How to get even eyelids? (Photo)

Question

I am a 35-year-old female. I'm not sure what this problem is or how to fix it. I have had a slight extra crease in my left eye my whole life, but as I've gotten older it's become much more prominent, especially later in the day when I'm tired. I went to see an Ophthalmologist today who basically told me there is nothing wrong, but I can see eyes are clearly different.

Kenneth D. Steinsapir, MD · Answer

What your ophthalmologist is doing is explaining that he or she does not understand what they are looking at. Rather than be embarrassed by admitting to that lack of knowledge, they are say nothing is wrong when plainly there is an explanation for what is going on. On the right side (your right side) you have an normal outie eyelid fold ( antiform fold). On your left side, you have an innie eyelid fold (synform fold) (essentially no fold). The difference between the two sides is caused by an abnormal attachment of the internal structures in the left upper eyelid. The levator aponeurosis, which is the tendon that connects the muscle that opens the eyelid to the hard platform structure (tarsus) is centrally disinserted. The slipping tendon retracts into the orbit and takes with it the internal fusion where the anterior orbital septum meets the levator aponeurosis. Anterior orbital fat that helps form the upper eyelid fold lives between the septum and the levator aponeurosis. Where these structures fuse makes the upper eyelid crease. This point had also slipped. The tendon that raises the eyelid has slipped but one does not see upper eyelid ptosis due to eyebrow compensation. You can see that the left eyebrow is significantly higher than the right eyebrow. That also causes the left upper eyelid to look more hollow. Some of the upper eyelid fold volume is contributed by the anterior orbital fat and some of the volume is contributed by the fat that lives just below the eyebrow. The fix for this problem is to perform an aesthetic reconstructive surgery to repair the slipping tendon. It is identified and reattached the the superior edge of the tarsus. This is done through an anterior crease incision that will make a new eyelid crease and a much lower location such as 7.5 mm above the eyelid margin. Anterior orbital fat is repositioned so it descends to the new crease location. An anchor blepharoplasty is performed to make a new hard crease. By repairing the levator aponeurosis, generally the eyebrow will relax to a more normal position and allow the two sides to appear to be much more symmetric. Do not have filler to fill up the upper eyelid fold. This treatment will make the sub brow more full but it will not look right. Don't ask a surgeon who does not understand this anatomy to make this repair. Your eyes can be your best feature.

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.​

Sam Speron, MD, FACS · Answer

This is a common question. Every single person is asymmetric throughout their body and this includes the eyes.

Asymmetries and eyelid wrinkles can be corrected with blepharoplasty cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you. That said, even after surgery I always warn patients that there will still be asymmetry and things will not look 100% perfectly even because some asymmetries cannot be corrected unless you reposition bone, remove muscle etc. and somethings are just not worth doing.Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid surgery but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all,you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope my answer helps and if it does, please take a moment to upvote this answer on the “response”button on the top right. Have a great day!

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. You may be a candidate for a blepharoplasty procedure to balance the shape of the eyes and create a more symmetrical appearance. This minimally invasive surgery can reduce the lid droopiness over the right eye while redefining the extra crease you describe over the left. 
In some cases, fat may be repositioned around the eye to volumize where needed and create a cohesive result overall. The ultimate purpose is to contour the creasing of both eyelids to bring them into harmonious balance with each other, as well as your other facial features. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can better assess your concerns and suggest the best method for achieving your aesthetic goals.

Gurkan Kayabasoglu, MD · Answer

Hello. There is a hidden upper left eyelid ptosis. If you pay attention, you also involuntarily raise your eyebrow to compensate. Therefore, you need to have ptosis surgery on one side. You can also book an online consultation and discuss your problems with me. With all respect.

Mehryar (Ray) Taban, MD, FACS · Answer

Yes, your upper eyelid asymmetry can be improved. You likely need asymmetric upper blepharoplasty with small amount filler added to left side although more detailed evaluation is needed to determine accurately and to assess any subtle ptosis. See an expert.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question and posting an appropriate picture. You seem to be a good candidate for a small amount of Botox in the lateral portion of the brow as well as upper eyelid hyaluronic acid filler like Juvederm Volbella to address your asymmetry.  Of course it is best to have a consultation either in person or virtually.

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