FACS · Answer

Thanks for the question.   Although best evaluated in person, it doesn’t appear that you have ptosis significant enough to correct.   Best to be seen by someone who does ptosis surgery, so that  a thorough exam may be done.

Deborah Kessler Hudak, MD, MHA · Answer

As an oculoplastics specialist (expert and surgeon of eyelid disorders), after examining your photos, I feel certain you have a very mild ptosis of the one eye.  The amount of ptosis is small, and is within normal limits to have this amount of asymmetry between the eyes. Likewise, everyone's right side of the face is not perfectly symmetric with the left side.  Yours is certainly within the normal range of asymmetry (and a beautiful face it is!)  
For now, I would suggest you use over-the-counter Lumify eye-whitening eyedrops (used for red eye) in the left eye with the droopier upper lid.  The active ingredient of Lumify (which costs about $15-$20 for a bottle that will last months) is brimonidine, which has as a side effect a slight lifting of the lid edge!  That is because it is an alpha-agonist, which works on the Mueller's muscles responsible for the first 2-3 mm of lid lift, in addition to its main action on the blood vessels of the mucous membranes to constrict them (without causing significant dryness like most other eye-whitening drops).
You should seek the attention of an oculoplastics specialist if the ptosis worsens as the years go by.  Only by examining you and taking various measurements (like Lid Function, which is excursion distance from downgaze to upgaze) can a physician determine the underlying cause of your ptosis....which (again) is not severe enough at this time to justify surgical intervention.  In other words, surgery could cause more harm than good, given the small degree of ptosis you have.

Would ptosis or eyelid surgery help correct this? (Photos)

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Would ptosis or eyelid surgery help correct this? (Photos)

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