Why are my eyelids two different shapes? (Photo)

Question

I've always had asymmetrical eyelids, but lately, I've become more self-conscious about it. It feels like I have a lazy eye, even though it doesn't significantly affect my vision. I've noticed that the drooping eyelid doesn't open at the same speed as the other one, but this only happens occasionally. I’m a 29 year old female.

Kenneth D. Steinsapir, MD · Answer

The disinserting levator aponeurosis, the tendon of the upper eyelid, retracts back causing the eyelid crease to rise. As the tendon insertion slips, it also takes the preaponeurotic fat back with it. The compensatory elevation of the brow also takes some of the upper eyelid fold volume with it. Most eyelid plastic surgeons you consult will tell you things like do posterior approach ptosis surgery or that the fold can't be lowered but a blepharoplasty on the good side will fix the problem-it won't. What you need is an aesthetic eyelid reconstruction to reposition the anterior levator aponeurosis, crease lowering, and upper eyelid fold reconstruction. Posterior approach ptosis surgery, also called conjunctival Muellerectomy, will not fix this eyelid. It lacks the power to allow the brow to relax. Also be aware that during an in person consultation, you need to be assessed for potential Herring's law ptosis on the opposite side. That occurs when you only fix the eyelid with the worst ptosis and after surgery the other side relaxes down so much that the unoperated eyelid becomes obviously droopy. When this is anticipated, surgery on both upper eyelids may be recommended. I am concerned that getting the care you need could be challenging even though you live in Boston. Listen carefully to what potential surgeons are recommending.

J. Renee Booth, MD · Answer

Everyone has asymmetric facial bones. People tend to notice the differences around the eyes more than the differences in the cheeks, jaws, etc. In your case, the left brow is lower because the bone (superior orbital rim) is a bit lower on that side. If you strongly wanted to pursue a method to make the illusion of even brows, you can use brow color or microblading. For a permanent method, a direct brow lift would be the only way to even out the brows, however it would leave a thin scar just above the brow. Most people do not want a scar there and choose not to have the procedure. Other brow lifts with hidden incisions do not correct asymmetry well.

Mats Hagstrom, MD (license on probation) · Answer

All people have facial asymmetry.
This typically includes both eye sockets sitting in different positions.
Based on your picture, it looks like your right eye sits higher than the left.
And mostBased on your picture, it looks like you’re right eye sits higher than the left.
In most individuals it’s the other way around, but regardless all people have facial asymmetry.
During embryological development, the two sides of the face develop independently from each other, and eventually fuse in the midline.
Asymmetry is the norm and it is based on skeletal structure.
Your face is normal and does not require intervention.
Best,
Mats Hagstrom, MD

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