How to correct aging asymmetrical eyelids? (Photos)

Question

Hello. I am a 51 year old female with no prior facial surgery, injections, laser or any other intervention. My eyes have always been asymmetric, but things seem to be worsening with age. The left eye appears to be sunken and the right to have ptosis. In addition the left eyebrow seems a little higher. I am not looking for miracles, but would like to restore some symmetry to my face so I could enjoy wearing makeup. What would be recommended in my case?

Boris M. Ackerman, MD · Answer

It appears from your photos that in addition to normal aging changes, you have a  unilateral ptosis.  This can accentuate the asymmetry of eyebrows and the degree of fullness in the upper eyelid.  See an experienced plastic surgeon for an in person evaluation.  You probably could benefit from bilateral upper eyelids surgery with ptosis repair and possibly some structural fat grafting.

Mehryar (Ray) Taban, MD, FACS · Answer

The main cause of asymmetry is left upper eyelid ptosis (droopy) which causes the same side brow to go higher in order to help lift the droopy eyelid. You are a candidate for asymmetric eyelid ptosis surgery. See an oculoplastic surgeon.

Kenneth D. Steinsapir, MD · Answer

The left one looks a bit worse than the right.  There is profound compensatory elevation of the eyebrows.  Ptosis surgery will significantly brighten your appearance and allow your eyebrows to relax down.  This will help you look more awake and, yes, more youthful.  I recommend seeing a fellowship trained oculoplastic surgeon for a detailed assessment and surgery.

Manish C. Champaneria, MD · Answer

Thank your for your question and your excellent pictures.Asymmetry amongst eyes is common. In your case, you seem to have a higher skin fold on your left, when your eyes are open. This typically indicates levator dehiscence or stretching that occurs due to age or other causes. Furthermore, with your eyes open and closed, it appears that you also have excess skin over the eyelids. What I cannot glean from pictures is the function of your levator muscle, and abnormal fat protuberance, and pupil and ocular mobility, and any pathology with your brow or forehead. Also, other causes of ptosis must be ruled out. That being said, a visual field test is also another exam that will provide information about visual field blockage. I believe a bilateral upper eyelid blepharoplasty with reinsertion of your left levator is an option. I recommend seeing your plastic surgeon for a personalized consultation and a more thorough evaluation (not gleaned from only pictures) to formulate a solid treatment approach.Regards,Manish Champaneria, MD

Howard Sutkin, MD · Answer

Thank you for your questions.  It sounds like a lot is going on in your case.  A well seasoned plastic surgeon who does a lot of eyelid work will be able to look at your face and study it with and without expression testing.  This will determine the diagnosis.  You may have brow muscle weakness or hypertonicity, you may have eyelid muscle weakening or aging and you may have both.  The good news is that all of these conditions are treatable.  Surgical correction of face asymmetry is the most challenging but most rewarding part of plastic surgery of the eyes.  I tell my students - it's not important how much skin/muscle I remove from each side of the eyelid - the key is how much is left behind.  Chances are you can have an awesome result with the proper diagnosis and treatment of your problem.  Good Luck.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

You would benefit from an in person examination by a board certified surgeon. What appears as an eyelid asymmetry may be the result of ptosis of the lid. You may need ptosis repair in addition to blepharoplasty for your eyelids.

Karthik Ram, MRCS, DNB · Answer

Hi, Your problem is caused partly by your  droopy eyebrows and partly by the loose excess skin on the eyelids that happens with aging.they can be easily corrected by a brow lift with an accompanying blepharoplasty . So contact a qualified plastic surgeon.

John R. Burroughs, MD · Answer

From your pictures you have a superior sulcus deformity (sunken in) on the left side and indeed your left eyebrow is higher than the right.  I first off suggest a consultation with an oculoplastic surgeon (preferably affiliated with ASOPRS).  A sunken eye can sometimes be a harbinger of an orbital malignancy (e.g., breast cancer).  Measurements can be done during the consultation to see if the eye is indeed sunken back (enophthalmic).  Sometimes imaging is needed of the bone sockets.  If serious secondary causes to your situation are excluded then you could try some botox over your left eyebrow to relax it and this would cause your upper eyelid skin to appear similar to the right side.  Dermal fillers or fat can be injected into the upper sulcus as well, and there are orbital implants that can be helpful.  Removal of some of your upper eyelid skin on the right may make it appear more similar to the left side, but this would pull the right brow down further worsening the brow symmetry.  As you can see this can be a somewhat complicated situation to evaluate and manage.  Robert Kersten and Reza Vagefi are at UCCF and are outstanding oculoplastic surgeons.  Best regards.

How to correct aging asymmetrical eyelids? (Photos)

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