Would a single eye blepharoplasty be the right choice to make my eyelids even? (Photo)

Question

I've always had asymmetrical volume in my eyelids. I much prefer my eye that has less volume and more lid show. Would have a blepharoplasty only on the eyelid that has more volume be a good choice to give my the symmetry I'm hoping for?

Kenneth D. Steinsapir, MD · Answer

Likely both upper eyelids have central levator partial disinsertion. This is the tendon that raises the upper eyelid. Normally this tendon fans out and inserts across the upper eyelid tarsus. This tenon can and often does slip from its insertion centrally. Before it gives rise to upper eyelid ptosis, it causes a change in the position of the upper eyelid crease and induces a compensatory eyebrow elevation. Some call this latent ptosis. At some point and often after blepharoplasty, this tendon slippage can actually be the basis for the development of upper eyelid ptosis. Here it is the basis for your upper eyelid asymmetry. The fold is composed of skin and two fat volumes. One fat volume is contributed by the fat that lives under the skin and orbicularis oculi muscle under the eyebrow. The second fat volume that contributes to the upper eyelid fold is the pre-aponeurotic fat that lives behind the orbital septum. When the eye is open the septum relaxes and this volume contributes to the upper eyelid fold. With slippage of the central aponeurosis, the pre-aponeurotic fat also slips with the levator. That means less fat is available to contribute to the fold. Also when there is a compensatory eyebrow elevation, less sub-brow fat is available for the fold. That is why one eyelid does not have an apparent fold. Letting an eyelid plastic surgeon remove the normal fold (and this is what is commonly offered in these circumstances), both eyelids will be skeletonized without the correction of the underlying central levator disinsertion. The surgery does not result in a correction of the compensatory eyebrow elevation so asymmetry will remain. An alternative repair would be to perform crease lowering on both eyelids with a repair of the central levator tendons and an anchor blepharoplasty. I would counsel you to have the eyelid missing the fold corrected. The presence of an outie fold makes for younger looking eyes. If for some reason you did not like the effect, you still have the option of removing the fold skin but making a fold is much more challenging.

Mehryar (Ray) Taban, MD, FACS · Answer

Eye asymmetry is complex and it has to do with various structures. You may benefit from asymmetric upper blepharoplasty and/or filler injection. See an expert.

Thanapoom Boonipat, MD · Answer

looks like you don't like your right eyelid? Surgery can remove fat and elevate the lid show on the right. It is hard to make them completely match. The left eye, if anything, looks too hollow from my opinion.

Mats Hagstrom, MD (license on probation) · Answer

All people have facial asymmetry.
During biological development, the two sides of their face develop independently from each other and eventually fuse in the midline.
Facial aesthetics, including a symmetry is primarily based on bone structure.
Soft tissues tend to be much more consistent from side to side and from person to person.
Your ocular asymmetry is more likely to be related to bone structure than soft tissues.
For that reason, a unilateral blepharoplasty is unlikely to create improved symmetry.
The exception to this is in individuals who have unilateral ptosis which is a soft tissue condition. 
The human brain is accustomed to seeing other people with facial asymmetry as being normal.
You probably don’t think of your friends and family as people who have facial asymmetry, even though they do.
Because people tend to not see facial asymmetry unless it’s severe it’s better not treated. Because the asymmetry is primarily based on bone structure trying to address, it is much more difficult than people anticipate.
I think any attempt at a soft tissue correction for a skeletal based facial asymmetry is likely to lead to a disappointing outcome.
Best,
Mats Hagstrom MD

Would a single eye blepharoplasty be the right choice to make my eyelids even? (Photo)

Answers (4)

Answer: Facial asymmetry

Answer: Facial asymmetry

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Would a single eye blepharoplasty be the right choice to make my eyelids even? (Photo)

Answers (4)

Answer: Facial asymmetry

Answer: Facial asymmetry

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.