Options for Correcting Asymmetry After Lower Blepharoplasty?

I had lower Blepharoplasty (with external incisions) 4 1/2 months ago. It appears that some skin was removed only from the left side, so now my left lower lid is higher, and my right eye looks rounder and bigger. I didn't have any asymmetry before. I don't have any bags anymore, just wrinkles, and a remaining small malar mound or festoon on the left cheekbone. I'm 55 with good, thick, smooth skin, and no other really objectionable wrinkles or problems.

Doctor Answers 12

Options are available to attempt to make the eyelids more symmetrical

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The eyelids themselves are naturally asymmetrical on nearly every patient. Unfortunately, your asymmetry is probably accentuated from the surgery that you had. Festoons are almost impossible to get rid of since they are not part of the eyelid complex and are located more on the malar cheek pad area. Options are available to attempt to make the eyelids more symmetrical and include different placement of incisions, removal of asymmetrical fat and/or canthoplasty. Check with a reputable surgeon who has lots of experience in this area.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

More skin removal for rounder eye

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The lower eyelid that is "higher" has had less skin retraction that the one that is "lower and rounder" more skin retraction. This can be improved with non surgical approaches and if considerable possibly a minor revision. It is unlikely that skin was removed only from one eyelid and not the other. Talk to your doc about your options.

Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.5 out of 5 stars 45 reviews

Correcting asymmetry from Blepharoplasty can be difficult

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The best thing to do is to discuss your situation while looking at the preop photos together with your surgeon. Anytime an incision is made on the lower eyelid for blepharoplasty, there is a chance that scarring will pull the lid down, even if the procedure was performed correctly. Early in the postoperative period, this can often be corrected with massage. However, since you are 4 1/2 months out from surgery, it will probably not help. Small changes can usually be corrected with a small surgery called a canthoplasty if needed. Be sure to go over your pictures with your surgeon. Good luck.

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 reviews

It's complicated but not impossible to fix

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Although it is difficult to determine what is going on without pictures some things we can say.

First, removal of skin does not elevate the lid. If too much is removed it will actually pull the lid down due to scarring. Typically on a few millimeters of skin is removed.

Did both eyes have the same appearance 2 weeks after surgery? If they did the right eye's canthopexy stitch may have ruptured. If not then did your surgeon do a canthopexy on the left and not the right? Questions for him/her.

The festoon is a pain. Massage will help. Sometimes a small, very small amount of steroid can help.

You need to have a long conversation with your surgeon. Don't leave until everything has been explained to your complete understanding.

Need a good examination with operative records present

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Your surgeon will be in the best position to answer this question. For a lower eyelid blepharoplasty, typically very little skin is actually removed. There are many things that can cause an asymmetry of the lower lids including pre-existing laxity. It would be important to view your pre-op photos and measurements.

At this point massage may be of some benefit stroking across the lid and then stretching the lower lid laterally. If there is any scarring of the lid, and if it is minor it can be helped by this gentle massage. Ask your surgeon for advice on massage for now and a surgical correction in the future if it does not respond spontaneously. If there is roundness in the corner of your it is possible that a suspension suture, placed at the time of surgery has ruptured.

There are a lot of possible solutions to your problem, but it is impossible to know without an examination and a knowledge of you exact operative procedure.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Please attache a pre and post pictures

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you have a problem that is not easy to discuss without pictures,Pre and post surgery picture will help a lot. you may need a revision surgery but you need to understand that lower eyelid does not have much support and this should by a experinced plastic surgeon.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Lowering a lower eyelid is exceedingly difficult.

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Dear Sueesquisite

This is highly precious real estate that you are describing. The challange in improving these types of asymmetries is that the analysis of the problem is often beyond the scope of the surgeon's ability to understand what you are describing. Their brains may glaze over when you are descrbing your concerns unless by training and by practice, they are comfortable dealing with these types of issues ( a very rare thing). The ethical surgeon may simply tell you that there is nothing that can be done, or that you look great and you are dwelling on very minor issues that no one else will notice.

The key is finding a doctor who will carefully and nonjudgementally listen to your concerns, examine you and then detail precisely what the issues are is sufficient detail that it is clear they understand what you are talking about and then have a precise plan to address these issues.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Options exist

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Dear Sue,
It sounds as if skin was removed from the right eye not the left. Unless a lid suspension was added to the left, which would explain that eyelid being higher. You may need to have a lid suspension or canthopexy performed on the right lower lid to symmetrize the lid positions. Speak to your surgeon and please look at your pre surgery photos. Some of your asymmetry may have been present before surgery and gone unnoticed by you. At any rate, your surgeon should be able to offer some reassurance, advice and options for correction if needed. Good luck!

Sounds like you need a sophisticated revision.

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To Sueesquisite,

Hi! Haven't I answered a question of yours before? All I can tell from your description is that you are not happy and that there are anatomical problems.

I suggest you go see a board certified plastic surgeon who does a lot of eyelids. Listen to his plan. Ask to see before and after pictures. Get more than one opinion. Revisional eyelid surgery can be tricky.

But I think you can have a good outcome.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

A canthoplasty may be required for correction

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I could tell you more if I saw your pictures.

If the right lid is lower and the right eye looks larger, then it is most likely that more skin was removed from the right eye. This would pull the right eyelid down and expose more of the right eye.

The fact that you still have excess cheek or malar skin on the left also supports the conclusion that more skin was taken from the right eye.

A canthopexy (tightening of the supporting ligament of the lower eyelid) can pull the right lid up.

However, the right side will appear tighter and you may need a canthopexy and some further skin excision on the left for symmetry.

This is all guesswork because I have not seen your photos.

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.