Unsymmetrical eyes + eyebrows - nonsurgical options? (Photos)

Question

Is there anything I can do non surgically to fix asymmetry in the eyes and eyebrows? My left eye always looks much smaller in photos and is also more down turned than my right. I don’t think i had this dramatic asymmetry when I was a kid. Last one is of me smiling.

Kenneth D. Steinsapir, MD · Answer

The ptosis, or heaviness in the upper eyelids, is often a bit asymmetrical. You also have retraction of the preaponeurotic fat pads which is a feature of central levator disinsertion. This is not fixed with Botox or fillers. Well meaning injectors may offer them. There is an FDA approved drug, Upneeq, which is a drop that helps open the eye. I am disappointed by this drug. Its effect is minimal and it is very expensive. I makes it difficult to recommend this but it is an option if you are motivated to avoid surgery. Surgically the Müllerectomy is the most popular ptosis surgery. Surgeons love it because it is a very simple surgery that does not take very long to perform. Many will also recommend upper blepharoplasty to remove upper eyelid fold. I would not take this approach. I think you will benefit the most by repairing the central levator disinsertion and repositioning the preaponeurotic fat pads to help restore the upper eyelid fold. This keeps the eyelid fold an outie rather than converting it into an innie which can skeletonize the eye appearance and make you look older. Often these eyelids need a lateral canthoplasty to preserve the almond shape of the eye. You may not be ready for surgery now but eventually you are likely to consider it. There is no substitute for a detailed in person consultation.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and being so thoughtful about your concern. First, I want to normalize what you’re noticing: nearly everyone has some degree of eye and brow asymmetry, and it often becomes more apparent with age, facial movement, and changes in muscle strength—not because anything is “wrong.”

From what I can see, your asymmetry appears to be driven mainly by muscle activity and brow position, rather than a structural problem with the eyes themselves. That’s actually good news, because it means there are nonsurgical options that can help.

Here’s how I would think about it:

1. Subtle neuromodulator (Botox/Dysport) balancing
This is often the most effective nonsurgical tool for this type of asymmetry. One side of your face appears to have slightly stronger muscles that pull the brow downward and give the eye a more downturned, closed appearance—especially noticeable when you smile. Carefully adjusting muscle activity can:

Allow the lower brow to lift slightly

Open the eye that appears smaller

Improve symmetry both at rest and with expression

This is very nuanced work—tiny differences in placement can make a meaningful difference.

2. Brow position support (without surgery)
If the brow tail on one side sits lower, small adjustments with neuromodulator can subtly elevate it. This is not a dramatic “brow lift,” but rather a soft rebalancing that keeps your expression natural.

3. Volume support (select cases only)
In some patients, a very conservative amount of filler to the brow bone or temple region can improve symmetry by supporting the soft tissue. This is only helpful when volume loss is contributing—and should be done sparingly to avoid heaviness.

4. Why this likely changed over time
It’s very common for asymmetry to become more noticeable in adulthood due to:

Habitual facial expressions

Sleeping patterns

Stress-related muscle tension

Natural facial aging (which is rarely symmetrical)

It doesn’t mean anything is “progressively wrong”—just that the balance has shifted slightly.

Bottom line:
Yes, nonsurgical treatments can absolutely help improve this type of eye and eyebrow asymmetry, especially when it’s driven by muscle imbalance rather than anatomy. The goal isn’t perfect symmetry (which doesn’t exist in real faces), but a more balanced, rested, and harmonious appearance that still looks like you.

Your asymmetry is subtle, and with conservative treatment, it can be softened without changing your natural expression.

Camille Cash, MD · Answer

We all have some degree of facial asymmetry and yours is certainly within normal limits.  Botox is a great tool to help improve this.  It can not only address dynamic wrinkles, but also give a conservative brow lift and address the brow asymmetry.  Visit with an experienced injector near you for treatment.  I've included a video that I hope you find helpful.

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