How can I correct my uneven eyes? One eye is noticeably smaller than the other especially when I smile.

I've unequal eyes, the white portion of my one eye is more visible and is less visible of my other eye. I've been noticing this problem from a long time now and when i smile one eye almost closes. please describe the problem and tell me some permanent solution. left eye is big and right eye is small. incase you want to see more pictures, google " John Abraham"

Doctor Answers 11

Correct uneven eyes

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You do have asymmetry. You should consult with an an experienced and expert oculoplastic surgeon in person to understand your options and to understand the reasons for the asymmetry. 


West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Uneven eyes

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As this has been a longstanding problem, most likely you have what many of us do - facial asymmetry. Rarely there are medical conditions causing pathological asymmetry - such a Parry-Romberg, but if there is a continued change I would have an orbital and eyelid specialist evaluate you. With regards to one eye almost closing when you smile, I would have an eyelid specialist take a look and evaluate your ocular health to make sure your eyes are closing properly!

Sean Paul, MD
Austin Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Uneven eyes

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Many different situations can lead to uneven eyelids. Some of these can be treated non-surgically and conservatively, even using some very advanced injection techniques with filler or very precise placement of Botox. Some situations truly do require surgery to resolve. 

It is important that you seek a consultation with an eyelid expert to delineate the exact cause and treatment options.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.

Cameron Chesnut

#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 123 reviews

Smaller right eye

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If you feel that this problem has been going on for a long time, than likely you have typical facial asymmetry, which can be common. However, as we start to age, this problem can become more accentuated. From your photographs, it appears your right brow is also lower, which can give the appearance of a smaller eye. I suggest having an evaluation by an eyelid specialist who can take a complete history and thorough examination including a neurological exam. Treatments may involve surgery or even non surgical like botox to relax an overactive muscle around the eye or lift the brow slightly. Hope this helps.

Malena Amato, MD, FACS
Austin Oculoplastic Surgeon

Asymmetry

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The eyes are the most common place to have asymmetries. There are some main causes that most patients fall into. This is in no particular order. You will need a good facial analysis to determine as some of this is dynamic and needs to be assessed with movements.

1. Hypoplastic maxillary sinus (the eye then sits deeper in the eye socket giving a smaller appearance to the eye). This is not a medical problem but is important if you were to have sinus surgery

2. Upper lid ptosis (weakness of the muscles that open the upper lid). To diagnosis this we would need to see you in clinic. 

3. Brow ptosis (weakness of the muscle of the forehead which lifts the brow. This then leads to the upper lid being lower than it should be.

For you it is hard to tell exactly with still photos. The fact that it worsens when you smile makes me lean towards a muscle weakness/neural issue but again a good physical exam and facial analysis is required. 

Hope this helps.

Best of luck,

DrC

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

The Management Of Orbital Asymmetry

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There are multiple anatomic abnormalities that can result in facial asymmetry. These may include deformities of the orbital bones, eyelid soft tissue and eyebrows. In most cases, they are relatively minor, but in some cases, they may be severe and extremely noticeable. Depending upon the deformity, treatment may or may not be possible. Although it's hard to tell exactly what's going on from your pictures, I suspect you have boney orbital asymmetry. It appears that on the side of your lowered brow, you also have a depressed orbital rim and flattened cheekbone.



Asymmetry of the facial bones can be a major contributor to facial asymmetry. When this occurs, it's not unusual to have one side of the face that has a depressed orbital rim and flattened cheekbone and an eye that appears smaller than the opposite side. This is often related to a condition called plagiocephaly.



When this situation arises, it's possible in some cases to disguise asymmetry. Unfortunately, it's not possible to correct this deformity without major surgery. In this case, a unilateral brow lift in combination with Botox on the opposite side are both possible options. If you're considering treatment, it's important that you meet with a board certified plastic surgeon who can help you with this decision.

Combo problem requires combo treatment

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From your photographs, it appears that you have both ptosis (droopy eyelid) and dermatochalasis (fullness/puffiness) of your right upper eyelid. A combined ptosis repair and blepharoplasty would probably correct your problem. Make a consultation with an oculoplastic surgeon. 

Asymmetric eyes

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There could be combination of right upper eyelid ptosis (droopy eyelid) and right enophthalmos (sunken eye). There is likely pre-existing facial asymmetry with smaller right face area.  See an oculoplastic specialist for evaluation and possible treatment.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

How can I correct my uneven eyes?

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Your eyes definitely do not look the same.  The right eye seems relatively set back compared to the left giving it a smaller appearance.  You need a full examination by an Oculoplastic surgeon to try to determine what is going on.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

Hard to precisely know your issue without an actual consultation.

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From a casual look at the photos, the most likely assumption would be that you have ptosis, which is a heavy upper eyelid.  While this is the most likely possibility, another potential cause for your issue is enophthalmos.  This is the medical term for an eye that sits deeper in the eye socket than normal.  A prior history of an orbit fracture on the right side would be consistent with such a condition.  There can also be a progressive condition called silent sinus syndrome where inner opening to the maxillary sinus closes due to scaring.  This leads to a slowly progressive loss of maxillary sinus volume.  The loss of sinus volume corresponds to a gain in eye socket volume.  The eye socket sits directly above the maxillary sinus.  The first step in addressing this issue is to make a firm diagnosis.

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