Surgical and/or non-surgical (preferred) treatment for asymmetrical eyelids? (Photo)

Question

25y (f) super asymmetrical eyelids. One seems to show more lid & the other more hooded. I had a consult with a place that specializes in lasers/injections & was told my eyebrow muscle is what’s causing the drooping & that botox can fix it. I want to know what my treatment options are to make my eyes more symmetrical. non-surgical is preferred but ultimately, I’d like to understand what is actually achievable

C. Blake Perry, MD · Answer

You asymmetry is due to a slight droop of your left upper eyelid. When the eyelid droops it makes the eyelid looker longer (increased tarsal platform show). Often the brow compensates for the droopy eyelid by pulling up which only makes the asymmetry worse. This is fixed by raising the eyelid which can be done surgically or in some instances with medication (eye drops). Best to see an eyelid expert.

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

Kenneth D. Steinsapir, MD · Answer

This is not caused by your eyebrow muscle. (Try not to get care from people who do not know what they are talking about.) You have bilateral central levator disinsertion ptosis. Perhaps the eyelids have always like this or perhaps this had progressively gotten worse over time. Both are possible. You have a classic innie eyelid with no fold. The fat volume needed to have a fold comes from a bit of the fat the comes from the thin fat pad just below the eyebrow and pre-aponeurotic fat, which is also known as anterior orbital fat. The pre-aponeurotic fat retracts into the orbit with the disinserting central levator aponeurosis removing this fat from contributing to the fold. The heavy eyelid sends a signal to the eyebrow to lift the eyebrows to compensate for the heavy eyelids. The forehead muscles lift the eyebrows. Weakening these muscles with Botox will worsen your upper eyelid ptosis. A detailed clinical assessment would determine that mobility of the pre-aponeurotic fat and the likelihood of Herring's law ptosis (That is a phenomena where just one eyelid is corrected and the other, apparently less ptotic eyelid becomes more heavy). I suspect you need surgery on both eyelids. The only real non-surgical treatment for this is Upneeq drops but most find this expensive and not always helpful. Your eyes can be your best feature.

Mark L. Mazow, MD, FACS · Answer

Thank you for your question and photos. This is asymmetrical ptosis which usually responds best to surgery. You should schedule an appointment with an ASOPRS affiliated Oculoplastic surgeon for and in person exam and consultation for an accurate diagnosis and customized treatment plan. Best of luck.

Surgical and/or non-surgical (preferred) treatment for asymmetrical eyelids? (Photo)

Answers (4)

Answer: This is ptosis

Answer: This is ptosis

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Everything you need to know about Eyelid Surgery

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Surgical and/or non-surgical (preferred) treatment for asymmetrical eyelids? (Photo)

Answers (4)

Answer: This is ptosis

Answer: This is ptosis

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.