Severely Assymetrical Eyelids - What Type of Surgery Do I Need? (photo)

My eyelids are severely assymetrical, they have been like that ever since I can remember and I've always been very selfconscious about it. I'm 35 now and as my left eyelid started drooping, the right one didn't and so the difference in the shape of my eyes is even more noticeable, actually it looks like I had two completely "different" or "mismatched" eyes. The eye sockets are symmetrical though. What kind of procedure would I need to correct this, on one eyelid only or on both?

Doctor Answers 7

Asymmetrical Eyelids

Asymmetry of the eyelids is not uncommon. In your case, the major asymmetry is in your eyebrows – the right eyebrow is higher than the left, giving the appearance of a deeper eyelid crease on the right side. This is normal – many people tend to carry one eyebrow higher than the other  If this bothers you, there are several treatment options: eyelid and/or brow surgery, or non-surgical options like injections (Botox, Restylane). See a board certified plastic surgeon for an evaluation as he will have to access your muscle function and whether there are other factors that need to be considered for the best approach.

Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

The procedure you need is called a detailed personal consultation with an oculoplastic surgeon.

First, your mismatched eyes may be obvious to you.  However, do not be surprised if most people do not understand what your are talking about if you discuss it with them.

Yes you hare holding the right eyebrow higher than the left eyebrow.  You also demonstrate upper eyelid retraction in both upper eyelids.  In other words the two upper eyelids should be sitting lower than then they are.  Normally the upper eyelid margin sits just over the colored portion of the eye, called the iris.  In your case the left upper eyelid is retracted higher than the right side. 

It is important to confirm that you have upper eyelid retraction and this is not just a photography artifact.  Upper eyelid retraction can be an early sign of hyperthyroidism.  Even though you have recognized this asymmetry, this is not a reason to rush out and have surgery.  However, I think it is appropriate to have an evaluation by a fellowship trained oculoplastic surgeon.  The American Society for Opthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a geographic directory on its website that will help you find a well qualified individual where you live (asoprs dot org).

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Brow asymmetry

From the photo posted, we can see that the right brow is in fact higher than the left. That will certainly make the upper eyelid look a bit more hollow. Botulinum toxin [Botox, Dysport, Xeomin] can help lower the brow and subtley improve that appearance.

In addition, you upper lids seem a bit retracted. That, is you have a bit of a "stare" look. This obviously could be due to the way you are looking at the camera and subconsciously doing that. But if this you normal natural appearance, then you may want to consider an evaluation for Thyroid Eye Disease.

A consultation with an ASOPRS trained Oculoplastics surgeon is your best bet. You can find one close to you by going to the asoprs dot org website.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Asymmetric eyelids

From the one photo you sent, it appears that either the right eyebrow is higher than the left, or you are unconsciously holding it higher.  This can easily be determined with a careful physical exam.  Injection of Botox or a similar modulator, or surgery can correct this.

Michael Leff, MD (retired)
Bellevue Plastic Surgeon
5.0 out of 5 stars 10 reviews

Asymmetric upper lids

The previous doctors are correct- you are seeing less of the platform (where you put eye shadow) of the left upper lid because you have an unconscious drive to carry your right eyebrow higher.  We have studied this at Brown University, and determined about 60% of normal adults have this asymmetric preference to carry one brow higher.  Usually it is the dominant eye.  Most times it can be helped with a  little neuromodulator to the right forehead area.  Because this is more complex than the usual Botox patient, I recommend you see a physician who is very experienced with neuromodulators, and brow issues.


Yoash R. Enzer, MD

Yoash R. Enzer, MD, FACS
Providence Oculoplastic Surgeon
3.4 out of 5 stars 8 reviews

Severely Assymetrical Eyelids - What Type of Surgery Do I Need?

Hi.  The major asymmetry you have going on is your eyebrows.  The right eyebrow is higher then the left giving the appearance of a deeper eyelid crease on the right side.  You should see a qualified physician for your treatment options.  You may have non-surgical options (like Botox) as well.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Asymmetric eyelids are not uncommon.

Asymmetry of the eyelids is not uncommon.  I would note that your right eyebrow is higher than the left which probably contributes to the asymmetry.  At some point, if you undergo eyelid or brow surgery, this can be improved more than likely.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.