How Can Eyelid Surgery Fix Asymmetrical Eyelids?

I am 26 and have had a 'droopy' eyelid since I was born (congential ptosis?). The issue is odd however, the eye only really sags when I am overly tired. The rest of the time my other eye looks like the one with the issue because the eye with excess skin actually goes under the skin. I'm assuming only a small amount of skin is going to be removed, is this common? Is symmetry going to be the main goal? What else should I ask the surgeon I'm seeing in a week?

Doctor Answers 8

Surgery for asymmetrical eyelids

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Hard to say without photos or exam. It sounds by your description that you may have drooping, (ptosis) of the eyelid. This can be fixed in most cases. Each patient is different. Please see an experienced board certified plastic surgeon, facial plastic surgeon, or oculoplastic surgeon. they will listen to you and do an exam to see if you need a standard blepharoplasty, or an operation to raise your eyelid.  Your case may require both.  

Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Photo is key

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I would say a photo is key to see what is going on. Your eyelid position is important to determine along with the contour of your eyelids and the skin above the eyelid.

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon

Correction of eyelid asymmetry usually requires surgery on both eyelids

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You need to see a board certified plastic surgeon who specializes in occuloplastic surgery.

Since you're ptosis is only evident when you are fatigued, perfect correction may not be possible.

Usually both upper lids require surgery to achieve the best symmetry. Lifting the ptotic eyelid will create a very specific supratarsal fold-the fold of your upper lid and often there is less skin overhanging the fold after ptosis repair.

A simple upper blepharoplasty on the normal eye can estab;lish a matching fold and skin overhang.

Very tricky surgery--you need the best specialist.

An oculoplastic surgeon can repair congenital ptosis

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An oculoplastic surgeon can repair congenital ptosis. The opposite eye may also have to be adjusted slightly because of the reflex that occurs between both eyes. The muscles are tightened, and usually not much skin is removed with ptosis repair.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Congenital eyelid ptosis

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Congenital ptosis is slightly different than the common aging ptosis. It is due to weak eyelid elevating muscle. Depending on the strength of the muscle, different ptosis surgical techniques need to be used. Asymmetic in eyelid "skin" that one notices is related to the height of the eyelid at the time; not because there is actually extra skin there. Recommend discussing with an eyelid/oculoplastic specialist.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Eyelid surgery

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If you have ptosis, it whould be evaluated for the cause.  Removing excess skin or presumed excess skin may not be the answer. If your eyelid droops, you may need a ptosis repair.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Repairing ptosis of eyelids

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There are several options to correct a droopy eyelid. These include stitching the muscles of the eyelid higher, removing some of the muscle from behind the eyelid, and also connecting the muscles in your forehead to the eyelid muscles to help them move. Finally, removing some of the skin of the upper eyelid may also alleviate the droopy appearance. The type of repair done depends on the cause of the droopiness. It's hard determine the best option for you without a physical examination. Take these options with you when you visit your plastic surgeon to get an idea of the best way to repair your ptosis. Good luck!

Eyelid surgery for asymmetrical eyelids

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Excellent question.

Various disease processes can result in droopiness of the eyelids. Traditionally, eyelid ptosis has been divided into CONGENITAL and ACQUIRED. Among the congenital causes are diseases such as muscle palsies, blepharophimosis and Marcus Gunn while the acquired class includes several broad categories such as APONEUROTIC damage (something weakened OR tore the sheet connecting the upper lid lifting muscle to the lid - things like age (senile), or trauma) - this will show a higher lid fold on one side than the normal eye, MYOGENIC causes (muscle disease processes like Myasthenia gravis or others can weaken the lid lifting muscles) and NEUROGENIC causes(injury to the THIRD cranial nerve or sympathetic nerves to the eye (such as Horner's syndrome - check our the famous picture of mobster Charlie "Lucky" Luciano and look at his right eye) - can cause lid droopiness among others. To complicate matters there are several imitators of ptosis out there ( so called PSEUDOptosis). Things like dermatochalasis, a sunken eyeball on the "bad" side or a bulging eyeball on the "good" side can imitate this condition.

"THE treatment" would depend on "THE condition" you have. If your lifting muscle is either defective or its attachment is partially or completely torn, the operation, if you need one, will be chosen BOTH to maximize symmetry and to restore as much excursion of the lid across the eye. Some of the most commonly performed procedures are a modified Fasanella-Servat procedure for mild droopiness with good levator muscle function and various tightening and reinserting procedures of the aponeurosis (the ligament sheet from the levator muscle to the thin cartilage that spans the upper lid).

I would see either an oculoplastic surgeon or a plastic surgeon who does a lot of eyelids and make sure a thorough examination is done before embarking on any procedures.

I hope this was helpful.

Peter A. Aldea, MD
Memphis Plastic Surgeon

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.