I started noticing this in high school, but it has gotten very noticeable in the last few years. I went to a eyelid surgery specialist and he recommended filler (Juvederm). It is expensive, and has to be repeated every year or so. I would rather do surgery, and wondering how this is fixed. I do not think it's ptosis, but actually caused by differences in the bones (orbit) beneath my eyelid. When I am puffy, it's not as obvious. If I am dehydrated it shows up much more.
Permanent Solution for Uneven Eyelids? (photo)
Doctor Answers 10
As you can see from the different answers below, it could be one of several problems. You can't make a 3 dimensional diagnosis from a photo. I am worried that the eyeball may indeed be sitting further back in its space. You need to see your ophthalmologist soon and he will rtefer you to someone for correction if that is indeed the problem.
Yes, experienced oculoplastic surgeon is the right call.
Looking at your photo, I am concerned that the right eye sits further back in the face than the left eye. There is a slowly progressive condition called silent sinus syndrome. I wonder looking at this photo if you might have this condition. If I were assessing you, I would have a low threshold for obtaining a CT scan of the orbits and sinuses. This condition is due to sinus disease with closure of the maxillary sinus opening. Over time the sinus gets smaller. Since the roof of this sinus makes the floor of the orbit, the eye also sinks as a result. Treatment starts with proper diagnosis, sinus surgery to open the sinus, and often orbit surgery to rebuild the floor of the orbit. There are other conditions that can also produce this picture. I recommend that if you are having difficulty finding an appropriately trained and experienced oculoplastic surgeon in your community that you consider being assessed at the closest University Medical Center with a Department of Ophthalmology and an Oculoplastic surgery service.
What is the cause of asymmetric eyelids?
Your eyelid configuration is unusual and more extreme than the usual degree of difference. I wonder if you ever had trauma to the right orbit? I would need a complete exam and possibly a scan of your orbits to further define the anatomy. A solution might require approaching both upper lids to "split the difference" and decrease the asymmetry.
Diana L. Elias MD
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Maxillofacial CT scan
Though the photo shows that there is asymmetry between the two eyelids, it cannot adequately provide a 3 dimensional picture.
As such you would need an in-person consultation. I would recommend either an ASOPRS trained oculoplastics surgeon [see link below] or a Craniofacial surgeon. Most University Medical centers will have both of these specialists.
A maxillofacial CT scan would be needed [with 3D reconstruction] to adequately assess the underlying bony structure.
Fat transfer for hollow upper eyelids and brows
Fat transfer to the upper eyelids and brows is an option for hollow upper eyelids and brows, such as your case. Fillers are an option too and although fillers are not permanent initially, fillers around the eyes can last many years after the second treatment. See an oculoplastic surgeon for evaluation.
You don't have ptosis, you have lid crease asymmetry which can be caused by a number of things. Simplest way to improve it is to add some volume to the upper lid area through Juvederm injection or fat grafting. One way to show you for sure it will work is to inject a little saline in the upper lid which will temporarily show you the effect of adding volume.
Surgery vs filler for eye asymmetry
The choice of surgery or filler really depends on which side you like better. The height of the eyelids is symmetric, but the skin folds very differently on the two sides. The area under the brow is full on the left and hollow on the right. Adding filler to the right side may help it look more like the left. Removing some skin on the left would help deepen the sulcus and make it look more like the right.
I prefer the appearance of the side that is more full, so would recommend trying filler first. If you didnt like the filler, it could always be dissolved. Once you remove skin and make the eye look more hollow, it is difficult to go backward.
Unfortunately you are not alone. It can likely be improved with surgery but a thorough in person evaluation is needed first. This is not an easy situation to fix and if done incorrectly, it will be extremely difficult to revise and obtain satisfying results. Please consult with a board certified specialist who can assist you with this. You want this to be done right the first time.
Without an exam it is hard to answer your question. The photo is limited. In the past I have consulted patients with normal asymmetry as part of your genetics which make you unique. Many people have facial bone asymmetries in their face ( dominant/non dominant side). This is OK and won't change much after surgery. Wait until you are older with aging changes before you consider any surgery.