Do I need ptosis repair? (Photo)

It is hard to tell from this photo but it seems more like fullness from eyelid skin hooding rather than ptosis. This asymmetry is likely due to some slight brow height and contour asymmetry. Depending on examination of the area, you can consider removing more skin from the more heavy side with a blepharoplasty. Silent sinus syndrome is possible, but unlikely, and can be assessed with formal examination. Typically, the eye looks more sunken in position and smaller which doesn't seem to be the case in the picture.