How can I make my eyelids more symmetrical? (Photo)

Question

I had ptosis surgery 2 years ago on my left eye (right eye in picture), the ptosis was congenital, but I feel it has made eyes more asymmetrical, as now I have a lid crease on left and not right and I feel that my eyelid looks droopy in the outer corner of my left eye compared to the right, can this be fixed? Or am I being unrealistic with results (right eye in picture)

Donald B. Yoo, MD, FACS · Answer

Based on your photos your lid margin appears fairly symmetric (distance from your pupil to edge of eyelid) but there is asymmetry in terms of the shape and size of your upper eyelid crease (supratarsal crease). It appears you have some excess skin on the right vs. left eye, which could be addressed during upper blepharoplasty. The height and shape of the crease could be set with anchoring sutures (supratarsal fixation) during the upper blepharoplasty to re-establish symmetry.

Zoran Potparic, MD · Answer

It is very difficult to achieve perfect symmetry after congenital ptosis correction; you seem to have very good result in that regard. A small amount of fat graft placed properly above eyelid crease may further correct current asymmetry; that requires a true master. Good luck.

Mohammad Dehabadi, MBBS · Answer

For a congenital ptosis repair, you have very good symmetry after your surgery. I would caution against chasing perfection with further surgery.

John B. Holds, MD · Answer

Congenital ptosis surgery is generally much more difficult to achieve perfect results in than adult acquired ptosis. From this one photo and without numerous details it is impossible to know if this is a pretty good result or can be significantly improved on. Having said that, I have certainly redone many similar cases with great results. 
Muscle function, details of prior surgery, any tendency for the eye to stay open at rest must be known. Definitely a case for someone with extensive congenital ptosis experience.

Mats Hagstrom, MD (license on probation) · Answer

The human phase is asymmetric. and we aspect of their face has a symmetry.
This includes the eyes and the eyes sockets.
Primary symmetry is primarily based on bone structure, but there can be soft tissue asymmetry in the eyelids as well.
During embryological development, the two sides of the face develop independently from each other, at least in the lower part of the face.
Eventually the two sides fuse in the midline.
 The human brain is seeing people with substantial degrees of asymmetry as being normal.
We don’t typically notice having a symmetry until we look at a face critically.
You can take any picture of any persons face and if you look at it critically you’ll see plenty of a symmetry in everyone.
Because asymmetry is normal You don’t notice it.
When people notice it on their own, they sometimes think of it as a flaw that distracts Aesthetic perfection. Aesthetic beauty has a little to do with symmetry and everything to do with balance.
Personally, I don’t think you should have any more surgical intervention unless it’s needed for other purposes.
Some providers will create a crease in the contralateral side when doing unilateral ptosis repair. Different providers also have different techniques for correcting unilateral eyelid ptosis. 
Some providers do it by removing a strip of skin and orbicularis muscle. Some do it by reinserting or tightening the elevator muscle tendon. 
If you want to create a crease on the other side, then that should not be all that difficult.
I don’t think other people see it as being an obvious defect but if it bothers you enough to have surgery, then you can consider having a correction.
Did your surgeon talk to you about this during your consultation before surgery? What kind of surgeon did your procedure? Was that provider and oculoplastic surgeon?
For complex procedures like unilateral ptosis I recommend patients seek out the help of highly experienced oculoplastic surgeons.
These procedures can be done by plastic surgeons, facial plastic surgeons, or oculoplastic surgeons.
In the end, the degree of experience and skill is what matters.
I generally always recommend people ask providers to show them an ample supply of before and after pictures before having any plastic surgery procedure.
Did your provider show you lots of before and after pictures of the procedure you had.
If so, did those patients have a one-sided Eyelid formation or change like in your case? 
Best,
Mats Hagstrom MD

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