One eye is more hooded and droopy than the other. What options are available to correct this?

Question

Over the last few years, my left eye has become more hooded and droopy than the right. I am wondering what the best treatment for this would be? Do hooding and droopiness require 2 different treatments? And lastly, would you suggest getting both eyes done (but more correction on the left), or just the left? Thank you.

Jason Emer, MD · Answer

For significant improvement, hooded eyelids require surgery if there is enough skin. For nonsurgical treatments: Radiofrequency (Thermage or Venus Legacy/Viva), injectable fillers, and a Botox brow lift can help contour the eyebrows and lift the eyelid skin. I recommend getting a formal evaluation with an experienced cosmetic dermatologist. Best, Dr. Emer.

Charles S. Lee, MD, FACS · Answer

The left eye muscle is not opening as well as the right side - this is corrected by reinserting the muscle more tightly to the lid cartilage. Your brows will descend as a result of this surgery, since your brows will not need to pull so much to help the eyes see better. The drop will occur over both eyes. Hence, the excess skin should be done on both eyes, in anticipation of the brow descent. If you like the current position of the brows, then a brow suspension will need to be performed to prevent the brow descent.

Joseph L. Daw, Jr., MD, DDS · Answer

You have excess skin in both upper eyelids but more on the left.  A difference in the amount of skin in the eyelids is actually common.  Upper blepharoplasty would be done by removing more skin on the left side than the right in an effort to minimize the hooding/drooping and balance the eyelids.  You also appear to have fullness in the inner corner of the upper eyelid, particularly on the left side.  This is typically due to an overly prominent fat pad that can be reduced.

Michael R. Macdonald, MD · Answer

Looking at the picture you provided, it looks like slight ptosis on your left eye.  I would need a complete evaluation to ask questions about any other treatments you may have received that may be contributing to the heavier left eye.  Once we've established what is causing it, we can proceed with a plan to correct this. Be Well!Michael Macdonald, FACS, FRCSC

Mehryar (Ray) Taban, MD, FACS · Answer

You may benefit from upper eyelid ptosis surgery, upper blepharoplasty, or both. Need to see an oculoplastic surgeon for more detailed evaluation.

Kenneth D. Steinsapir, MD · Answer

However, the right eyebrow is being held higher than the left eyebrow. This suggests that ptosis may involve both upper eyelids. If the left ptosis is only corrected, it is highly probable that the right eyelid will fall. This is called Herring's law ptosis. A detailed consultation will determine if you need ptosis surgery on just the left upper eyelid or both upper eyelids. I suspect that you need a ptosis repair in both upper eyelids. You will also benefit from a structured blepharoplasty to set your upper eyelid crease and firm the upper eyelid platform. This work will make your eyes your best feature.

Victor Liu, MD, FACS, FRCS · Answer

Hi, 
After more than 25 years of doing cosmetic surgery, I found that what makes a patient happy is whether the surgery can meet the patient's expectations.
In your case, if you just wish to correct the depressed areas in your upper eyelids, the simplest solution is just to inject the areas to fill them with a filler, which can be any of the synthetic materials such as hyaluronic acid, or use your own nana-fat.
If you also wish to correct the excess skin and fat and hooding of your upper eyelids, then you should have upper blepharoplasties with or without a brow lift.

William Portuese, MD · Answer

As long as there's no ptosis present, an upper blepharoplasty procedure can accomplish a nice cosmetic improvement for your upper eyelids. Everyone has some degree of  Eyelid asymmetry, and the amount of skin that is removed on each side during the blepharoplasty procedure is always quite variable depending upon the asymmetry. The goal is to make  the eyelids look more symmetrical. This procedure can be performed under local or general anesthesia as an outpatient procedure.

Robert T. Buchanan, MD (retired) · Answer

There is a difference in the brow position and excess skin in the upper lids. Because there is some excess skin in the eye with the higher brow, both eyelids will probably need treatment. Because of the eyebrow malposition, something will probably need to be done to at least the lower brow. It may also be possible to treat you with Botox to even the brows. Only a direct examination by an expert in eye and brow rejuvenation will be able decide what your best options are.

One eye is more hooded and droopy than the other. What options are available to correct this?

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