Is this an upper or lower lid issue or levator? (photo)

Question

Noticing as of last year an assymmetry in my eyes, specifically when I smile: My left eye looks smaller and “squintier.” There is also significant wrinkling on the side. I can’t tell if this is excess lid skin on the upper lid or something going on with the lower lid or the musculature.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos you are a very suitable candidate for brow lift and lower upper eyelid operation, we can make a consultation for details.
Best Regards!

Edward Daniele, MD · Answer

Hi,  On the photo, you can see a combination of both. The way we measure eyelid ptosis is something called the MRD where we measure the light reflex to the lid margin. You have a slight amount of asymmetry from your left to right, which could be a slight weakness in your levator. Causes could be from long term contact wear or just weakening of the muscle. Theres also a slight amount of extra skin there, but I think what you're referring to is (squintier) is the slight ptosis. You can try Upneeq which stimulates a different muscle to open the eye further. If this improves things to your liking, then your issue is eyelid ptosis specifically.

William Portuese, MD · Answer

The decision to perform upper or eyelid surgery is made at rest, not when smiling. The primary goal for upper eyelid surgery is to remove extra skin and a small amount of fat in the inner corners. The primary goal for lower eyelid surgery is to remove fat bags, creating the puffy look. The incision for lower lids is placed on the inside of the lower lids, known as a trans-conjunctival approach.If there's any excess skin on the lower lids at rest, then a pinch technique skin excision can be performed on the lower lids, and this incision is closed with tissue glue in our practice.

Is this an upper or lower lid issue or levator? (photo)

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