Severe asymmetry with eyebrows. What can be done? (Photo)
Doctor Answers 10
You have a mild ptosis (drooping) of the one eyebrow. First, a thorough history and exam needs to be done to make sure there is not a medical cause for the drooping. Second, Botox can help with some asymmetries of the brow, but your asymmetry would require Botox along the whole brow on the one side and has a significant chance of causing eyelid drooping. Your best option is to consult with a board-certified expert. An endoscopic browlift could restore most, if not all, of the asymmetry. Best wishes.
Severe asymmetry with the eyebrows. What can be done?
The forehead anatomy is complicated, but basically is composed of both elevator and depressor muscles which appear to be slightly out of balance as noted in one single photograph. Botox offers a temporary improvement to the asymmetries of the eyebrows, A surgical browlift can help address the asymmetries permanently. An asymmetrical amount of skin is removed on the lower side, the muscles are weakened on the more active side to make the eyebrows more symmetrical. There is no perfect facial symmetry. For many examples, please see the link and video below
How to correct brow asymmetry
Hello. Great question - well-articulated and nicely photo-documented. I do, indeed, see the concern that you have. As you acknowledged, all faces have some natural asymmetry. Although it is widely believed that facial symmetry is an important component of facial beauty, this is not exclusively the case. On some faces, it is the asymmetry itself that lends a unique beauty. However, you have this concern, it frustrates you, and you would like some answers. There are many possible reasons for brow asymmetry, here are a few: 1) Our body is unconsciously "compensating" for some type of an eyelid raising problem - perhaps a "ptosis" of some sort. It does not appear that you have a ptosis; your eyelids appear to be open the same amount. 2) We have some weakness or injury to the neuromuscular mechanism that raises the brow itself - on the lower brow side. This is most often an injury to the frontal (or "temporal") branch of the facial nerve. With no history of facial surgery or facial trauma, and a normal functioning nerve at least through age 17, such a unilateral injury is unlikely in your case. 3) An asymmetric application of a neuromodulator such as Botox cosmetic. This is not the case with you - in 5 years, your problem hasn't "resolved". 4) This is a "habit" that you have fallen into more of less unconsciously. Given your focused efforts to correct this issue, that habit-reasoning is also unlikely. 5) There is some "other/stranger" mechanism in place here, that a thorough medical exam may uncover - a visit to a qualified facial plastic surgeon (or even a neurologist) may be the first step in that possible workup.
As for correction, you have some choices here as well. 1) Well-placed neuromodulator such as Botox or Dysport could effectively, temporarily, lower the hyperactive side and provide some symmetry. This will likely create some of the same eyelid hooding that you mentioned you notice in your lower-brow side. If you treat only one side with Botox, other asymmetry will be episodically noticeable in certain facial expressions. 2) Brow lift. The best brow lift for the correction of asymmetry is the transfollicular brow lift in which the incision is made just behind the hairline, the forehead and brows are released and the brows are raised and re-positioned to a symmetrical position. This is a reliable procedure, that many of us do in-office without general anesthesia.
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Thank you for your question. You are correct that asymmetry is normal. No facial features can be perfectly asymmetrical through genetics alone and even with facial plastic surgery. Many patients often combine a brow lift and an eyelid lift because the surgeries are complementary especially when performed at the same time, and more efficient for recovery time and costs of surgeries, operating room time and medications. I suggest that you move forward and consult with a board certified facial plastic surgeon.
Brow Asymmetry: What are the best correction options?
Good Day. Thank you for your question.
Your concerns are confirmed by your excellent photograph of mild brow asymmetry.
I don't recommend brow lift surgery.
I recommend using one or a number of the following options:
Botox or Dysport above the left brow to drop the forehead a minor amount or at the superior right crows feet area and/or below the right apex of the brow to provide a lift.
A filler (bellafill is permanent) along the superior aspect of the right brow hair to lift the brow to the height of the left side.
You can also reshape some of your brow hair, hair transplant to the brow or brow tattoo to make minor changes to the brow hair: shape, size and position.
Some skin tightening procedure can also produce a fit to the right brow using either RF or ultrasound.
In summary, I do NOT recommend surgery unless the alternative treatments do not achieve your desired outcome. Eye brow hair treatments, a Disport muscle relaxant isolated injections and brow filler for lifting is my recommendation.
Have a wonderful day!
without any medical causes can be addressed with Botox on the forehead on the high side to see if that brow will drop a little. If you like the left side better, then a little Botox under the arch of the right brow may allow it to ascend enough to make the asymmetry less appreciable. And if you want more of the sure thing, then a unilateral browlift on the right side should do it for you BUT perfect symmetry is still unpredictable and all that can be guaranteed is that your right brow will be higher and your natural asymmetry less.
Brow symmetry can be helped with Botox and endoscopic brow lift
Thanks for the photo. Some asymmetry is common. If the excess arching on one side and higher position of the peak of the brow causes you concern, three common approaches may be appropriate:
1. Have Botox performed to try to slightly lower the higher side by asymmetrically treating the high side's frontalis muscle more than the lower side. Doesn't sound like you would like this idea since you prefer the higher side.
2. Try to raise the lower side with treatment of the brow depressors - this usually is only helpful if the goal is to raise the outer, arching area of the brow, not the whole brow itself.
3. Have an endoscopic browlift performed to raise the lower side to correct its position.
By the way, I doubt you actually have a droopy eyelid. More likely, you have brow ptosis (drooping of the forehead) which causes forehead tissue to descend down onto the upper eyelid tissues, making the eyelid look heavier.
Eyelid and eyebrow asymmetry
Your eyelid asymmetry is caused by your eyebrow asymmetry; by perfoming a brow lift, you will be able to correct both your eyelid and eyebrow asymmetry.
Eyelid ptosis causes eyebrows to raise
You likely have left upper eyelid ptosis, causing the left eyebrow to raise in order to assist lift the droopy eyelid. See an oculoplastic specialist for eyelid ptosis evaluation. See following link.
As you said, it is normal to have asymmetric brows and your right brow is very slightly lower than the left which makes your right eyelid a little more "hooded" than the left. Please note that your eyelids do not droop which is a condition called Ptosis. A one sided browlift can be performed but in your case I would not recommend it since the amount your right brow sags is so minor. No matter how hard a surgeon tries, it is difficult to make the brows perfectly even.
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.