Uneven brows and lazy/puffy right eye -do I need surgery? (Photo)

Question

I'm 49 with migraines since 18. I've been getting Botox for migraines for years, but recently asked my neurologist to stop injecting my forehead to see if that would improve the dissymmetry (now Botox free in forehead for 6 months). I did have cosmetic Botox to crows feet to "open up" eyes, with 3 spots of injection on right vs 2 on left, but I still have a lot of dissymmetry. My migraines are almost always on the right side. Is surgery the only answer? Do I need a oculofacial plastic surgeon?

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Kenneth D. Steinsapir, MD · Answer

First, your photo does not show manifest ( obvious) ptosis. It does show a compensatory left eyebrow elevation. There is more eyelid platform show on the left side. This combination of a high fold and a compensatory brow elevation on the same side often is consistent with latent ptosis that is compensated by the brow elevation.  Other finding consistent with this would be a high crease or absent crease on the side with the brow elevation. These findings are consistent with a central levator disinsertion. Repairing this disinsertion can restore the platform symmetry and allow the brow to relax. Again no one can promise this work would resolve your migraines.

Zoran Potparic, MD · Answer

Your situation can be approached in two ways, depending whether you like position of your higher or lower brow. Unilateral procedure of lifting lower brow using endoscopic brow lift or, lowering  higher brow using transpalpebral approach (scar placed in the upper eyelid crease) would be my choice of options. In both cases I would suggest using resorbable plates for brow fixation. In person or teleconference consultation with board certified plastic surgeon experienced with endoscopic brow procedures, is recommended.

Uneven brows and lazy/puffy right eye -do I need surgery? (Photo)

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Uneven brows and lazy/puffy right eye -do I need surgery? (Photo)

Answers (3)

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.