How can I fix my uneven eyes? (Photos)

Question

My eyes are becoming noticeably more assympetrical and I am quite self conscious. Curious as to what type of procedure I need to fix this and the approximate cost. Thanks

Kenneth D. Steinsapir, MD · Answer

The anterior levator aponeurosis is the tendon that supports and raises the upper eyelid. Over our life times they are slowly separating from the tarsus, the hard platform of the upper eyelid. This seldom occurs symmetrically. In you case, the left upper eyelid (your left, right in the picture) is heavier than the right side. There is also compensatory eyebrow elevation which is also stronger on the left side. You can see that the left brow tends to ride a bit higher than the right. In the third picture, you eyebrows are more relaxed and it appears that you have more upper eyelid volume. That volume is the upper eyelid fold. With stronger brow compensation, that volume is missing and it simply looks like you simply have too much skin. You do not. Fat associated with the sub-brow tissue and anterior orbital fat contribute to the upper eyelid fold. With the partial disinsertion of the anterior levator aponeurosis, anterior orbital fat associated with the levator is retracted into the orbit. The heavy lid causes the brain to compensate for the heavier eyelid by raising the eyebrow. This lifts the skirt of fat from the sub-brow area so it is not available to contribute to the upper eyelid fold. The fix for this is not radically removing upper eyelid skin. That is precisely what most eyelid surgeons regardless of their primary training will offer you. That will permanently hollow you eye leaving you with an innie eyelid. The actual fix is to repair the partial disinsertion of the the anterior levator, form a new hard crease at about 6.5 mm and mobilize the anterior orbital fat so it sits forward to contribute volume to the upper eyelid fold. On personal examination I would also assess the lateral canthus. I suspect that this area is also slightly disinserted and if so, this should be corrected at the time the upper eyelids are reconstructed. I strongly advise you to be careful when you see other surgeons. Sadly they do not seem to understand this set of issues and simply offer subtractive blepharoplasty which will harm your wonderful youthful appearance. Your eyes can be your best feature.

A.J. Amadi, MD · Answer

There is a eyelid asymmetry, however if we look at the photos very closely, you can see that the right eye socket and eye is slightly higher than the left side. This is usually a congenital anatomic variation; that is, it is present at birth. However, if you feel that the asymmetry is becoming worse, you may want to have an oculoplastic/orbital surgeon evaluate you, possibly with a CT scan or MRI. Sometimes the soft tissue asymmetry, is due to underlying bone changes. 
Good luck

Mehryar (Ray) Taban, MD, FACS · Answer

I believe you can benefit from asymmetric upper blepharoplasty and filler injection but need more detailed evaluation to determine accurately.

How can I fix my uneven eyes? (Photos)

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