One eye is higher than the other. What can I do? (Photo)

Eye asymmetry can be a complex problem. Need personal evaluation to determine the cause of eye asymmetry. There are nonsurgical and surgical options for improvement.

Hi Gem
You have given a very limited image which cannot substitute for a face to face consultation, as you know. Nonetheless the eyebrow and upper lid crease look symmetrical whilst the left lid 'shelf' (pre-tarsal show) seems longer than the right. This may be a left upper lid blepharoptosis, but because the left eye itself seems lower than the right (lower pupillary light reflex) I suspect the whole of the left eye is low. The lower lid is appropriate to the eye, therefore the left lower lid is also low. I think you have a vertical orbital dystopia - the whole of the left orbit is low. Its a natural asymmetry. A craniofacial or orbital - oculoplastic surgeon can give you your options. None are easy and all based upon appearance change where we always seek to minimise risk. 
Seek face to face advice always, and a few measurements will help you determine the details. There are no simple solutions and its worth noting that small personal differences in facial balance are an endearing reminder of individuality.
good luck

Jonathan Britto, plastic and craniofacial surgeon, London

Facial and eye asymmetry is a reason many people have BOTOX, in order to try and even out the most apparent asymmetries. Often the underlying cause is a facial and orbital bony asymmetry or even an eye size asymmetry if one eye is more short sighted than the other. Indeed there are many causes and each patients cause can be different so you require an assessment by an oculoplastic surgeon.Thank you for your photo which shows one brow lower than the other. It may be possible to even out the eyebrow heights and hence the appearance of the eyes using BOTOX but it depends on the relative strengths of the various muscles acting around the eyes, which can only be assessed clinically.

It would be very difficult to give an accurate assessment without n in person examination. Eye asymmetry is a very sensitive case and a photo of the eyes may seem to alter these due to different angles at which the photo was taken, the lighting, or the current eye position during the photo. Your best course of action would be to schedule an appointment with a board certified plastic surgeon for an in person examination and a detailed discussion of your surgical options.

From your picture it looks like you may have orbital asymmetry. Which is very common. No one has 100% symmetrical eyelids.There are many causes of droopy eyelid which could be determined during an in person consultation where we would go over the best treatments available. For more information visit our website, we have helped thousands of patients with ptosis correction. Make sure you see an oculoplastic surgeon who specializes in the eyes.

Botox wears off in 3 months or so. It's unlikely to be the cause of any issues now.Sometimes using Botox to help with brow asymmetry reveals other asymmetries.Ptosis repair or even retrobulbar fat (expert level stuff) may help but it seems the right globe is further back and higher up that the left. An in person consult would help. You may need some surgery on the orbit (expert level stuff) to get the most symmtric post op result in the fewest surgical sittings. The right sequence of steps is good to think out long before you start.

From the picture it looks like there may be a slight ptosis of the right upper eyelid.  Although ptosis can be caused from Botox accidentally migrating to the levator muscle (the muscle that elevates the eyelid) it is typically a temporary effect.  I have never seen or heard of a permanent ptosis being caused by Botox, but I suppose anything is possible in the world of medicine.  I do agree that the brow looks slightly lower on the right-hand side compared to the left, however all of us have varying degrees of asymmetry and it is very difficult if not impossible to try to make the two sides perfectly symmetric.  Although seeing an ophthalmologist can be a great start not all ophthalmologist are comfortable treating ptosis of the eyelid or brow.  I would recommend finding a facial plastic surgeon, plastic surgeon, or oculoplastic surgeon in your area and discussing with them in greater detail the available options to correct ptosis and brow depression.  I hope this helps, good luck!!