What kind of procedure would you recommend to achieve symmetry with my eyes? (Photos)

Question

I am writing to inquire about treatments for sunken and asymmetrical eyes. In 2024, I received upper eyelid filler to address hollowness and symmetry. While I was pleased with the initial results, the effects have diminished, and my eyes once again appear sunken. Before scheduling another filler appointment, I wanted to ask if there are more effective or longer-lasting solutions. Is there a specific procedure or treatment you would recommend to achieve better symmetry and reduce the hollow appearance of my eyes? Thank you

Zoran Potparic, MD · Answer

You do have a deep set eyes but,  very likely, a bilateral eyelid ptosis, droopy eyelids. This needs to be confirmed on the basis of in person evaluation. Correction of ptosis and conservative fat grafting would be my suggestion. Good luck.

Kenneth D. Steinsapir, MD · Answer

One eyebrow is higher than the other. I strongly advise against letting someone graft your subbrow area with fat. This is a bandaid approach to your issue that simply does not address the actual problem. A careful in person assessment will determine the status of your preaponeurotic fat. You have bilateral central levator disinsertion ptosis. The eyelid heaviness causes a reflex brow elevation. As noted one brow compensates more than the other. The fix is reforming the eyelid surgically by lowering the apparent upperlid crease, repairing the upper eyelid ptosis, repositioning the slipped preaponeurotic fat, and making a new hard crease at a lower location. By repairing the ptosis, the eyebrow will relax which contributes to fold volume. This restores the eyelid anatomy and contributes to a softer, more youthful appearing face.

Mehmet Ozdemir, MD · Answer

It is completely natural to look for a more permanent solution now that your upper eyelid filler has faded. For a long-lasting fix that beautifully addresses this type of deep hollowness (often called an A-frame deformity), autologous micro-fat grafting is highly effective; it uses your own living fat cells to structurally fill the hollows and establish a permanent, natural results. Alternatively, if your asymmetry is partly due to a slightly droopy eyelid muscle, a conservative surgical ptosis repair or an upper blepharoplasty can structurally lift and balance the lids. I highly recommend consulting with an oculoplastic surgeon, who can perform a physical exam to determine whether precise fat grafting or a minor surgical adjustment will give you the permanent, balanced rejuvenation you are looking for.

Carl Truesdale, MD · Answer

'Asymmetric eyes' is a description, not a diagnosis. Before any procedure, the specific source of the asymmetry needs to be identified, because the corrections are completely different.
Common contributors to eye asymmetry:
Eyelid position (ptosis): One upper lid sits lower than the other. If the lid margin covers more of the iris on one side, that's ptosis, and the fix is a ptosis repair &mdash; tightening the levator muscle on the affected side. This is the most common reversible cause.
Brow asymmetry: One brow sits higher or lower, which makes the eye underneath look different even when the eyes themselves are symmetric. Fix is a targeted brow lift or strategic Botox.
Orbital or bony asymmetry: The bony eye socket itself is uneven. This is the hardest to change and sometimes a 'live with it' situation, though filler or fat grafting can camouflage mild cases.
Lower lid or under-eye asymmetry: One side has more fat herniation, hollowing, or skin. Fix is asymmetric lower blepharoplasty &mdash; treating each side to its specific need.
Globe position: One eye sits deeper or more forward in the socket. Often related to old trauma or thyroid issues. Needs an oculoplastic evaluation.
You mentioned 2024 &mdash; if you had surgery or an injury that year, that history is important and you should bring those records to any consult.
Most important point: perfect symmetry is not a realistic goal. Everyone's face is asymmetric &mdash; the two sides are never identical. The goal of treatment is to reduce noticeable asymmetry, not eliminate it. Surgeons who promise perfect symmetry are overselling.
What to do: see an oculoplastic surgeon or facial plastic surgeon who specifically does eyelid work. Bring photos from before whatever happened in 2024, plus current photos. The exam should measure lid position (marginal reflex distance), assess brow position, and check globe position. The right procedure becomes clear once the cause is identified.

What kind of procedure would you recommend to achieve symmetry with my eyes? (Photos)

Answers (4)

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