Asymmetrical eyes. What are my options? (Photo)

Question

My left eye (and really the whole left side of my face) is lower than the right. I think that my situation is due to bone structure. im wondering if anything can be done to minimize how drastic it looks. Ive been seeing more botox for eyes, but many people want to make their eyes look both bigger and more even , where i prefer my eyes when they are closed slightly, as i think it makes the aasymmety less obvious. Are there any people out there specalizing in eye symmetry? What are some options ?

Mehryar (Ray) Taban, MD, FACS · Answer

Eye asymmetry can have many different causes that needs proper eye evaluation in consultation to determine. Treatment depends on the exact causes.

Carlos L. Wolf, MD · Answer

You appear to have ptosis. Ptosis is a condition where one Eyelid is lower than the other. It may be acquired because of trauma or because of a tear in the levator mechanism of your eye lid. It can also be caused by a neurologic problem. Once you make sure that you do not have any potential neurologic condition then You can undergo repair of  your problem. Botox will make your asymmetry more accentuated.

Chase Lay, MD · Answer

An additional photo of you looking straight ahead would be helpful also.I think a combination of filler and botox could help a bit and it's a safer avenue to take.  A step beyond that would be strategic fat transfer to the left side of the face (and some areas on the right) to the cheeks, orbit, temple, hairline, and so forth.  An otoplasty on the right to pin the ear back will also distract from the symmetry.Beyond that you're looking at orbital floor augmentation on the left to lift the eye in addition to a combination of craniofacial surgery, implants and the like.Start with something safe and temporary before taking a very deep plunge to change all that. Besides that...you're actually quite pretty to so don't get carried away.Chase Lay MD

Daniel Lensink, MD · Answer

Your left eye sits modestly lower in your skull than does your right. This is because the entire boney orbit (eye socket) is lower in your skull on the left than the right. The only anatomically correcting solution would be an exceedingly drastic procedure to cut the bones around your eye socket, extending way back in your skull behind your eye, to raise the entire eye socket. This would be a crazy risky procedure wherein the benefit is far outweighed by the risk. We all have facial asymmetry to some degree. I doubt most people notice your condition, and I should know. I've had ten operations on my right ear. Because of it, my ears are woefully uneven, and almost nobody notices. I've used myself as an example for patients concerned about asymmetry for decades. You have a very pretty face and should not allow this matter to distract you from thinking so.

David A. Sieber, MD, FACS · Answer

Thanks for the great question. After looking closely and your photos, it seems like you mostly have a bony problem where the bony structure of your left eye sits lower. The most drastic thing to do would be to divide those bones and move your left side up so it's more even. This however requires a very invasive surgery. Things like fillers and botox may help a little, but they may also create new asymmetries that weren't there before. I don't know of anyone that specializes in non-surgical treatment of asymmetry. Find a doctor you trust who is willing to work with you. There might be some trial and error until you find a combination that works. Best,~Dr. Sieber

Shoib Myint, DO, FAOCO · Answer

Hello browzzz,You certainly have some asymmetry with your left side being lower than your right. There are many causes for this from bony infrastructure to musculature to fat to skin. There are many ways to fix this and will depend on a mutual agreement with you and the plastic surgeon. Remember to weigh the risks vs the benefit for best outcome. Surgical lifting to volume augmentation to neuromodulators are reasonable options. My suggestion is to see out an expert oculofacial or facial plastic surgeon to get a detailed evaluation and management plan. Hope this helps.Cheers

Kathleen Waldorf, MD, FACS · Answer

Thanks for your question.
Based on the photos you posted, you do have asymmetry of your face and it is most certainly derived from the underlying skeletal anatomy rather than soft tissue of your face. This is very very common and most people, if you look closely, have some degree of facial asymmetry. This type of facial asymmetry is not easily corrected or adjusted. I would invite you to speak with a highly reputable board certified plastic surgeon who does a high volume of facial recontouring operations to discuss your concerns, but be prepared to be told that little should or could be done to improve your skeletal asymmetry.
Best wishes

Sara A. Kaltreider, MD (retired) · Answer

Your least invasive options would be Botox over the right eyebrow, Botox along the lateral orbital rim for the left eyebrow, and filler along the cheekbone on the left. These options would not correct - and actually might increase - the asymmetry of the upper lids. There is a greater distance from the lid margin to the brow on the left compared to the right. Surgical options include left brow lift, and cheek implant on the left. In your photo it appears that you have ptosis on both sides - but repair is elective and up to your personal preference. I would recommend trying the least invasive options first as they are temporary with Botox and reversible with HA filler. Best wishes with your decisions.

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