What options are there for superior sulcus deformity and eyelid asymmetry?

I have superior sulcus deformity and asymmetry. 3 months ago a doctor shrunk both of my eyelids with laser resurfacing, we agreed he would fix the asymmetry but he did them both the same - I want it to look like the LEFT side. Is this possible? Please can someone break down my options? Filler or fat? I have heard of something called autologus dermis-fixation on the orbital periosteum, and also anterior levator ptosis repair. I don't understand any of these terms or their implications.

Doctor Answers 5

There are a variety of solutions that have been attempted.

None of them are right for every patient.  Because you live in Los Angeles, I recommend that you consider personal consultation with a select number of eyelid surgeons so that you can be personally assessed when you are ready.  The autologous dermis-fixation method is a korean method that is intended to address severe upper eyelid hollow.  A roll of harvested dermis is placed in the orbit.  Unfortunately this method causes the eye to be depressed in the orbit and also results in unpredictable scaring.  I personally do not recommend this approach and do not feel your issues warrant such a radical surgery.

Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Supra ocular sulcus

Fat injections used with very small incremental volumes over a period of time would be the safest and best option to fill in this area.

Laser Resurfacing

Hi catreal09,
Thanks for your question and photo. I'm sorry to hear you've been struggling with your laser resurfacing. Occasionally, this procedure can cause contraction of the skin surface and shortening of the upper or lower eyelid skin length. If severe, this can result in trouble closing the eyes.
Both fat transfer and hyaluronic acid filler, in the right hands, can be effective in treating superior sulcus deformity. Based on your photo, I think a conservative application of filler to your left superior sulcus could improve the symmetry. I would not, based on your photo, consider any type of ptosis repair.
I would recommend you discuss your concerns with your surgeon further or seek a second opinion with a skilled oculofacial plastic surgeon in your area. 
Good luck!

What options are there for superior sulcus deformity and eyelid asymmetry?

You may benefit from left upper eyelid filler injection to improve the superior sulcus deformity or hollowness and sunken appearance. Best to see an oculoplastic specialist. See link below for more details including a manuscript on upper eyelid filler injection. (also get evaluated for eyelid ptosis)

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Eyelid asymmetry and superior sulcus deformity.

Looking at your eyes, I would suggest starting with a dermal filler.  I would encourage an experienced oculofacial plastic surgeon to do this.  Specifically one with comfort at injecting the upper eyelids, brow area.  At the Jules Stein Eye Institute in LA is Dr. Robert Goldberg, who has excellent experience and teaches other surgeons very advanced techniques.  I would go with a dermal filler such as Restylane before considering any other surgery or other treatments.  I think some improvement of your eyelid crease can be obtained by doing the filler injections.  The other benefit to a filler injection (instead of harvested fat) is that it can be reversed if you don't like for any reason with a dissolving enzyme (hyaluronidase).  Your eyelid heights are symmetric, so I don't think you should have any ptosis surgery (anterior levator).  Autologous dermis grafting (using some of your own skin dermis/fat) can be done and I have done this in patients, who have lost their eye and have very deep superior sulcus.  It can work well, but requires another site of surgery on your body to get the dermis and fat.  An advantage to the dermis fat graft is that it can give very long lasting results.  I've attached a publication talking about dermis grafting that I published that shows one technique for obtaining the graft.  Best regards.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

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.