How to fix asymmetrical eyes? Is this just happening with age? (photos)

Question

I’m 33 years old and I guess my eyes have always been slightly assymetrical but lately I feel it looks much more drastic. Is this just happening with age? Can this be fixed easily? It’s super distracting to me when I see a picture of myself now.

Kenneth D. Steinsapir, MD · Answer

You have bilateral central levator disinsertion that is more advanced in the left upper eyelid. The levator aponeurosis is the tendon of the palpebrae superiorus muscle that opens the eyelid. Then tendon is held across the tarsus of the upper eyelid with loose areolar connective tissue and the aponeurosis itself is subject to fraying.. Over time those contributes to a splaying out of the tendon in the eyelid. The posterior capsule of the tendon may still be in place over the tarsus but the bulk of the levator get splayed out and effectively retracts into the anterior orbit with the pre-aponeurosis fat. This causes the upper eyelid crease to slip upward and accounts for the high or absent crease, high hollow sulcus, poor support for the  eyelid lashes. There is upper eyelid ptosis and a compensatory eyebrow elevation. Your surgeon has no idea how to address this except perhaps with posterior approach ptosis surgery and subbrow fillers. Many will tell you the fix is removing the fold in the right upper eyelid. Neither of these “fixes” are right. The Mullerectomy (posterior approach ptosis surgery) is inadequate to address your concern. You need the disinsertion tendon repaired and repositioned back into its insertion in the eyelids. This needs to be performed with an anchor blepharoplasty with crease lowering and fold reconstruction. Don’t get the wrong surgery from a well meaning surgeon. Simply removing the right upper eyelid fold will leave you looking older, not younger. Don’t do that to yourself. There is no substitute for an in person assessment.

C. Blake Perry, MD · Answer

The symmetry of the eyes depends upon the eyelid height, brow position, and soft tissue around the eyes. It appears you have a slightly droopy left upper lid with a corresponding lifting of the left brow (frontalis over action or compensation). This makes the eyelid platform longer compared to the right side. Surgery can improve the symmetry. Best to see an eyelid expert.

Zoran Potparic, MD · Answer

It appears that you have droopy eyelid on one side. That is condition that can be corrected surgically. Consultation with board certified plastic or Oculoplastic surgeon is recommended. Good luck.

Camille Cash, MD · Answer

We all have facial asymmetry to some degree and fortunately have a few tools to improve it.  From your photos it appears you have brow and lid asymmetry.  You may consider Botox which can help to bring this into better balance.  If it is still bothersome to you, you can consider surgical intervention for improvement.

Oakville Plastic Surgery &amp; Medspa · Answer

Botox can significantly improve the variance in your eyes. It is very possible for your eyes to appear much more balanced, as I've personally helped clients who are much more asymmetrical than you by manipulating muscle strength through botox. This includes opening the upper & lower eyelid and raising or lowering the brows. The treatment would not be very inexpensive (under 20 units). I recommend finding a nurse or doctor injector who is experienced in clients who have had a stroke, nerve paralysis or bell's palsy.

How to fix asymmetrical eyes? Is this just happening with age? (photos)

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