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.
