Within the normal population, a 1-2 millimeter difference between the two eyes is natural. In order to properly assess ptosis, you have to be examined by an ophthalmologist and oculoplastic surgeon that may evaluate the level of ptosis or level of droop of the eyelid. It’s important that a proper ptosis evaluation be done so that any medical issue that could be associated with the ptosis is ruled out.
From the photo that you sent, I assess that there may be a slight difference, but I would like to further know if other people like your family are aware of the difference or if it is noticeable in your pictures. If that is the case, then you fall under the category called congenital ptosis which could be associated with swelling after birth. Something that you’ve always had does not need much further work-up. However, if the ptosis is new then a medical evaluation by an ophthalmologist or oculoplastic specialist is appropriate.
Ptosis surgery is a procedure typically done under local anesthesia with light IV sedation. Usually for someone who has a mild amount of ptosis, surgeons advance a muscle called the levator muscle. This muscle is responsible for lifting the eyelid. During ptosis surgery in adults, the patient must cooperate during the procedure so that the eyelid height and shape can be optimized.
A disadvantage of ptosis surgery is typically asymmetry. Even after a successful surgery or if the patient looks good at the operating table, the eyelid may still be too high or too low. Nobody who does ptosis surgery for any length of time gets it perfect every time because it’s a very tricky muscle. To avoid that from happening, you should find yourself a good specialist with an established reputation.
As far as the hyperpigmentation is concerned, your situation looks more of an ethnic hyperpigmentation. Patients who have pigment have a tendency of genetic darkness under the eyes. This is very common with people with any ethnic background. We have to distinguish the pigmentation that is genetic which basically we can’t do much about. People may try bleaching creams and eventually they stop because of the irritation of the delicate skin under the eyes. In our cosmetic surgery skin line, we have an eye rescue cream and it has some active ingredients and moisturizer that most of our patients seem to like.
In some people who have dark circles or if there is a lot of environmental and age-related changes, I recommend non-surgical procedures such as platelet-rich plasma. This procedure uses your own blood with which we concentrate the healing factor called platelets to help stimulate collagen under the skin. This will help the skin quality and healing. I hope this was helpful for you and thank you for your question.