What procedure is right for me? My lower left eye area is not symmetrical with the right lower side (Photos)

My lower left eye area is not symmetrical with the right lower side, especially when I smile. There is a bulge that forms that makes my smile feel crooked because I can feel it under my eye. I feel like the right side is a normal crease that forms when you smile, but the left side looks puffy and unnatural. You can see it when I don't smile as well (the picture where I'm looking up). What is causing this asymmetry and what are my options to fix it?? Thank you!

Doctor Answers 4

Eyelid asymmetry

For eyelids, it can be difficult to diagnose issues from a still photograph. It appears that you either have orbiculares hypertrophy on the left (treatable with botox or excision) and/or fat herniation (treatable with a lower eyelid transconjunctival blepharoplasty). Further refinement of this recommendation would likely occur at a consult, but those are bother very likely factors.


Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

Lower eyelid bulge

Lower eyelids are difficult to evaluate without palpation to see if the fullness is fat or muscle (hypertrophic obicularis).  There will always be lines and asymmetries when the muscles are active so the evaluation should be at rest and not smiling. If there is herniated fat it can be removed from inside the eyelid. If it is a muscle bulge one can very carefully use Botox (temporary) or remove a small amount of skin/muscle with a "pinch" technique beneath the eyelashes. Only a real consultation with a qualified surgeon can help you make this decision.

Wayne F. Larrabee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Bulge under eye likely fat

It appears you have more under eye fat prolapse on one side than the other which can be treated with lower blepharoplasty but best to get in person evaluation by an oculoplastic specialist.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 61 reviews

I would strongly caution you to be careful what you look for.

It is very hard to control a difference that one only sees when the muscles are tensed.  This can not be effectively helped with surgery.  Botox will weaken the muscle and a very good Botox injector could manage this but the treatment will only last a few months.  Fillers may be another away to help this.  Get several opinions and do not have surgery, laser resurfacing, or fat grafting for this.  It will mess you up and not achieve what you are looking for.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 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.