Drooping & uneven right eyelid & eyebrow. What are my options to fix this? (photos)

Question

Hello my left eyebrow & eyelid is higher and open than my right eyebrow & eyelid. My right eyebrow and eyelid seem to be uneven and droop. I can raise/arch my left eyebrow using facial muscles but I can not raise my right eyebrow. I have had this problem for a few years and i think i can recall getting botox in eyebrow before a few years ago. What are my options to fix this? Thank you in advance

John J. Martin, Jr., MD · Answer

It is unusual that you can't elevate your right brow.  Has this always been the case?  Surgery in the past that might have damaged a nerve?  You need a good consultation with an oculoplastic surgeon who can evaluate both the brow and forehead muscles.  If you relax your left brow, it will be interesting to see if your lid drops.  You may be trying to lift your lid by elevating the brow.  Some Botox on that left side would help to drop the brow if all else seems ok.

Matthew Richardson, MD · Answer

Brow asymmetry is quite common, but there are many different potential causes for this problem, including nerve weakness or injury, eyelid malposition, or simple facial asymmetry. In many cases, Botox can be used to improve the brow asymmetry. In some cases, brow lifting techniques can be helpful, but most brow lifting techniques do not help very much with improving asymmetry.Photographs alone are inadequate in this scenario, so I would recommend seeing a facial plastic surgeon or plastic surgeon who specializes in facial aesthetics for a formal evaluation. All the best,

Brian S. Biesman, MD · Answer

It does appear that your left upper lid is a bit lower than the right.  Your left brow may represent an effort to compensate for the low position of the eyelid.  There is a simple and straightforward test that can be performed in the office which can help determine whether correcting the eyelid position and will help the brow assume a more symmetric appearance.  These issues can be complex and I do recommend evaluation by an oculoplastic surgeon who also has a strong interest in aesthetics.  While surgery may be an option, a nonsurgical approach using Botox may be an option as well.

Mehryar (Ray) Taban, MD, FACS · Answer

The problem is actually your stems from your left upper eyelid being droopy (ptosis). That in effect causes the brow on that side to go up since the forehead is trying extra hard to lift the droopier eyelid.  The symmetry can be improved by left upper eyelid ptosis surgery.  Of course, you need to be examined to determine this. See an oculoplastic surgeon.

Sirius K. Yoo, MD · Answer

Thank you for your question.  First, do you get BOTOX to the forehead?  If so, you just need it evened out.  You look like the left brow is over arched.  You can see this in the photos that show the forehead muscles pulling too much on this side.  This also raises the upper lid too much.  If you do not get botox, then the solution is likely just as simple.  You probably have asymmetry in the tone of the forehead muscles and the left one is a little too strong and would require a couple of units of botox to even things out for you.  I see this commonly in people who do the "Mr. Spock" raising of one eyebrow to get laughs.  If you do this, I would bet dollars to doughnuts its on this same side (your left).  I don't see ptosis from the photos you show.  I think your right eye is fine.  Its the left eye that has an overly severe arched brow.  A full exam would be necessary, but your solution seems fairly straight forward.  I would recommend seeing a well respected facial plastic surgeon or a general plastic surgeon in your area to sort this out.

Kenneth D. Steinsapir, MD · Answer

You exhibit a compensatory left brow elevation and appear to have a pronounced left upper eyelid platform.  A very careful examination will reveal if you have frank upper eyelid ptosis as the basis of your asymmetry.  In the photo, you do not look particularly ptotic but this may be due to the ability to compensate with the brow elevation.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a regional directory of highly trained eyelid plastic surgeons that will help you find a well qualified surgery close to home (ASOPRS dot org).

Tatiana Khrom, MD · Answer

Facial asymmetry is present in everyone. In some it is more obvious than others. However, in your case, as mentioned before, your left brow is working excessively hard to compensate a left upper lid ptosis and the inability to raise your right brow is concerning. Though your cosmetic concern of asymmetry can be addressed with injections of a neurotoxin (Botox, Dysport or Xeomin) into the area of the glabella and a little bit into the forehead muscle above your left brow (to slightly lower it), as well as under the tail of the right brow (to slightly raise it), your initial consultation should be with a neurologist. The Botox injections you have received over a year ago should not be responsible for your inability to raise the right brow and you should be fully evaluated for a cause of your right brow immobility. After this evaluation, the Botox injections can be used to achieve a more symmetrical look and can be repeated every 4 to 6 monthsBest of luck

Darryl J. Blinski, MD · Answer

Try directed BOTOX injections to try an even out your brow asymmetry. It could take a few sessions to find the correct amounts of BOTOX and the placement./..

John R. Burroughs, MD · Answer

It appears you left eyelid is low (ptosis) causing a compensation with your forehead muscles on the left side to raise it more open.  It is concerning that you cannot raise your right brow.  I would recommend an in-person consultation to evaluate why you have apparent right-sided facial nerve branch weakness and to evaluate your blepharoptosis.  Botox can cause some of your findings, but you didn't mention this as having been done recently and it loses its forehead effect generally by 6 months after injection.

Jeffrey Zwiren, MD · Answer

You appear to have some degree of ptosis of the left upper eyelid. Your supratarsal crease on the left is higher than on the right and this is characteristic of ptosis.

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