What is the Best Way to Fix Uneven Eyelids?

Question

I am an asian male whose right eye has no crease, while my left eye has quite a high crease. It looks very unbalanced when looked up close. I have noticed this problem since I was a little kid. Is it possible to make it uneven?

Brian K. Machida, MD, FACS · Answer

Your condition can be corrected with an eyelid procedure. If this has been present since birth, you may have ptosis which is causing the problem. It's best to see a qualified surgeon for evaluation.

James R. Gordon, MD, FACS, FAAO · Answer

Very good question. It is quite common for people of all ethnicities to have asymmetric eyelids with varying crease height. There are several techniques to change a crease location based on the cause of the asymmetry. Consultation with a board-certified cosmetic eyelid surgery specialist (oculoplastic surgeon) will allow the physician to determine the precise cause of your problem and recommend you the plan of treatment. Good luck.

Charles S. Lee, MD, FACS · Answer

The most common causes for an very asymmetric crease is uneven eyelid muscle strength on the two eyes. A double eyelid operation can correct this but you need a careful preoperative exam to prevent any surprises as after surgery.

Kenneth D. Steinsapir, MD · Answer

There is no replacement for an actual consultation.  It is important to find a surgeon who actually is accomplished in performing this surgery.  Generally this will be someone who devotes a good deal of their practice to performing eyelid and eyelid reconstructive surgery.  The surgeon's ethnic identity is less important than their skills, training, and experience.

	What you are describing is a situation where one eyelid has a crease and a double fold but the fold is held high with a large amount of eyelid platform show.  The other eyelid does not have a crease and is a single fold eyelid. Generally, the crease forms with attachments between the levator aponeurosis and the skin.  This defines a double fold.  When these attachments are not present, the crease and double fold are not present.  Double fold surgery is a type of specialized anchor blepharoplasty.  In is incumbent upon the surgeon to precisely measure where the crease should be and to expose the levator aponeurosis.  Non-oculoplastic surgeons are generally not properly trained to identify these tissue planes.

	Additionally, I believe that you are describing  the presence of a compensatory brow lift that may be caused by upper eyelid ptosis.  This might account for some of the marked asymmetry between the two eyelids.  This question would be immediately resolved with access to your photographs or more ideally a personal consultation.  I would encourage you to carefully assess the credentials of your surgeon.  Regarding the setting for surgery, it is essential that you are awake for this surgery because the surgeon must monitor the effect of surgical manipulations.  This requires the ability to open and close the eyes during the procedure.  Because conscious sedation is utilized, this, like so much surgery we perform, is done on an outpatient basis. Due to persistent swelling in the eyelid, the newly formed crease may look high for many weeks until the eyelids have healed sufficiently.

Leo Kim, FRACS(Plast), MS(Plast), MBBS(Hons) · Answer

Uneven eyelids are common both in the Caucasian population and in the Asian population. This unevenness though needs to be approached carefully because they have different causes and hence difference solutions. Some causes of unevenness and solutions are below.
1) Excess skin- relatively simpler problem to address, a blepharoplasty or an eyelid surgery can address this problem. Uncommon in the younger age group.
2) Difference in the anatomy- Asian eyelids are different to the Caucasian eyelids including the absence of the skin attachment from what's known as the levator mechanism, a muscle keeping your eye open amongst other things. If one of your eyelids have one and not the other, and the one you do have the crease you're happy with then you can simply create one on the other side.
3) Could be a problem of ptosis- This is when one or both eyes appear to be more "closed" and happens commonly in the older age group where the levator mechanism stretches over time. It can also happen in traumatic situation but the solution is the same- while awake under local injection of anaesthetics sutures are placed precisely to correct this ptosis.
Wish you the best in your journey.
Dr Leo Kim, Specialist Plastic Surgeon in Sydney

Jeffrey M. Joseph, MD · Answer

The eyelid anatomy in those of asian descent is unique. So are the goals of surgery. Forming a low, natural crease, remove a small amount of skin, repositioning some of the eyelid fat, may all be options to help you reach your goal.

Eric In Choe, MD · Answer

Your description of your eyelids indicate that your problem may be more than just the asymmetry of eyelid creases. You may possibly have ptosis related problems causing uneven eyelids.

	Fortunately, there are procedures to significantly improve this condition though  they can be very challenging at times.

Chase Lay, MD · Answer

this is a very common thing that I see my clinic even then. Probably a quarter of the procedures that are performed are to create creases that will match the crease on the opposing side. This performed under local anesthesia with about seven days of down time and sutures that will need to be removed. If you had this problem since your child it's most likely due to a congenital weakness of the levator muscle and one eyelid or a poor attachment of the levator tendon to the edge of your eyelid. In any case be sure that there is a good physical reason for this asymmetry and not of medical reason. Evaluation with an ophthalmologist would be wise.

William Portuese, MD · Answer

Uneven eyelids are a common problem in both Caucasian and Asian eyelids. It is rare to ever see perfect symmetry in the eyelids of any patient. The degree of symmetry is variable depending upon the individual. Asymmetrical surgery can be performed to make the eyelids look more symmetrical by placing the incision in the desired location to create the crease either higher or lower and then removing excess fat and skin on the asymmetrical side.

Kimberly Lee, MD · Answer

Yes, it is not uncommon to have asymmetry between the eyelid creases. This can be fixed with an Asian Blepharoplasty to create a crease on the right side to match that on the left or vice versa. This is a procedure that can be done while you are awake with local anesthesia and you can go home right after the procedure.

What is the Best Way to Fix Uneven Eyelids?

Answers (10)

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