Eyes Appear Asymmetrical. One Eye Doesn't Barely Has a Fold. What Can I Do?

There are many consideration in an Asian blepharoplasty that are different from a caucasian one: epicanthal fold, eyelid crease, and eyelid fat extension.

A photo would be very valuable for us to determine exactly what the anatomic issue is for you. Lid crease reformation is one of the most common procedures done in the Asian population and it behoove you to seek a consultation with an Oculoplastics surgeon that has a lot of experience in this area.



If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.

During the blepharoplasty procedure there are different methods to make the eyelids look more symmetrical.  Some of which are, removal of asymmetrical fat from the puffy side, possibly removing a small strip of orbicularis oculi muscle on the fuller side, and performing ptosis repair if needed.  An asymmetrical skin excision can also be performed to give a symmetrical result.

This is a challenging question to answer without further information.  The information necessary for a proper answer would include your age, gender, and ethnicity.  Also a photograph would be very helpful.  Based on the probability of who might ask this question, I would assume you are a younger Asian female and I will answer the question making that assumption.

The epicanthal fold is a very tricky thing to operate on.  It is my opinion that epicanthal folds should be left alone unless there is a gross abnormality.  The risk of a scar-band forming in this area is high and can have permanent consequences.  The crease position and shape can be addressed with an upper blepharoplasty.  Your success, especially in the long term, will probably be higher using the open approach where an incision is made in the eyelid.  It is also possible that you have a condition known as levator ptosis.  This will affect the crease position and shape as well as cause a slight (or not so slight) lowering of the eyelid margin where it touches the eye.  You may also notice a higher eyebrow on the side where the eyelid is lower. 

Frequently the most symmetric result is obtained by doing both eyes but this can be decided in a consultation.

A proper consultation with an Oculofacial cosmetic surgeon is necessary to determine how to fix the asymmetry of your eyes and to better understand the complexity of your situation. Assuming you are Asian: generally, Asian eyes require delicate finesse with the typical epicanthal fold that lies in front of the eye so that proper rejuvenation does not mar the natural beauty of this type of eye and you get natural looking results after eyelid surgery. If you are Asian, I perform Asian Eyelid Surgery for Asian individuals who seek the “double eyelid fold” surgery, which gives the upper eyelid a visible crease when the eye is open.