Can blepharoplasty help eyelid asymmetry? (Photo)

Question

I previously had squint surgery on my left eye. Since then, my eyelids have become uneven. One lower eyelid sits lower than the other, making my eyes look asymmetrical. My left upper eyelid also has a little more visible space. I've also noticed that when I lift my left lower eyelid, my vision seems to improve, and I can move my eye inward more easily without the restriction that I still experience after surgery. I'm not sure if this is significant, but I wanted to mention it. I also experience tightness around my eyelids and discomfort in my right eye. Overall, I think surgery could boost my confidence and help improve my vision. A plastic surgeon suggested that a lower blepharoplasty with an eyelid lift procedure might improve the asymmetry. However, I have received different opinions from several oculoplastic surgeons, so I'm unsure whether surgery is appropriate. Could lower blepharoplasty (or another eyelid procedure) help in a case like this, or could it potentially make the problem worse? Is the improvement I notice when lifting the lower eyelid something that should be evaluated further? Thank you for any guidance.

A.J. Amadi, MD · Answer

Based on this one photo alone, it is not possible to accurately diagnose whether your eyelid asymmetry is due to an eyelid problem (eyelid retraction), which can be caused by prior "squint surgery", otherwise known as strabismus surgery, or due to the fact that one eye may be more bulgy than the other eye, a condition termed exophthalmos or proptosis. 
An examination with an oculofacial plastic surgeon, also known as Oculoplastics Surgeon, would be your best option. 
In both cases, there are ways to surgically correct this problem. A canthopexy alone is not the fix, however. Either you can consider orbital decompression surgery for the bulgy eye, or eyelid retraction repair, usually with a graft, if the eyelid needs to be adjusted.

Zoran Potparic, MD · Answer

It appears that you have a condition called proptosis, in other words your eyeballs are bigger than bonny orbits and they are slightly protruding, pushing lower eyelids down. This can be confirmed only on the basis of in person evaluation. Correction of lower eyelids can be achieved with tightening, procedure called canthopexy; this should be done very carefully to avoid over correction which can push lower eyelids further down. I hope this helps. Good luck.

Julian De Silva, MD · Answer

Hi pn00, thank you for describing this so carefully. The details you mention are significant.

From your description and photo, this is not a routine cosmetic asymmetry. A lower eyelid sitting lower after squint surgery can reflect scarring or tethering of tissues the two areas share, and the fact that your vision improves when you lift the lid, together with the residual restriction of eye movement and the tightness you describe, tells me the functional side needs proper assessment before anyone plans cosmetic surgery.

My honest advice is to see an oculoplastic surgeon, a specialist in eyelid surgery around the eye itself, ideally one who can liaise with your original squint surgeon so the operative notes inform the plan. A standard lower blepharoplasty removes or repositions fat and skin; it is not designed to correct lid position after strabismus surgery, and performed in the wrong plane it can make things tighter rather than better.

The encouraging part is that lid position, comfort and symmetry can often be improved once the mechanism is properly understood. An in-person examination, ideally with orthoptic assessment, will give you a far clearer answer than photographs can. Your instinct to keep asking questions before committing is exactly right.

Can blepharoplasty help eyelid asymmetry? (Photo)

Answers (3)

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