Hi Doctors, I'm in my early 30's and unhappy with the way my eyes look. I suspect I have ptosis in my right eye. My brother also suffers from a droopy eye and we both wore contacts for close to 10 years. I want my eyes to look even, younger, and more awake. I showed these pictures to one doctor, and he said I look great and don't need any surgery. I'm confused. Which surgery(s) would I need? A blepharoplasty? Ptosis surgery? or both? Help, I really want to get this fixed ASAP.
Do I Need a Blepharoplasty And/or Ptosis Surgery? (photo)
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Doctor Answers 10
Best to do nothing
Blepharoplasty or ptosis surgery
From the pictures shown there is a small amount of ptosis on the left eyelid. Blepharoplasty is not needed. A simple ptosis surgery via the external or internal approach is all that is needed on either one or both eyes.
There are two problems. One is that you have mild left (on photo) upper eyelid ptosis. The other is that you have bony facial asymmetry with right side of your face smaller than the left, which causes the soft tissue, including eyelids/brows, to be closer together. Left upper eyelid ptosis surgery can help but it is risky given such minor ptosis. You can camouflage the asymmetry by performing filler injection in the left brow area to help cover the left upper eyelid platform. Right upper blepharoplasty (skin removal) can also make things more symmetric but not advised. See an oculoplastic surgeon for evaluation.
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It appears that you have some ptosis of your left upper lid and retraction of your right upper lid. If you cover the left eye I would bet you have ptosis of your right upper eyelid also. You should visit an experienced oculoplastic surgeon for evaluation and treatment.
You do not have ptosis that needs surgery
The position of the upper lid is lower and cover the pupil in patients that have ptosis. You have asymmetry of the eye brow and eye, but this is very common and will not look better with surgery. Your pictures are taken with lens too close to your face.
This is why there are eyelid specialists in the world.
It is interesting that you have identified the right eye as being droopy or ptotic. In fact you have mild ptosis of the left upper eyelid with a compensatory left eyebrow lift. This causes the right sub-eyebrow area to appear fuller than the left side. In addition you have left upper eyelid eyelash ptosis. This means the the eyelashes on the left side also shade the left cornea more than the right and this makes the left eye look more dull. As Dr. Koltus rightly points out, there is a means of improving the ptosis using a surgery that is strictly carried out on the back of the eyelid which means no scar. The problem with this approach is that it will not correct the eyelash ptosis. To fix this problem, an eyelid crease incision must be made on the front surface of the eyelid so that an connection can be make between the eyelid platform skin and underlying muscle and the levator aponeurosis, which is the tendon of the muscle that lifts the eyelid. This procedure is called anchor blepharoplasty and it would rotated the eyelid lashes upward like the you have on the right side. With the levator exposed like this, doing a small ptosis procedure is a straight forward matter.
I think you will be hard pressed to have precisely this type of very refined cosmetic eyelid surgery expect from a handful of surgeons in the world so please be careful out there. You are very attractive which means the landing pad for improving your appearance is quite small and the chance of actually making your appearance worse probably much more likely.
Without an actual exam it is impossible to be exact. However, it appears that you simply have a little natural asymmetry. You do not have any ptosis although the left eyelid appears to be lower than the right at first glance. When carefully examined, it crosses above the pupil at exactly the same point as the right. Both appear to be at a proper elevation indicating there is no ptosis present. The upper part of the right eyelid is merely lower. The right brow is also slightly lower also. A blepharoplasty will not solve the problem, and neither will a ptosis operation. In fact, they would probably only make the problem worse. Elevating the right eyebrow a millimeter or so might, if you are very lucky and everything goes exactly right, correct the asymmetry, but would be exceedingly hard to accomplish. You also may be able to reduce the appearance of the asymmetry by placing a filler in the upper part of the left eyelid. Since the eyebrows are also asymmetric, this will remain. However, the asymmetry you see may appear less. My advice is to realize that everyone is asymmetric and accept yours in an otherwise very pretty face.
Fix for droopy eyelid
Based on your photographs it appears you have mild ptosis of the left upper eyelid.
Droopy eyelids can be associated with contact lens use. A ptosis repair (different than blepharoplasty which is not necessary in your case) on the left side can help to improve asymmetry caused by a drooping eyelid. This can be performed with an incision on the front of the eyelid or on the back of the eyelid (no visible scar).
It is not mandatory to have the ptosis repair, but it is the procedure of choice if you wish to look more even. This is a personal decision that no one else can make for you. You will want to seek an evaluation with surgeon that understands your concerns, has experience in eyelid surgery, and you feel comfortable with.
Best of luck!
No one needs a blepharoplasty.
The photo demonstrates youth full and symmetrical eyelids in orbit. Eyelid surgery will not improve this. All cosmetic surgery is elective and is never necessary.
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.