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

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.

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.

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.