Your eyelid problem looks like ptosis, with eyebrow position possibly compensating for it, but probably natural asymmetry
Thank you for your question. Your question with the photos you submitted is that your right eyebrow arch is very different from your left side, and you’re asking is it because of the drooping of the right upper eyelid. Your follow-up question is whether you can fix both. I can give you some guidance with the absence of a physical exam, but the photos you submitted are certainly very good and helpful. I can explain to you how I approach this problem in my practice every day for someone like yourself.
A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice for over 20 years in Manhattan and Long Island and dealing with complex and cosmetic issues around the eyes is an area I work a lot in. I think your question has a lot of logic to it.
I will first talk about a little bit of terminology. When referring to the right upper eyelid being lower compared to the left upper eyelid, this is a condition called ptosis. Ptosis means droop, and in the case of eyelid drooping, it’s eyelid ptosis. It is within a normal range to have an eyelid slightly lower than the other eyelid, as long as it is within 1-2 millimeters where most people don’t really recognize it.in your situation, you are clearly noticing it and there is certainly a difference. Whether or not it is justifiable to do something about it, you have to understand the risks and benefits of performing a ptosis procedure.
When you talk about the arch of your brows, you are probably on the right track. In my practice, when people have acquired ptosis or age-related ptosis, as their eyelids droop more, they tend to raise their eyebrows as an unconscious reflex. What they don’t realize is that their eyelids are getting lower and lower, their brain is actually activating whatever muscles they can to try to open the eyes so that they can see better. Very often, people come in with horizontal forehead lines. With that concern about the lines, and I’ve seen many patients who went to a dermatologist to treat the lines across the forehead and not realizing that it was a compensatory mechanism for drooping eyelids. The doctor injected Botox™, relaxed their forehead and then they were upset because they have all this extra skin over their eyes, but that’s a different topic altogether.
I think with the photos you submitted, your eyebrow asymmetry is probably more associated with bone structure. The human face is not perfectly symmetric - there’s one side that is always more prominent than the other, and it can affect the shape and position of the eyebrows, and it’s extremely common. These anatomic issues you have identified very well are not usually related. In other words, the eyebrow arch is not necessarily because of the eyelid droop, but this requires a physical examination. In a physical examination, I actually relax the eyebrow where I’m putting the hand on the forehead to see how the eyelid position changes. There are a lot of things we do to evaluate eyelids and eyebrows that can’t be done with photos alone.
That said, I would recommend you meet with a qualified experienced specialist, someone who really understands eyelids and eyebrow position. Typically this would be an oculoplastic or oculofacial plastic surgeon. Learn about your options. Figure out if the eyelid droop is significant enough for you to pursue treatment.
When we perform ptosis surgery in our office, we do this under local anesthesia with LITE™ sedation. We have the patient open and close their eyes during surgery, and sit them up during surgery. It’s a very dynamic process. That is something to be factored in because your goal is to achieve a certain level of symmetry, but with that comes a set of risks and benefits you have to understand before you pursue this type of option. I hope that was helpful, I wish you the best of luck and thank you for your question!
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The majority of people have some degree of asymmetry in the face. Sometimes people can have arched brows because they have lid ptosis. From the pictures, it seems that your right lid may be higher in an effort to compensate for right greater than left lid ptosis. It is important to be evaluated by your doctor to ensure you get the appropriate intervention.
Ptosis and brow position
When an eyelid droops, there may be reflex contraction of the frontalis (forehead muscle) - and this may produce asymmetry of the eyebrow position. I believe that repair of the muscle in the right upper lid - ptosis/ levator repair - will eliminate the reflex elevation of the right eyebrow. Examination with measurements of eyelid movement would be very helpful to determine precisely what surgery you would need. I would suggest evaluation by an Oculoplastic Surgeon in your area. Best wishes with your decision.