My eyes are aging asymmetrical. What can be done to fix this? (Photo)

Question

How to make eyes more symmetrical? Is tissue sparing (fat and muscle) blepharoplasty an option in my case?

Charles S. Lee, MD, FACS · Answer

The tendon that pulls your left upper lid upward has slightly disinserted and is causing you to reflexively lift your left brow. The upper lid fat is getting pulled up deeper into your eye socket, creating an  apparent hollow. The treatment is to reinsert the tendon so that the two eyes are opening symmetrically. The fat needs to be pulled back into the sunken area. The right eye may or may not have the same problem to a lesser degree.  One thing to note is that once your ptosis is corrected, your brows will drop to some degree. Some doctors would advocate a simultaneous browlift or in your case, a brow suspension to stabilize the brow and prevent a descent of the brow. A comprehensive exam and a discussion about your goals of surgery would point you into the direction that you want to go.

Kenneth D. Steinsapir, MD · Answer

You have bilateral upper eyelid levator aponeurosis disinsertion ptosis.  The disinsertion is a bit more dramatic on the left side.  These white line disinsertions allow the levator aponeurosis to retract back in to the orbit.  A normal outward upper eyelid fold is an antiform fold eyelid.  When the tendon disinserts, the fold collapses and inverts.  I call this a synform fold eyelid.  These are terms that are analogous to how geologists describe land folds.  The fat is all there it is just pulled into the anterior orbit.  The solution is not to fill up the sulcus with fillers because this does nothing to fix the underlying problem which is the upper eyelid ptosis. You do not need a brow lift and in fact you are performing your own brow lift due to the compensatory brow elevation caused by the upper eyelid ptosis.  A fat and muscle sparing blepharoplasty is the wrong solution.  You need structural help in the form of anterior levator aponeurosis advancement ptosis surgery, an anchor blepharoplasty with preservation of the skin, and preservation and redeployment of upper eyelid fat to help reform the natural antiform upper eyelid fold.  The surgery will also support your droopy upper eyelid lashes.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. Your right eyebrow is dropping, causing extra skin to develop in the eyelid. You are losing fat and structure in your left upper eyelid. There are numerous treatments available. See an Oculofacial Surgeon for comprehensive evaluation and discussion of potential options. Good luck,

Mehryar (Ray) Taban, MD, FACS · Answer

The asymmetry is from either 1) hollowness in left upper eyelid, or 2) mild left upper eyelid ptosis, or both. Filler injection helps with option 1 and ptosis surgery with option 2. See an oculoplastic specialist for evaluation. See following video and link too.

Ritchie Younger, MD · Answer

Plan to see a board certified facial plastic or oculoplastic surgeon who has vast experience with blepharoplasty surgery.  A careful compilation of upper eyelid surgeries that I have performed  over the last 31 years has clearly indicated that 62% of the patients that I have seen have some degree of asymmetry-mostly related to having a slightly asymmetrical eyebrow position-which lends itself to differing appearances of the upper eyelid itself.  A  careful and experienced surgeon will methodically assess the reasons for asymmetry, and plan accordingly.  Some patients may require variations as to how much skin or soft tissue from each lid may need to be resected, and some may require differing levels of eyelid crease fixation to get better symmetry.  Do your homework-see an experienced surgeon who enters the eyelid surgical arena with vast experience and great results-good luck to you !!

Toby Mayer, MD · Answer

First, I need to see better photos as described on my website and others. This can be corrected by a very experienced Facial Plastic or plastic surgeon. But you may need a Browlift done as well.

Gilbert Lee, MD · Answer

My review of your photos shows that you are missing more of the periorbital fat above the left eyelid, leaving it looking more hollow than the right side.
I often replace this loss of volume with fat or filler which is done through a small needle.  No incisions.  Minimal to no recovery.  Problem solved.
A blepharoplasty can remove the skin excess, but will still leave you more hollow on the left side.

Vasdev Rai, MD · Answer

You have different issues in your right and left eyelids.  That is not an uncommon happening. Blepheroplasty will need to be custom tailored to each eyelid situation. Blepheroplasty will help your eyelids.

William Portuese, MD · Answer

From the very limited photographs, there is asymmetry in the upper eyelids with regards to the amount of skin, muscle and fat.  A conservative upper blepharoplasty  with more tissue removed from one side versus the other side can accomplish making the eyelids look more symmetrical.  Experienced eyelid surgeons deal with this issue routinely.  The eyelids will never be perfect, just more symmetrical to a degree. For many before and after  eyelid surgery examples, please see the link and the video below

Robert Singer, MD · Answer

Fullness and asymmetry of the
upper lids can be cosmetically improved with a number of surgical options
depending on individual anatomy and desired outcome. An artistically
performed conservative upper blepharoplasty may improve the asymmetry, but not totally correct it.
Following the advice of anyone who would presume to tell you what to do based
on a limited photo and more importantly without taking a full medical history,
examining… SHOW
MORE you, feeling and assessing your tissue
tone, discussing your desired outcome and fully informing you about the pros
and cons of each option would not be in your best interest.  Find a plastic surgeon that you are
comfortable with and one that you trust and listen to his or her advice. The
surgeon should be certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS).
You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California

My eyes are aging asymmetrical. What can be done to fix this? (Photo)

Answers (12)

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