What can be done to correct this (obvious) eye asymmetry? Is this ptosis? (Photos)

My left eye (my right eye in the pictures below) is obviously higher, and the crease is deeper. The lid appears to come down lower on my left eye, but I'm unsure if this is ptosis (or maybe slight hypertropia?). Is there anything that can realistically be done to help correct this asymmetry?

Doctor Answers 8

Unilateral eyelid ptosis

Yes, you do have left upper eyelid ptosis, which causes the same side eyebrow to elevate in order to lift the upper eyelid. It also causes the eyelid crease asymmetry. The treatment is upper eyelid ptosis surgery where the muscle responsible for lifting the upper eyelid is tightened. This can be done under local and conscious sedation. See an oculoplastic surgeon. See link and video below.


Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 61 reviews

Eyelid Ptosis

Thank you for sharing your case and photos.  You have ptosis of your left upper eyelid that can be corrected with a safe outpatient surgery.  Usually, the incision can be hidden on the back of the eyelid to ensure a nice cosmetic result.  Your insurance will likely cover the condition with an oculoplastic surgeon.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Treatment of eyelid asymmetry

It does appear as though you have ptosis of one of your eyelids.  This can usually be repaired with surgery.  I would recommend consulting with an oculoplastic surgeon or another surgeon with experience in ptosis repair.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Ptosis

I agree with the surgeons' answers below - your pictures show relative ptosis on the left, but you may have ptosis on the right as well. An examination by an Oculoplastic surgeon is important to determine whether you need surgery on just the left side, or both. An anterior skin incision approach gives precise control of the lid crease placement, lid fold symmetry, and contour of the lid margin. A posterior, conjunctival approach removes normal tissue and the surgeon has no control over these important anatomic features of the lid. Best wishes.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Ptosis

Hi Elle. Greetings from the UK! Yes I agree with others that you you've got an aponeurotic ptosis as shown by a mildly droopy left upper eyelid and elevated skin crease on your left hand side- commonly brought on in young people by contact lens wear.  You'd do well with ptosis correction surgery. I wouldn't normally recommend blepharoplasty surgery at the same time as skin crease reformation during your ptosis surgery normally would equalise matters giving you symmetry again. I personally perform these via an anterior approach and it works well for me anyway and allows me to reform the skin crease via an incisional technique. However it's increasingly fashionable for some of my colleagues in the UK to go for a posterior approach citing that the recovery time is a bit quicker with the option of adjustability. Whatever works in the end. Either way I'd recommend that your surgeon be able to demonstrate that they perform these ops regularly as if it goes badly, future revisional surgery can be a bit more unpredictable with a more adverse risk profile. Essentially the chances for a good result are highest at the primary operation. Yes I'd also agree with Dr Steinsapir's opinion about contralateral latent ptosis. Due to way your upper eyelids are innervated, essentially your elevation muscles within BOTH your eyelids are now working extra hard to compensate for the stretched tendon on your left hand side. Therefore this a risk that if you undergo ptosis surgery to YOUR left side, YOUR right upper lid may drop slightly as both elevation muscles relax in response. We call it a contralateral consecutive ptosis. Of course one can then have the right side done too at a later date as a second procedure but some surgeons would recommend bilateral simultaneous surgery if there are any signs of mild ptosis on both sides specifically for this reason citing that they get better chances of symmetry. Hope that makes sense! Complicated concepts...  bw David

David Cheung, MBChB, Bsc(Hons), FRCOphth
Birmingham Oculoplastic Surgeon

Difference in eyelid creases the bigger problem along with ptosis.

I think the reason for the asymmetry is more the unevenness in the folding pattern of the upper eyelids.  There is a very mild ptosis to the left eye but the upper eyelid folding pattern is more noticeable.  I would recommend a modified approach to blepharoplasty, which would be make the eyelid folding pattern more equal along with correcting the mild ptosis.  Good luck!

Eyelid asymmetry

Thanks you for posting your questions and photos!
It does appear that you have Left eyelid ptosis. This is a condition that can be corrected by repairing some of the levator mechanisms of your eyelid. You should be seen and evaluated by a reputable plastic/oculoplastic/facial plastic surgeon who has expertise in eyelid ptosis repair. They should be able to do an in depth examination and give you recommendations for repair.

Yes you have ptosis. Yes the left eye sits higher in the face than the right eye.

You also have a compensatory brow lift and left eyelash ptosis.  You most definitely do not want posterior ptosis repair for this issue.  Even if the neosynephrine test indicates that you are a candidate for a posterior conjunctival Mullerectomy surgery, I would not recommend it.  Your left upper eyelid is demonstrating a levator aponeurosis dehiscence.  That is the reason the left upper eyelid is hollow.  Also posterior surgery does not correct the eyelash ptosis.  With an anterior approach, a hard crease with an anchor blepharoplasty to support the upper eyelid lashes can be performed at the time the anterior elevator is repaired.  The other concern I have is that when there is a levator dehiscence, the Muellectomy tends under perform testing.  Finally, whoever you see for consultation needs to also assess the right upper eyelid for latent ptosis.  This avoids a surprise after surgery where the unoperated eyelid falls after surgery (Herring's law ptosis).  Hope this information is helpful.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

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