I have one eye bigger than the other; what can I do? (Photos)

Thank you for your question. You’re 20-years-old and submitted a single photo of a close up of your eyes. You went to several doctors before your teens about the unevenness of your two eyes, and they explained that your vision was normal and you didn’t need surgery. Now at age of 20, you are asking about how to make your eyelids look more even.

I can certainly give you my opinion based on the limited photos you submitted. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. As a cosmetic oculofacial plastic surgeon, I do a lot of procedures to help people have more even-looking eyes. I can give you some guidance about the terminology related to your situation, the basis for delaying any procedures, and what your options are at this point.

When I look at your photo, I note that the right upper eyelid is lower than the left upper eyelid. Now the term for an eyelid that’s low is ptosis, meaning drooping - if we refer to eyelids, we call it eyelid ptosis. In a situation where someone is born with it, which appears to be the case for you, we refer to it as congenital ptosis. Congenital ptosis means the muscle called the levator muscle, or the levator palpebrae superioris muscle, didn’t fully develop so it doesn’t contract or relax like a normal muscle.



When we perform a ptosis evaluation, we look at the level and degree of ptosis and at the muscle function. Before the age of 6, ptosis has to be monitored to ensure vision develops appropriately. If ptosis is blocking vision, or minimizing or disproportionately reducing vision in one eye, then that eye can have permanent vision loss which we call amblyopia.



What your doctors were able to establish through proper ophthalmologic examination was your vision wasn’t affected, so they advised to defer surgery which I think is very reasonable. With this type of surgery, if you can wait until your face has grown and your face has developed more, then that’s ideal. However, if there is a vision issue and visual development is in question, then you do a procedure to lift the eyelid.



At the age of 20, you now have the opportunity to have a ptosis operation. What we would do in our practice with someone like yourself is first decide what kind of ptosis operation is necessary with a proper examination. There are two types of surgery: one is where the muscle is shortened to get the eyelid to open, and one where the muscle is bypassed called a frontalis sling. After the evaluation, we figure out what operation would be ideal. What is good with dealing with someone who is older is we can get their cooperation. Ptosis surgery is deceptively complex that requires optimizing the shape, the height, the contour and the symmetry. What we do routinely in our practice  is we actually sit someone up during surgery so the staff and I look together to make sure the eyes look good, balanced, and bright - that type of finesse maximizes the success and outcome. However, there’s always a percentage of patients who might get an overcorrection where the eyelids are too open, or undercorrection where the eyelids are too low.



You have to get a proper examination and evaluation, and understand what the best procedure is at this stage. Understanding that the muscle is not normally a functioning muscle is something to accept, so you go in understanding that your eyelid can look symmetric, but usually in the primary gaze when you are looking at somebody, and sometimes poor levator muscle function will make you raise your eyebrows to engage the muscles needed to keep that eye open. Again, this is without examination, so there are some details that can’t be determined to make more recommendations. In summary, you have congenital ptosis, so have an evaluation typically with an oculoplastic surgeon or oculofacial plastic surgeon who specializes in plastic surgery of the eyelids and face, and learn about your options. I hope that was helpful, I wish you the best of luck and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Thank you for your question. I suggest that you consult with a board certified facial plastic surgeon to explore ways to adjust your eyelids. For example, the Blepharoplasty (or eyelid surgery) procedure can correct eyelid drooping issues that may cause your eyes to seem asymmetrical. Please provide better pictures as well so that we can delve into more detail in our assessments. Thank you. 



Best wishes,

You have ptosis.  See an oculoplastic surgeon who can evaluate the eyelid muscles and determine what surgery would be best to elevate your lid.