Eye/eyebrow uneven. One eyebrow is higher than the other. What can I do to correct this? (Photo)

Question

For as long as I can remember I’ve always felt insecure about having one eye noticeably smaller than the other, but I’ve only recently noticed how unlevel my eyebrows are which I think makes my eyes look worse. I’m desperate to try and find out more about why I have this and what I can do to correct the issue as it’s making me massively upset. I’m only 25 years old but would rather have a fix than having to keep paying for Botox treatments every few months. Any advice would be greatly appreciated!

Lucian Ion, FRCS · Answer

The asymmetry in eyebrow position can be related to several factors including:
- differences in position of the eye socket which are universal
- differences in activity of the facial muscles which can be either due to nerve deficiency on the lower side or overactive tendency on the higher side
- overactivity on the side where the eyebrow is lower for the muscles that push it downwards as in focusing or frowning
- a weakness of the upper eyelid muscles on the side where the eyebrow is higher and a tendency to compensate for it by an over activity of eyebrow elevation. This is termed upper eyelid ptosis

It would be important first to eliminate upper eyelid ptosis because botulinum to the left side would level the eyebrows but would create also a problem with the appearance and possibly function for the left eye.

Botulinum toxin can help to lower the elevated eyebrow and can also help to raise the lowered position I brought. The elevation tends to be more effective laterally than towards the inner corner of the eyebrow.

The surgical alternative in your case would be a formal brow lift on the right side since the temporal lift would only address the outer corner of the eyebrow. It would also help to improve the symmetry in the appearance of the upper eyelid crease.

Even with a surgical intervention you cannot expect the symmetry to be perfect but might bring it to a level where it is no longer a concern to you.

Amir Sadr, MD, MSc (Plast), FEBOPRAS · Answer

Dear VAA122
Thanks for your question and sharing your photos. There are many reasons for asymmetric eyes. Looking at your photos I suspect the cause is the asymmetric bony skull and eye socket as it seems to be wider on the side with higher positioned brow. You need a clinical examination by a plastic surgeon who can assess and tell you what your options would be. They could range from simple measures such as botox to procedures such as brow lift or in some cases surgery on the bones of eye socket. It would be even better if you have a consult with a plastic surgeon who subspecializes in craniofacial surgery.I hope you find this explanation helpful.

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

Patrick Flaharty, MD FAACS · Answer

There are a number of reasons for eyebrow asymmetry including underlying orbital bone asymmetry and asymmetric activity of the frontalis muscle which raises the eyebrow. Although bone asymmetry is difficult to fix asymmetric frontalis activity can be easily improved with a small injection of Botox to relax the overactive muscle on the left side of your forehead which will bring that eyebrow down in line with the right eyebrow. Consulting with an Oculoplastic Surgeon experienced in this type of treatment would be a great place to get an assessment to determine if this treatment is right for you.

Eye/eyebrow uneven. One eyebrow is higher than the other. What can I do to correct this? (Photo)

Answers (4)

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