What suggestions do you have correct my uneven brows and eyes? (photo)

Question

Ok really need a fat graft and a possible cathoplasty. (? - my almond eyes back) had a bleph 7 years ago, now my eyes are rounds and my eyeliner will not meet... Hollow doll eyes and uneven brows..... Suggestions

Earl Stephenson, Jr., MD, DDS, MBA · Answer

It is hard to make a critical evaluation based on your picture.  Hollowing of the area above the upper eye can be treated with conservative fat grafting sessions over time.Dr. ES

Boris M. Ackerman, MD · Answer

Previous eyelid surgery can result in certain unfavorable appearance years 
later.  In your particular case you might have had too much fat taken out from 
your eyelids.  Your photo is sub-optimal for thorough evaluation, nevertheless 
certain things are obvious.  The hollow appearance of your upper eyelid can be 
softened with  fat grafting, but this needs to be done with a very specific 
technique and instrumentation to avoid common pitfalls.   The uneven eyebrow is caused by a frontalis muscle spasm on the right side.  There are a 
few different causes for this phenomenon and some very specific treatment options.  A 
thorough evaluation by a plastic surgeon that’s an expert in eyelids and brow 
surgery is required.

Kenneth D. Steinsapir, MD · Answer

I am sorry to learn that you have had a very unsatisfactory eyelid surgery.  I can categorically state that the solution you are considering (canthoplasty and fat grafting) will not resolve your issues.  Your canthal angles in these photos look fine.  If you have vertical inadequacy of the lower eyelids, canthoplasty will not resolve this issue but can make the situation worse.  Shortening the lower eyelid which is what isolated canthoplasty will not lift the lower eyelid but rather force it below the curvature of the eye.  For the upper eyelid, there is a website out there that implies that this situation can be improved with fat grafting.  Having actually had the opportunity to examine individuals who have had this "fix."  It is my opinion that the method seldom accomplishes what is promised.  The difficulty is the scar tissue that forms each and every time grafted fat is placed into an eyelids.  Eyelid have gliding planes.  These grafts only further gum up the gliding plane.  A careful examination would be necessary to determine why you have eyebrow asymmetry and what needs to be done to improve the situation. Restylane filler in the sub brow area can help camouflage the hollow area by creating fullness.  Yes this can also be done by grafting fat into the eyebrow appropriately but this is very different than grafting fat pearls into the eyelid behind the orbital septum.

Jeffrey Zwiren, MD · Answer

From your photograph it is difficult to fully evaluate your anatomy and degree of asymmetry.  Fat grafting is a possible option but a physical examination is needed first.  It is possible that you were over resected and too much skin and fat were removed yielding a hollowed out appearance.

Darryl J. Blinski, MD · Answer

Over the internet very hard to respond. Best to seek IN PERSON opinions. Plus re post frontal looking photos could help in determining the eyebrow positions...

What suggestions do you have correct my uneven brows and eyes? (photo)

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