How Can I Improve my Uneven Sagging Upper Eyelids

I've always hated my eyes. When I was younger my upper eyelids were very fatty but now that I'm almost 40 my eyes have a more hollow look as well as being uneven and sloping down at the outer edges. I currently get a "botox brow lift", which gives my eyebrows a nice arched look but it does nothing for my eyelids. Would you suggest filler or surgery to improve the symmetry and outer droopiness?

Doctor Answers 8

Uneven upper lids

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Dear cyberkitty,  I agree with the last doctor's comments. Do not let any doctor do surgery on your upper lids.  They are the ideal we eyelid surgeons strive for in our patients.  Only recently have we begun to understand the "hollow" you describe.  As Dr. Steinsapir said, for the expert eyelid surgeon it readily stands out, and we can comfortably and reliably correct this with a small amount of hyaluronic acid filler (off-label), but this is a very advanced technique, so do not just go to anyone in your community.  Find the expert eyelid injector.  This will nicely restore the contour you are missing, and usually lasts for many years.

Yoash R. Enzer, MD

Providence Oculoplastic Surgeon

Saggy uneven eyes looking for solutions.

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Your eyes look quite good however, the right eyebrow appears lower than the left. This results in more fullness of the outside right upper eyelid but not enough to warrant an upper Blepharoplasty at this time. I do agree that the upper eyelids are a bit hollow and either Restylane or Juvederm could be used to soften the hollows. Placing some Restylane or even Perlane along the outer upper eyelid socket would also lift the eyebrows allowing the natural almond shape of the eyes to show.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Uneven or Sagging Upper Eyelids

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Some asymmetry to the eyes is completely natural and normal.  It is relatively common for one eye to appear different then the other.  This is due to differences in the bony, muscular, brow and skin anatomy between the sides.   Some asymmetries can be a sign of disease and should be further investigated for example progressive drooping of the eyelid or bulging of the eye.  Your pictures do not demonstrate any evidence of asymmetry beyond what is normal.  In my opinion, you have very attractive eyes that do not warrant any intervention.   If you are still bothered by your eyes, you need an in person consultation to assess the causes of your concern.  Eyes are a dynamic structure that require a thorough physical exam. 

James C. Marotta, MD
Long Island Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

You look great...

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But I totally agree, there is a slight A frame to your upper eyelid.  This give that upper eyelid fold a slight aging look.  Upper eyelid Restylane will make a huge difference for you.  The trick will be finding an injector who can help you with this.  This treatment is an advanced technique.  Please do not compel a doctor to do this treatment for you if they are not comfortable.  Also this requires advanced skills to make a smooth treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

You have gorgeous eyes!

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The photo shows beautiful eyes and the eyelids do not appear saggy. However it is a single view with make-up. You would need a closer examination by a Board Certified Plastic Surgeon to determine the skin laxity of your upper eyelids. Getting the Botox brow lift is good for now but you might need a blepharoplasty down the road. Best of luck.

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

Upper lid asymetry

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I think you are probably going to hear a lot of people telling you definitely no surgery. I agree. The simplest way to start is with very conservative filler injections in the areas you are describing.

Sherwood Baxt, MD
Paramus Plastic Surgeon


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Well I believe your eyelids look beautiful.  When you look so good it would take a set of all 9 views of eyelids to suggest any treatment.  You may have a little relative ptosis in you right upper but minimal.  A brow lift done surgically may be a consideration.  Possible a meticulous mini bleph of your eyelids may help.  Then again a peel often refreshes.  Latisse helps 100% of people.  Fillers are not likely a benefit.   The botox has been a plus so stick with it.  The next step is a very detailed consultation.  Best of everything to you,  dr george commons plastic surgery.

Eyelid asymmetry can be treated with surgery

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Eyelid asymmetry can be treated with surgery. Also, depending on the eyelid, and it’s hard to tell from this picture, BOTOX can be helpful for lifting the brow.  And, sometimes using filler off-label in the upper eyelids can be used to make them look less hollow and fuller.  You should always go to an experienced oculofacial plastic surgeon who is an expert injector for any injectable treatments around the eyes. 

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.