Lack of symmetry post op. Any suggestions? (photos)

I had an upper blepharoplasty late 2012 on my right eyelid. After the surgery I wasn't entirely happy but it was an improvement. The issue is a lack of symmetry. The right eyelid still droops but only slighty and the left eyelid has multiple creases contributing to my off kilter appearence. I've had discussion with two other surgeons/consultants and they've given me mixed messages. Would I be better off going in for a second blepharoplasty on the right eyelid or fixing my creases on the left?

Doctor Answers 4

I would definitely not recommend posterior approach ptosis surgery here.

You have bilateral upper eyelid ptosis, a long upper eyelid platform, and a very high apparent crease.  What you have here is profound disinsertion of the anterior levator aponeurosis.  The upper eyelid crease needs to be lowered.  Traditionally patients were told that this was impossible.  However, that is not the case (see the accompanying video).  The key is how much levator function you have.  This is not evident in these photos.  It is a measure of the motor excursion of the upper eyelid.  When there is less than 10 mm of excursion, improvement of the eyelids is unlikely.  When the excursion is more than 12 mm it is much more likely that the reconstruction will be successful. The right upper eyelid is heavier than the left upper eyelid but both are ptotic.  Similarly, you have a much higher apparent crease on the left side.  Surgery must address all of these concerns to be completely satisfactory.  Most surgeon who you see will not fully appreciate what needs to be done to make a satisfactory difference here.  It is improbable that you will find satisfactory surgery close to home.  

Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews


Thank you for your question. A blepharoplasty (or eyelid surgery) will remove excess skin and/or fatty tissue, but it cannot address the underlying bone structure which creates unevenness. There will always be some asymmetry or slight difference in the position of both eyelids. Always consult with a board certified facial plastic surgeon, and please consult with the surgeon who performed your surgery to learn more about your first blepharoplasty.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 93 reviews

Right-Sided Ptosis

Hi ksulte,
Thanks for your question and excellent photos. Based on your pictures, I can appreciate your concern and I do see a subtle ptosis of your right upper eyelid and the lid crease on the left is about 1mm higher. The question of how to manage this isn't exactly clear cut as we are talking about a 1-2mm margin of error. However, if the only procedure you've had in the past is an upper blepharoplasty, than one could consider a posterior ptosis correction of your right upper lid. Depending on your exam findings, this may give you the result you are seeking. 

I would seek a third consultation with a skilled oculoplastic surgeon in your area to break the tie. 

Hope this helps, good luck!

Better off as is

Adjusting the resting position of the lid is very tricky stuff. Most surgeons who perform ptosis surgery look to have the result within 1-2 mm of the other eye. From the pictures you have provided I do see a SLIGHT difference but I would likely leave well enough along at this point as the difference is quite small. Depending on where you live another opinion from an eye plastic surgeon will likley confirm this.

Benjamin C. Marcus, MD
Madison Facial Plastic Surgeon
4.6 out of 5 stars 39 reviews

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