I Had a Double Eyelid Surgery, Why are my Eyes Obviously Not the Same? (photo)

Question

i had a blepharoplasty / double eyelid surgery this October 19 this was my second surgery coz i want my eyes to look more bigger my first surgery was about 2years ago.. but now my left eye is bigger than left and its really obvious though its just 2weeks ago but i think there should be difference not like this this is not normal my doctor told me that it is just swollen i just have to wait but im worried that my eyes are still like this.. :'( i really need advise thank you so much

Kenneth D. Steinsapir, MD · Answer

Pipat

	I am not sure that my colleagues understand what they are seeing in your post-operative photograph.  Your surgeon has done very different things in the two eyelids!  The left upper eyelid is actually over rotated at the eyelid margin.  In the photo you are seeing the actual light colored eyelid margin.  This should not be visible.  Notice how the eyelashes are over rotated.  This is the result of the upper eyelid platform being too aggressively sutured to the levator aponeurosis-the fan shaped insertion of the levator palpebrae superioris muscle that raises the upper eyelid.  It is also possible that too much skin was removed below where the upper eyelid crease should form.  You can see that on the right side the upper eyelid is too low.  This is a compensatory effect of the over rotated left upper eyelid.  The eyelids are yoked by the brain and get the same signal to the muscle that raises the eyelid.  The left side is essentially mechanically restricted and this decreases the signal to the right side so it looks too low.

	My concern is that the left upper eyelid demonstrates ectropion from over rotation.  If you were my patient, I would want to take the eyelid apart now surgically to free up any adhesions that might be causing this over rotation.  Generally I place three sutures to force the formation of the upper eyelid crease that I can release to soften this type of issue.  However, it is unlikely that your surgeon did this.  Hopefully they will know what they did.  If the crease was formed by suture, the suture should be removed immediately.  If this does not sufficiently relax the left upper eyelid, then finger winking and eyelid massage has the power to soften the eyelid position.  Please do not let the eyelid heal this way.  Consider showing your surgeon this response.  If they want to email me with any questions regarding what they can do to help this, they can use my contact form on my website.  I will respond to them as soon as I can (lidlift dot com).

	Good luck and yes you did the right thing seeking help on Realself.com

Charles S. Lee, MD, FACS · Answer

The left eyelid has eversion of the lashes and possibly ectropion. There may be slight retraction (over-opening) that is worsening the droopiness of the right eye. I strongly suspect that you have a mild degree of preexisting droopiness on the right eye. Frequently, patients will rotate the face to "hide" the sleepier eye when taking photographs, which appears to be the case in your preop photo. 

	The left eye is better corrected sooner, than later in order to prevent permanent distortion of the eyelid cartilage. I would prefer to address the right eye as long as I'm already in there fixing the left eye. However, it would be okay to wait on the right eye. The left eye I feel as some others that it should be addressed sooner than later. Massage may help if the internal fixation sutures were not overly firm.

Philip Young, MD · Answer

Depending on how long ago you had the procedure done you might wait just a bit longer and see how much the swelling goes down.

Chase Lay, MD · Answer

Hi Pipat,

	First of all, you are still quite swollen and you'd be surprised how different you'll look in two weeks.  However, if this is what you look like after two weeks there is a problem.

	I am somewhat in agreement with Dr. Stainsapir.  I don't want to repeat everything he commented on but there are some significant asymmetries here.  Your left upper eyelid skin appears to have been sutured too aggressively and too high up on what is known at the levator muscle.  If it has been two weeks you can re-operate now but it must be now.  Otherwise you should wait for about 9 to 12 months before re-operating on the eye.

	Follow the advice of your surgeon.  If he/she can't help you I would seek the advice of an eyelid surgeon who has a lot of experience performing eyelid reconstruction.  These surgeons tend to have a better understanding of eyelid anatomy and what to do when things are scared and misplaced. . .so to speak.

	Another options is to see if you like the way your left eye looks in a few weeks.  It may be easier to match the right eye to the left one in several months.

	Best of luck

	Chase Lay, MD

Kimberly Lee, MD · Answer

Asymmetry following Asian blepharoplasty is common.  Please allow the swelling to subside before evaluating the final results.

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