Alternatives for botox for eyelid ptosis? (Photo)

Question

I have uneven eyelids and quite literally feel the muscles on the right eyelid are much stronger then the left side. I have tried botox and it has fixed the issue, but i have experienced side effects and have decided to discontinue the use of botox. Is there any treatments or procedures that with help with evening out the eyelid and lifting the outer corner for a less tired look and more of "snatched" look? Thank you in advance

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photo. You have ptosis. That is a droopy eyelid due to a weak muscle. You can use eye drops (see Drop N’ Lift) or have surgery. Make an appointment with an experienced oculoplastic surgeon for evaluation and proper guidance. 
Good luck’!

C. Blake Perry, MD · Answer

You have slight drooping of your upper lids (ptosis), more on the left than right. You also have asymmetric platforms on your lids causing them to look asymmetric. The symmetry can be improved with surgery to raise the lids and remove skin in a thoughtfull manner. You need an in person consultation to determine the exact cause of the ptosis. Best to see an eyelid expert.

Mats Hagstrom, MD (license on probation) · Answer

Botox can work to help very subtle droopiness of the eyelids, but when it is significant, especially if it’s blocking peripheral vision, then surgery is indicated.
Usually surgical intervention is the way to go.
The upper eyelid has muscles that lift the eyelid and a muscle that closest the eyelids. 
It is possible to inject Botox in the orbicularis muscle, which alleviates the downward force and can help lift the eyelid slightly.
The effect of Botox is pretty subtle and surgery is by far a better option, especially if this is a significant concern.
The simplest procedure is to remove orbicularis muscle during an upper eyelid blepgaroplasty which kind of does what Botox does. 
A More official and appropriate surgical approach is to shorten the tendon of the muscle that lift the eyelid.
 This can be done to adjust the eyelids so they are set equally and raise one or both of the eyelids. 
The surgery can be done by plastic surgeon, facial plastic surgeons, but it’s probably better accomplished in the hands of an experienced oculoplastic surgeon.
There are also medical conditions that can cause weakness of the eyelid muscles. For that reason you may need to be evaluated for medical conditions like myasthenia gravis.
Don’t let my response scare you into any conclusions.
Droopiness of the eyelids is not uncommon and most cases do not have an underlying auto immune condition or serious underlying medical conditions. 
My point is that a good evaluation may be in order to make sure there isn’t anything else that needs addressing or treating.
To get an assessment and better understanding of surgical treatment options I suggest you consult with senior board-certified oculoplastic surgeons in your community.
If you consult with plastic surgeons or facial plastic surgeons then you should ask them how often they do these procedures, how many they’ve done and what the approach is going to be.Ask them to show you lots of before and after pictures. 
 Repositioning of the eyelids is a bit tricky and there’s no substitute for someone who has experience with the surgery to minimize the need for undesirable outcomes and need for revision surgery.
I’m curious what kind of provider you’ve been going to who did not recognize and encourage you to get a formal assessment by an oculoplastic surgeon?
Based on your picture, your condition is very much outside the scope of what is appropriate for Botox treatments IMO. 
Best,
Mats Hagström MD

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