What can be done to fix this? Uneven after upper bleph? (photo) (updated)

I had upper blepharoplasty done in Feb 2012 for medical purposes. Then in Feb 2013, I had to have a revision, but just on the right lid. Now, the right eye appears larger than the left. I think it's because of my eyebrow, but I'm not sure. Since I've had the surgery the second time, it seems that brow is drooping and won't raise as high. Also, for some reason a tiny fat pocket has developed between the lid and the brow on that side. I hope there is something that can be done to fix this.

UPDATE: This Community Member has never had botox, filler, or any other additional surgeries (like a brow lift).  The original blepharoplasty was to correct ptosis and was covered by her insurance.  She has asked for this information to be added to her original question.

Doctor Answers 6

What can be done to fix this? Uneven after upper bleph?

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Please no more surgery... try BOTOX to help elevate your lid... Best to seek a few IN PERSON opinions from docs in your area/city..//

Your left brow is more peaked than the right

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It actually appears too high. Have you had either a brow lift or some botox to elevate the brow? The lid height appears fairly equal. I do not see any fat deposit in the lid. You really need to be seen in person to better evaluate the situation.

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

Uneven after upper blepharoplasty

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Pictures or an evaluation in person would be needed to fully answer your question about uneven upper eyelids after blepharoplasty. In general, there sometimes are minor surgical procedures that can be done to help with any asymmetry, but it is impossible to know if you might be a candidate for such treatment without visualizing the issue.

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

A photo would really help here

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there are several options but a photo would guide suggestions. This may range from simple skin excision to revision surgery and or fat grafting.

Please send before pictures

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You have indicated that you had blepharoplasty for medical purpose but not clarified what kind? You have mild ptosis of your left eye and the position of the left eyebrow is in response to the ptosis. You will need in person examination.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

You might need to see an aesthetic eyelid surgeon rather than an insurance based surgeon.

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I don't think your analysis of what is going on here is correct. I don't know what you had before eyelid surgery for "medical purposes," but you definitely have bilateral upper eyelid ptosis which is more pronounced on the left side. That is your anatomic left side as opposed to the right and left side seen in the photos. You also look so line free in the forehead that it seems highly probable the you have BOTOX in your forehead. This complicates the analysis of what is going on because BOTOX treatments can actually cause upper eyelid ptosis. So my advice to you will very much depend on whether you have recently had BOTOX or not. No history of BOTOX: If you had no ptosis before surgery then it is likely that your blepharoplasty injured your levator aponeurosis that connects the levator palbepra superioris muscle into the upper eyelid. It is very common for the surgeon to cut the levator when cutting skin and muscle from the upper eyelid. This weakens the tendon and cause ptosis after eyelid surgery. The left upper eyelid demonstrates ptosis that is greater than on the right side. There is a compensatory left brow elevation. What you need for this needs to be very carefully assessed at the time of an oculoplastic consultation. On the other hand, if you have a recent history of BOTOX to the forehead, it must be assumed that the upper eyelid ptosis is related to the BOTOX service. Generally ptosis after BOTOX service lasts a few weeks. However, I have seen about 10 cases where the ptosis last much, much longer than this. In two cases, the residual ptosis did not resolve for 12 months. For this reason, if BOTOX is the cause of the upper eyelid ptosis, my best advice is to postpone any consideration of further eyelid surgery for at least 6 to 12 months. In either case, you will benefit from careful assessment of your situation by an oculoplastic surgeon. The American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a geographic directory on their website that can help you find a well qualified surgeon in your area.

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