Plastic surgery or Botox? I've came to the conclusion that every picture I take, my eye will be almost closed (Photos)

I've always thought this was called a lazy eye, but every time a smile, or sometimes even when I don't my left eye is dramatically smaller than my right, I'm left handed so not sure if that has anything to do with it. What can I do to fix this?

Doctor Answers 11

Eye Gets Smaller When You Smile

Many people feel that BOTH of there eyes get smaller when they smile in photos.  That problem can be treated with a small amount of Botox given to the lower eyelids (by an experienced Botox doc).  However you seem to have a very different problem.First, it is important to say that a definite diagnosis can only be made after an examination with special attention to how your face moves.  However, with the information at hand I would say that most likely you have something called aberrant regeneration of the facial nerve.  That means that the "wires got crossed"  when your brain tells you face to smile, it also accidentally sends a signal to your eyelid muscles on one side.  That problem usually occurs in people who have had a Bell's Palsy in the past.  Did you?  If that is the case then this problem can often be improved with Botox.  However this is a very advanced treatment and should only be done by a physician experienced in treating this type of a problem.If you have not had a Bell's Palsy in the past then it is very important that you get an evaluation by a Neurologist, Neuro-ophthalmologist, or Oculoplastic Surgeon.  Aberrant regeneration of the facial nerve can be the sign of something pressing on the nerve, if you haven't had a Bell's Palsy in the past. Once again, I am making these suggestions based on limited information.  You should be evaluated in person by a doctor to see if you even have aberrant regeneration of the nerve.  Then you can go from there.  

Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews


Hello, thank you for your question.  I definitely see asymmetry in your facial muscles when you smile.  I would suggest having a complete examination by either a facial plastic or oculoplastic surgeon.  I would first want to rule out any medical causes for the asymmetry before treating the cosmetic issue.

Jessica Lattman, MD
New York Oculoplastic Surgeon
4.8 out of 5 stars 31 reviews

A BOTOX® injection from a highly-trained injector will likely address asymmetry.

I would not recommend plastic surgery for your situation. In your case, a small, careful injection of BOTOX® around your left eye by a cosmetic surgeon who’s experienced with facial procedures can help to correct your asymmetry. However, I suggest you also bring this issue up with your physician, as the asymmetry you’re experiencing may indicate past trauma to the facial nerves. You’ll want a thorough medical check up to make sure your health is in good shape overall.

Gordon Andan, MD
New York General Surgeon
4.9 out of 5 stars 12 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Laser Resurfacing, Clear+Brilliant, Micropen, Viva, Ultherapy/Thermage

If youre eye is small and closed looking you may need a surgery to open this (ptosis).  I suggest you speak to an eye specialist.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

Facial asymmetry

Hello, and thanks for your question. I'd recommend getting evaluated by a physician to rule out a medical problem prior to addressing your facial asymmetry, which can likely be minimized with Botox. I recommend an in-person consultation with a well-trained dermatologist or plastic surgeon. Best of luck, Dr. Frucht. 

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Smile assymetry

It is difficult to tell exactly from the few photographs. But it appears that you may have had a Bells palsey or some facial nerve issue at some point in your life. Your smile causing a closure or almost spasm of the eyelid is from the facial nerve regenerating to the wrong muscles. You need to see an oculoplastic or facial plastic specialist to figure it out exactly. But Botox in the right places can be very helpful. It has nothing to do with you being left handed.

Byron A. Long, MD
Marietta Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Eye closure with smiling

The closing of your eye with smiling maybe related to a condition know as synkinesis. It can be caused by any injury to the facial nerve and this could have happened when you were a child. This can be treated with Botox injection. I recommend you see an experienced injector, first for a diagnosis, and then for treatment.

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 58 reviews

Botox can help

Botox can help eye asymmetry and is a good start.It needs an evaluation to see where it can be placed in order to help.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 19 reviews

Smaller Eye

Thank you for sharing your case and photos.  I can definitely see what you mean when you say your right eye appears smaller when smiling.  This type of condition is best evaluated in person when all of the movements of the face can be examined.  A full history is also helpful.

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 31 reviews

Eye closes when smiling

A photo when you are not smiling would be helpful. If your eyes are much more symmetric when you are not smiling, then low dose botox injections may help. Did you ever have a Bell's Palsy on the left side? This type of problem is commonly seen after that condition.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 167 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.