Can my asymmetrical eyes be fixed with unilateral blepharoplasty? (Photo)

Question

More of the hood of the eyelid is visible on my left eye. I have no hx of surgeries and no trauma. I am so scared a doctor is not going to be able to help me. I am not sure what the problem is. I don't know if it is muscular, a matter of more tissue/fat in my eyelid area causing the creases to be asymmetric, if there is a difference in the sizes of my orbital sockets, cranial nerve damage, uneven brow bones, or a combination of factors. Is strabismus a risk of surgery?

Kenneth D. Steinsapir, MD · Answer

Any surgeon who tells you that it can be corrected with blepharoplasty doesn't know their eyelids. What is going on there is central levator aponeurosis disinsertion. The levator aponeurosis is the facial expansion of the levator palbebrae superiors muscle, the muscle that raises the upper eyelid. Centrally this facial expansion, which functions as the tendon of the levator muscle, comes loose of its attachments on the central tarsus and retracts into the orbit. It takes with it fat and tugs on the skin to make the eyelid look like an "innie" eyelid. Compare that to the right side that has a normal fold or "outie" eyelid. Most  eyelid specialists really don't understand what is going on anatomically and propose goofy fixes for this problem. Some may recommend adding hyaluronic acid fillers to attempt to make the innie eyelid into more of an outie eyelid.  However, this approach does not address the disinsertion of the tendon and therefore, does not correct the heavy upper eyelid. In my opinion, they mean well but the result is unsatisfactory. The other common fix is to offer a blepharoplasty (removal of skin and muscle) on the other side to make it look more like the abnormal side. Blepharoplasty will not fix this problems but will make the situation worse. What you need is ptosis surgery but not just any ptosis surgery. The Muellectomy is a vastly popular ptosis approach with oculoplastic surgeons. They like it because the anatomy is simple and the surgery is quick. They love it so much that they use the surgery in the wrong situations and try to claim that incomplete repairs are good. The Muellectomy does not work when the central levator aponeurosis is disinserted like in your left upper eyelid. Instead you need an anterior surgery called an anterior levator resection ptosis repair. You would also benefit from an anchor blepharoplasty to make a hard crease in the upper eyelid to help address your upper eyelid lash ptosis. There is no substitute for a detailed personal assessment.

A.J. Amadi, MD · Answer

What is likely going on is that you have a droop of the left upper eyelid, and thus are compensating by using your forehead muscles to elevate your eyebrow to help the eyelid open up more. This compensation actually makes the eyelid asymmmetry look worse because more of the eyelid platform is visible when you raise your eyebrow. The answer is NOT a blepharoplasty on the other side, but rather ptosis repair on the left side. There are two options for ptosis repair: internal approach  vs external approach. Both involve advancing the levator muscle, though by slightly different mechanisms. The posterior approach works by shortening the conjunctiva and muller's muscle, this action actually drags the levator muscle along with it and helps elevate the eyelid. It works on mild to moderate eyelid droop cases, and requires no external skin incision and has a quicker recovery because of that. An in office eye drop test is done in the office to see if you are a good candidate for this surgery. If you do not respond to the eyedrop test, or you have moderate to severe eyelid droop, then its probably best to use an external levator advancement surgery using an open skin incision. This is a more challenging surgery, as it is slightly less predictable with a higher revision rate, can cause more contour problems and requires you to be awake for best result.  Thus you need to find a surgeon that has significant experience in this technique. Most Oculofacial plastic surgeons (Oculoplastics) are experienced in this technique. Good luck.

Steve Laverson, MD, FACS · Answer

The answer is YES, symmetry can likely be improved by carefully planned and skillfully executed unilateral upper eyelid blepharoplasty under local anesthesia.  This should be performed only by an expert with experience in such corrective procedures.  In my practice, would be a $2K operation after which you need a ride home, driving immediately after not recommended.

Mehryar (Ray) Taban, MD, FACS · Answer

You may have left upper eyelid ptosis as the cause of the upper eyelid asymmetry in which case left ptosis surgery could be an option. Otherwise right upper blepharoplasty may be another option. Filler injection may be another option. Best to have personal consultation with expert oculoplastic surgeon.

Janet Turkle, MD · Answer

Hello and thank you for the question and photos. I certainly understand your concern regarding surgery of the eye area. Please find an oculoplastic surgeon or Board certified plastic surgeon in your area with lots of eyelid experience. Carefully review before and after photos and ask questions in your in-person consultation. Best of luck on your journey!.

Can my asymmetrical eyes be fixed with unilateral blepharoplasty? (Photo)

Answers (8)

Answer: Upper eyelid asymmetry

Answer: Upper eyelid asymmetry

Answer: Eye asymmetry

Answer: Eye asymmetry

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.

Can my asymmetrical eyes be fixed with unilateral blepharoplasty? (Photo)

Answers (8)

Answer: Upper eyelid asymmetry

Answer: Upper eyelid asymmetry

Answer: Eye asymmetry

Answer: Eye asymmetry

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.