Botox for hooded eye/uneven brow or surgery? (Photos)

Question

I have a pretty drastic difference in the position of my eyebrows and my left eye is more "hooded" than the right. It's not noticeable when I'm looking in the mirror but in pictures or when smiling I notice it a lot. As I've gotten older, it has become more pronounced and it really bothers me a lot. I'm wondering if botox will help this or it needs surgery to correct?

Barry M. Weintraub, MD, FACS · Answer

Although your photos have been taken from quite a distance, there does appear to be some disparity in your upper eyelids and your eyebrow height. Please keep in mind, however, that we are our own worst critics, and other people are generally not as focused on such discrepancies. Some asymmetry to the face is natural. Unilateral upper blepharoplasties are performed when the disparity is very apparent, and unilateral eyebrow lifts as well. In order to make such an assessment, you should be seen in person by a board certified plastic surgeon. In some cases, Botox can partially help to raise one eyebrow to match the other, but may not fully improve the asymmetry. You might want to try the Botox approach first, as it is a less expensive and less invasive approach. It is also not permanent, so after it wears off in approximately three months, you can consider another option if not fully satisfied with its effect. Be very careful, however, who injects the Botox. I would seek out a plastic surgeon to inject this, because if not injected properly, your eyebrow and upper eyelid can actually be made worse!

Jason Emer, MD · Answer

For significant improvement, hooded eyelids require surgery if there is enough skin. For nonsurgical treatments: Radiofrequency (Thermage or Venus Legacy/Viva), injectable fillers, and a Botox brow lift can help contour the eyebrows and lift the eyelid skin. I recommend getting a formal evaluation with an experienced cosmetic dermatologist. Best, Dr. Emer.

Sam Speron, MD, FACS · Answer

Hello and thank you for you questions and pictures!  Upper eyelid hooding can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day, you can shower the next day and most patients take no pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Edwin F. Williams, III, MD · Answer

Thank you for your question. I definitely think some botox can help with the brow asymmetry and I would recommend that over surgery given your young age. I recommend consultation with an experienced injector to further discuss. Best of luck!

David K. Isaacs, MD, FACS · Answer

It's important to have an evaluation regarding the difference in eyebrow position and asymmetric eyelid hooding because there are medical conditions that can cause these findings. For example, a droopy eyelid can result in brow elevation on the same side, and it would be important to find out why the eyelid is droopy in the first place.

Treatment options can be discussed once the problem(s) is/are defined.

Botox for hooded eye/uneven brow or surgery? (Photos)

Answers (6)

Answer: Uneven brow

Answer: Uneven brow

Answer: Difference in Eyebrow Position and asymmetric eyelid skin hooding

Answer: Difference in Eyebrow Position and asymmetric eyelid skin hooding

Recommended reading

Everything you need to know about Eyelid Surgery

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

Botox for hooded eye/uneven brow or surgery? (Photos)

Answers (6)

Answer: Uneven brow

Answer: Uneven brow

Answer: Difference in Eyebrow Position and asymmetric eyelid skin hooding

Answer: Difference in Eyebrow Position and asymmetric eyelid skin hooding

Browse related questions

Recommended reading

Everything you need to know about Eyelid Surgery

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