Brow and eye lift to correct asymmetry? (photo)

Question

Hi I have always had a bit of asymmetry but as I get older it has gotten much worse. I have had Botox and fillers but it never seems to really help.

Goretti Ho Taghva, MD, FACS · Answer

Hello jessphila, thank you for your question.  I highly recommend that you see a board certified plastic/ oculoplastic surgeon in person for a physical exam before a treatment plan can be made.  You may have ptosis on your right eyelid that leads to compensatory brow elevation on your right side.  If that is truly the case, ptosis repair and blepharoplasty alone should be able to restore some symmetry to your upper face.  However, if brow asymmetry is not a result of ptosis, then an endoscopic brow lift +/- blepharoplasty may be the treatment of choice.  Good luck!Goretti H. Taghva MD

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

Jonathan Kulbersh, MD · Answer

You have ptosis of your right eyelid causing your asymmetry.  You will require at a minimum a ptosis repair to improve the symmetry of the eyebrows and eyelids.  
I suggest consulting with a board-certified facial plastic surgeon with a good track record of successful ptosis repair and blepharoplasty procedures to find out which approach will work best for you.
I hope this helps!

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. Botox and fillers are temporary solutions, and a brow lift, eyelid surgery or both have the potential to create greater symmetry as well as reduce signs of aging. I suggest that you move forward and consult with a board certified facial plastic surgeon.
Best wishes,

Bahman Guyuron, MD · Answer

A large majority of eyebrow asymmetries are dynamic and are related to the forehead compensation for the eyelid ptosis (droopiness). This means that the muscle that is supposed to open the eyelid is not functioning properly and it is not lifting the upper eyelid enough and the forehead muscle comes to help and in the process the eyebrow gets lifted more on the affected side. If you measure the distance from your eyelashes to the first crease above the the eyelashes on the right you will find that it is longer than the left side. This is a sign of eyelid ptosis for us. Meanwhile, even with the compensation the eyelid is not opening enough on either side, more so on the right. However, Botox can cause all of this also. But, you indicated you had this before the Botox injection. I suggest that you consult a board certified plastic surgeon who has experience in forehead and eyelid surgery and understand all of this to help you properly.

Brett E. Stompro, MD · Answer

Thank you for the helpful photo. Body asymmetry is very common but some cases may be bothersome to the individual and more significant than others. If this is something that bothers you and you've tried non-surgical approaches, it may now be time to consider other options like surgery. For you, I would recommend a brow lift with overcorrection on the left side to result in an even brow position bilaterally. I believe this procedure alone will correct the asymmetry you are experiencing. I do not recommend any eye lift procedures at this time. Make sure you have an in office consultation to be properly evaluated. Good luck to you!

William Portuese, MD · Answer

The photographs demonstrate asymmetrical eyebrows, and asymmetrical  upper eyelids. It's important to evaluate patients for ptosis, and address that issue if it is present. Botox on the higher eyebrow can attempt to bring that brow down on a temporary basis. Trying to adjust the opposite brow upwards would most likely make the patient looked too surprised. As long as there's no ptosis present, an upper blepharoplasty can be performed for cosmetic purposes to make the eyelids look more symmetrical

Mark L. Mazow, MD, FACS · Answer

You appear to have ptosis (droopy lid) on the right side compared to the left. Your brain will compensate by attempting to raise that brow to raise the lid. You should consult with an oculoplastic surgeon who is specifically trained to evaluate cases such as yours. Simple office testing by an experienced surgeon can properly diagnose the issue and provide treatment options. It may well be that simply raising the lid to the appropriate height will normalize the brow.

Brow and eye lift to correct asymmetry? (photo)

Answers (8)

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