Hooded eyelid or ptosis? (Photo)

Question

My eyebrows are symmetrical when I raise them but don't appear even when relaxed. (The right is lower) I'm wondering if I should have surgery done to correct this or if it is not noticeable. One photo is flipped because I took it on. The front camera. It is my right side I'm concerned about.

Toby Mayer, MD · Answer

You do have asymmetric eyebrows. It is not a great deal and most people probably would not even notice this in you. You have a very high forehead and the hairline can be lowered if this is something that you wish and at the same time the low brow raised.  See a very experienced brow lift surgeon who is skilled in lowering hairlines. This should be done with the Irregular Trichophytic forehead incision where the hair grows thru the scar and not behind it.

John J. Martin, Jr., MD · Answer

You have one brow higher than the other.  This makes the eyelid skin look asymmetrical.  You could lift the lower brow to even this out.  Your brows are pretty high already so don't want to be lifting too much.  It also looks like you have a high forehead so need to take this into account if any surgery is done. You could use some Botox to drop the higher brow so the lids would look more even - but then both would look a little heavy.    Really need an in person evaluation to decide what might be best.

Curtis Wong, MD · Answer

and certainly everything mentioned could be considered so you must decide on what will give you the look you want.  Browlifts are not precise and mild asymmetry is normal.  Skin excisions can help but also cannot predict your exact outcome.  The most conservative option would be to use some type of procedure to tighten the skin such as resurfacing or external radiofrequency.  I am NOT an Ulthera fan as it did not produce any results for my patients when I HAD it.  If you decide to try such technologies, you should know what happens if you do not get the desired results?  Will you get a second complimentary treatment?  Or a partial refund?  If your provider cannot give you some reassurances, then don't do it.

Lily Lee, MD · Answer

You could consider many of the things other doctors have suggested below, but one other thing to consider if you do not want to do surgery is to use Ultherapy. I would try Ultherapy focused only on the right side only to try to tighten the brow and forehead skin for a small lift. Results happen slowly over 3-6 months, but I have been impressed that we can get 2-3 mm of lift without cutting and no downtime! If you lift your forehead 2-3 mm and it fixes the way your eye looks, then I think you would be a good candidate for it.

Jeffrey M. Joseph, MD · Answer

Differences in eyebrow height and contour from one side to the other are very common. This can be related to eyelid ptosis, but most commonly is just reflective of normal variations in anatomy. Surgery (upper eyelid blepharoplasty) can be very useful for the hooding while botox injection is an excellent tool to improve brow symmetry and contour (see the link below)

William Portuese, MD · Answer

There is significant  facial asymmetry and one eyebrow, eyelid, and eye socket is lower than the other.   There does not appear to be any ptosis present. A one-sided upper lid blepharoplasty in attempt to remove some of the hooded look to balance out with the opposite side, however there will still be significant facial asymmetry present.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

There are asymmetries of your eyelids and eyebrows which can be corrected surgically. You would benefit from an in person evaluation by a board certified surgeon with expertise in eyelid and eyebrow surgeries.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos but an examination is really needed as sometimes asymmetric brows are due to a subtle eyelid ptosis as the brow is kept elevated to lift the eyelid on the affected side.Dr. Corbin

Francis R. Palmer, III, MD (retired) · Answer

Hi, The right eyebrow, as you mentioned, is lower which increases the amount of upper eyelid fullness on the right.  Brow lifts will raise the eyebrows, however you have a very high forehead and only one low brow.  It might be better to remove some excess skin (not all as it will lower the right eyebrow upon closing the incision) from both upper eyelids which is a much smaller and easier procedure.    I did want to point out that from the photos, your cheeks are very flat (concave) anteriorly (in the front) and there is excess fat in front and below the cheeks which combine to create an oval shaped face.  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. Hope this helps.

Jon A. Perlman, MD (retired) · Answer

Consider a combination of botulinum (Xeomin or Botox) injection to lower your higher brow and to elevate your lower brow (when injected to different areas) and blepharoplasty surgery.  Expect a nice improvement in your appearance, a less tired look and less asymmetry.  Your photo also suggests some lower lid fatty bags and if present these could be corrected at the same time.Best wishes.Jon A Perlman MD FACSCertified, Am Board of Plastic SurgeryMember, Am. Society of Aesthetic Plastic Surgeons (ASAPS)Beverly Hills, CA

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