Uneven Eyelids After Blepharoplasty

I am three weeks today post-op from upper/lower blepharoplasty, outside incisions. There has been no change in my eye size difference, one being bigger than the other. It has been this way since day of surgery. My left upper eyelid is noticeably bigger than my right. Is it still swelling at this point, or will I likely need a revision?

Doctor Answers 17

You have pre-existing asymmetries, but also looks like asymmetric incision

You have pre-existing asymmetries that are accentuating the post-surgical differences. However, in your eyes-closed post-op view, it appears that that is a distinct asymmetry in the distance between your upper eyelid margin and the incision. The distance is greater in your left eye (right side of the picture). At this point, I think it is best to wait and let all of the tissues settle and swelling resolve for several months before having additional surgery. Good luck with your recovery.

New York Plastic Surgeon
4.9 out of 5 stars 72 reviews

Couple points from your photos

There are a couple things in your photo I noticed.

1. Your eyelid crease incision on the left is slightly higher than the right. This difference may be non noticeable after full healing in three months

2. Your brow on the right is a little lower that then left. Obviously nothing was done during surgery which was on your eyelids. However as their irregularities are corrected this brow ptosis can become more noticeable. If you lift your right brow to the level of the left, see if that improves things

3. You are in the early phases of healing. You need to give it a solid 3 - 4 months. 

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon
4.9 out of 5 stars 7 reviews

What was done?

You look like an attractive woman in her 20's. Preoperatively I see bilateral lower lid, congenital, ectropion but with asymmetry. Upper lids had good position with no excess skin. Brows are in good position.

Postoperatively I see bilateral lower lid ectropian but now with upper lid ptosis, sagging which may be due to swelling.

Whatever was done to the lower lids wasn't enough. What you needed was a canthopexy with muscle plication. This would have corrected the lower lid issue. I would not have operated on the upper lids.

Wait 6 months and if there's still an issue take it up with another surgeon.

Orbital dystopia

Of course you are quite early arfter surgery and should wait before making any decisions on the final outcome.

However, your eyes are asymmetric. Your left eye appears more prominent and higher. This is a result of the eyeball in the eye bone socket, and is not affected at all by surgery. So that asymmetry will always be there, and cannot be corrected by blepharoplasty of any type.

There are certain tricks that can be used to camouflage the appearance of orbital dystopia, however the relationship of the eyeball with the bony socket is not easily changeable.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 136 reviews

At 3 weeks blepharoplasty post-op, swelling is definitely still playing a role

At 3 weeks post-op, swelling is definitely still playing a role.  It will be some time before your post-operative results can be carefully assessed for the need for any revision surgery. 

I suggest that you keep in close contact with your surgeon so that he/she can walk you through this expected recovery process and address any problems down the road should that become necessary.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 17 reviews

You see result of Blepharoplasty in 3 months.


I see what you are talking about.  You may need a revision blepharoplasty in 6 months, but probably not.  Minor asymmetries can be temporary.  I am more concerned about the new lines in your lower lids.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Allow full healing to take place

Even though it has been only three weeks postoperative for upper and lower blepharoplasty, there is still some swelling left in the eyelids. A formal decision cannot be made at this point between the asymmetry on the eyelids. Asymmetry on the eyelids is a natural phenomenon, which can be either made better or worse with blepharoplasty surgery. The goal with blepharoplasty is to make the eyelids look more symmetrical, even if they are asymmetrical in the preop condition. No revision surgery is needed for at least three to four months after the original surgery.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Lid assymmetric pre op - Blepharoplasty

I agree with those surgeons noting the asymmetry of your eyes preoperatively. This may affect incision placement.  As time goes by this should not be a big factor.


Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.5 out of 5 stars 34 reviews

Best to allow yourself to heal after Blepharoplasty

I see that you have a difference in the height of your fold. This could be due to many reasons. Waiting could be helpful to allow yourself to heal.

Many times, this can allow your eyes to even out if there is any residual swelling contributing to the difference. If there is a persistence of this difference after 3-6 months you could ask your doctor what he thought could rectify this issue.

If there is a difference at this later time, you would have to ask yourself which eyelid you liked better. This would then allow your doctor to have a better idea as to which eye or both he would need to approach to fix the difference.

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.9 out of 5 stars 64 reviews

Time will help some of these issues but not others

Dear Daisy,

We like to say that if you tell the patient before surgery it is an explanation but if you tell them after surgery, its sounds like an excuse.

Your photos are helpful but it would be even more interesting to also have the before pictures. I agree with Dr. Moellenken that you have facial asymmetry, almost every one does. In your case the left eye sits higher in the face than the right eye. This is a surprisingly common situation when one looks for this. This asymmetry existed before surgery. However, it is the surgeon's burden to point these issues out prior to surgery.

However, you seem to have difference between the two sides that go beyond this basic asymmetry. The crease height, where the upper eyelid incision is placed, seems to be higher on the left side than the right. This may account for more visibility or apparent length of the left upper eyelid platform. Also although the right canthal angle is lower on the right side than the left, the right lower eyelid seems to bow downward more that the left lower eyelid.

One thing that is definitely true is that things get better in time. While some of the issues may not change much over time, enough will that you may or may not feel that you would benefit from a revisional surgery. I would recommend and I think most surgeons would agree that you should heal from this initial surgery 6 to 12 months before considering a revisional procedure.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

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.