What treatment options do I have for eyelid asymmetry and overall rejuvenation?

Hi, I'm 27 and am concerned about fine lines and hollowness under eyes, and assymetry of eyelids and eyebrows. What combination of treatment options should I consider and in what order? Eg laser resurfacing, eyelid lift, brow lift, lower bleph, fat grafting, filler etc. It's all a bit confusing!

Doctor Answers 11

"The enemy of great is perfect!" Best Treatment for Beautiful 27 Year Old with Minimal Facial Asymmetry

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Hi Cat,

First of all you are young and beautiful (as well as extremely critical of yourself.)  You have a slight ptosis of your left eyelid that can be corrected surgically, and you may have a little Restylane filler injected in the lower eyelid hollow areas.  That being said, if you were my daughter, girlfriend, wife, or patient I would likely tell you to do nothing but enjoy your youthful beauty in good health.  Should you choose the treatment route, please make sure that you choose your treating physician most carefully to avoid problems.  "The enemy of great is perfect!"  Good luck and be well.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Less is more.

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Many of the options you have listed are not appropriate for you.  It is critical to understand that surgery can use up the precious resources that make you look youthful.  Once they are gone, the are gone forever.  For that reason, the absolute best strategy requires some honesty and humility about what should and should not be done.  Your photos are relatively low resolution so what they suggest and what would be recommended based on an actual physical examination will differ.The most obvious concern is the eye area.  You have a mild left upper eyelid ptosis with a compensatory brow elevation.  Both upper eyelids exhibit eye lash ptosis.  A careful assessment would determine which ptosis approach would be ideal for you.  I suspect that you have about 1 mm of ptosis.  correcting this and also performing an anchor blepharoplasty to support the eyelashes will brighten you eyes powerfully.  The lower eye does not exhibit herniated orbital fat.  What looks like a "bag" is actually your orbital rim, which is part of the facial skeleton.  Fat grafting is a terrible option for this because is causes scaring is tissue planes that have to glide when you smile.  You will hate the bunching it causes when you smile.  Hyaluronic acid filler in this area will be a powerful option for you that can be maintained for a very long time, possibly pushing lower eyelid surgery out into your 40's.  Forehead surgery in my opinion will not be a good option for you.  First it tends to be over done suggesting the deer in the headlight effect.  You have a longish forehead so some persuasive surgeons may try to talk you into a pre-trichial forehead lift which places a scar along your hairline.  They will tell you that the incision is beveled and hair grows through the scar and hides the scar in plane sight.  Unfortunately it does not.  It is true that hair will grow through the beveled scar, but the hair compresses so it is not a natural hairline and generally women who get talked into this proposition are very unhappy with the choice so be careful.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

What treatment options do I have for eyelid asymmetry and overall rejuvenation?

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Dear catreal09, An examination would be needed to give you the best course of action for your concerns however some of your photographs show some flatness in the cheek area that may be helped with Voluma or Radiesse. This should help detract from the appearance of hollowness under the eyes. I am not a big fan of injecting the tear troughs so other then possible volume added to your cheeks I would not advise surgery at this time. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Eyelid asymmetry and options

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Hi Catreal,
Thank you for your question and pictures you sent.  You are young and have beautiful eyes.  As a surgeon, I love to operate, but remember surgery has risks, as well as tremendous benefit.  I would recommend on holding off on anything surgical and attempt to correct some of the lower eyelid hollowness with Restylane or a dermal filler.  These fillers will typically absorb over time and or can reversed with an enzyme if you don't like them.  You can adjust the eyebrows with filler to simulate the subbrow fat pad and possibly smaller orbital/frontal bony formation.  Good luck!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Eyelid asymmetry -- see oculoplastic specialist

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Your left upper eyelid is more droopy than the right side (eyelid ptosis). That also makes the left upper eyelid appear more hollow.  You may be candidate for eyelid ptosis surgery. Filler injection can camouflage the asymmetry too.  For lower eyelids, there is some bags and some hollowness. Options include filler injection vs. surgery. See an oculoplastic specialist.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Eyelid options at 27yo

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Hello Catreal29-
You are young and look youthful. You have beautiful eyes framed by symmetric brows. Most everyone has a little bit of asymmetry and in you, as in many, it does not detract from your overall beauty. At this point in time, I would suggest leaving your eyes alone or, if you must, consider a little filler (HA) in lower lids. Please be aware that there is nothing without risk and even lower eyelid fillers can cause issues like bruising, overfilling and sometimes persistent edema. 
Good luck. 

Mark Anton, MD, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 38 reviews


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You have very little that looks aged or wrinkled.  You have a very slight ptosis of the left upper eyelid.  It is so slight that I would not recommend surgery.  When you look up, the fat in the lower lids will become more pronounced and accentuate the tear trough.  When you look straight it looks much better.  IF this slight tear trough bothers you, have some HA filler put in there.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Hollowness under eyes / cheeks

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Thank you for your question. You are absolutely beautiful, especially when you smile ! 
I do not notice any asymmetry in the pictures you have submitted. I did notice the hollowness in your lower eyelid and cheek area and would strongly advise  that you be evaluated by a Board Certified Facial Plastic Surgeon who has a lot of experience with injectables and facial contouring. I presume he/ she would propose to place some Voluma / Juvederm in your upper cheek area near the cheek/lid junction. This needs to be done FIRST (!!!) before attempting any filler in your tear troughs in order to ensure a natural result. (Otherwise if your tear trough gets filled first, it will look strange to have an empty cheek below it and a full tear trough !!!!! Also they would need to put a "ton" of extra filler in the tear trough if they don't fill the cheek first and that would look un-natural).  It needs to be done very slowly in a stepwise fashion, not all in one visit. I hope this helps ! I can't stress enough how important it is to go to a Board Certified, experienced  Plastic/ Facial Plastic Surgery Specialist since the anatomy in this area is very complicated and they need to have the proper prerequisite training. 

Best of luck in your quest, 
Dr. Anna Petropoulos
Boston's North Shore

Anna Petropoulos, MD, FRCS
Boston Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Tear trough filler

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Hi. Thank you for posting. First of all, you look good right now. In your photos, I can see that you have a mild tear trough and possibly early cheek deflation. It is most obvious when you look up. Obviosuly an I person exam is needed to evaluate you, but it looks like your best option is tear trough filler. Maybe some cheek filler as well. Since this is a more difficult area to inject, be sure go to an injector that is an expert at treating the trough. I wouldn't do any surgery at this time. Best regards, Ira Vidor, M.D.

Ira Vidor, MD
Newport Beach Oculoplastic Surgeon

Eye Rejuvenation

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Thank you for the question and sharing your photos. I do not see the asymmetry you are referring to, but placement of filler in your tear trough might look good. You should see an experienced injector in person for a comprehensive evaluation and discussion of possible options. 

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.