Extremely asymmetrical eyelids. Do I need to get rid of excess skin on the right eye to treat the double crease? (Photo)

Question

I’m 26 years old and have had very asymmetrical eyelids my whole life, probably gotten worse with time. On the eye labeled “right” I have 2 crease lines and feels fairly thin lIke there’s excess skin that I can pull. On the eye labeled “left” there’s only one crease line and feels kind of padded. I researched blepharoplasty and if I’m correct I would need to get rid of excess skin on the right eye to get rid of the double crease? I would really appreciate some expertise before I book consults :)

Kenneth D. Steinsapir, MD · Answer

If you see surgeons who offer blepharoplasty, think you need a blepharoplasty, you are going to get a blepharoplasty. That surgery will permanently ruin your eyelids. Blepharoplasty is a surgery that cuts out skin, muscle, and fat. That is not your problem. Unless you have flipped you photographs, the side you have labeled right is actually your left side. Be that as it may, you have bilateral upper eyelid ptosis. The side you have labeled "right"does not have more "excess" skin than the right side. What it has is more advanced issues related to upper eyelid ptosis. You have more slippage of the anterior levator aponeurosis, which is the tendon of the levator palpebrae superioris muscle. With its slippage, anterior orbital fat associated with the upper eyelid fold also slides back into the anterior orbit causing the fold to collapse. The fix is repairing the ptosis and mobilizing the anterior orbital fat and repositioning back into the upper eyelid fold. If you let some well meaning surgeon remove that "extra" skin, you lid will look hollow and depleted, you will skeletonize the upper eyelids, and look much older. I guarantee you will be very unhappy with that result. Your eyes can be your best feature.

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photo. It appears that you have loss some fat behind the right upper eyelid. This is the cause of the depression above what appears to be extra skin. The left side has has more volume and a little extra skin. You should have a comprehensive, in-person evaluation with an experienced oculoplastic surgeon for discussion of treatment options. Good luck!

Mehryar (Ray) Taban, MD, FACS · Answer

You may benefit from left upper eyelid filler injection or something else. Need more detailed evaluation to determine. See an expert.

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