I don't expect that you can create perfect symmetry in eyes. Why create this asymmetry?

Frequently I see incision lines that are quite different on a patient's left and right eye; the incisions are NOT at the same height NOR along the same trajectory/curvature. Consequently there is a noticeable difference in lid margin from lash to crease AND from inner to outer corner and often additionally there is a big difference in loose skin "overhang" draped over the crease. WHY create this asymmetry?

Doctor Answers 5

Eyelid

Grace60, Incisions should be as symmetric as possible. Send photos if you have a more specific question. As usual seek the opinion of several facial plastic specialists with years of experience. The only reason one eye could be significantly different one side versus the other would be if the patient has significant eyebrow assymetery which can directly affect the fullness of the upper lid area.  Hope this helps. Good luck!


Charlotte Facial Plastic Surgeon
4.8 out of 5 stars 45 reviews

Asymmetry in the Eyes After Blepharoplasty?

Your question is not clear.  Are you talking about surgery that you had and the results?  I would re-post your question with pictures if possible. 

In regards to incisions for an upper blepharoplasty, they should be make at the same height and trajectory on both sides.  On women, the lower extent of the incision typically lies between 8mm and 12mm above the eye lash line.  The amount of skin to be removed should be identical between each sides.  At least 20mm of skin should be left between the eyelid and the bottom aspect of the thick skin of the eyebrow region.  

During and upper blepharoplasty, I use a caliper (a precise medical ruler) to ensure I have symmetry between both eyes.  

I hope this helps.  

Why are eyelid incision asymmetric in a well-performed blepharoplasty?

This is an excellent question. In a perfect world, patients would present for upper blepharoplasty with perfect symmetry in their brow height, orbit (eye bone) shapes and volumes, amount of fat in each eye socket, globe (eyeball) sizes and shapes, amount of excess eyelid skin present, and degree of sun damage and elasticity changes between the left and right eye.

In reality, in every patient, each of those factors weighs differently between the left and right eye. Patients present with one brow slightly higher or at a different angle than the other, asymmetric eye sockets, asymmetric skin creases, asymmetric skin folds,asymmetric fat volumes, and so on.

Creating the most balanced results after surgery requires that the amount of skin and fat we leave behind be equal between the two eyes - not that we remove the same amount from each eye. Creating the best symmetry frequently demands different amounts of skin and fat excision from each upper eyelid, and doing that requires different incision lengths (and occasionally different placements) between the two eyes. Put another way, if we want to prune two bushes to the same shape and size, we need to cut more away from the bigger bush.

Fortunately, these asymmetric eyelid incisions typically fade to near-invisibility, leaving behind the most symmetric final lid shapes possible. On the other hand, if we arbitrarily took the exact same measures with skin and fat excision on each eye to assure symmetry of the early, visible incision lines, the resultant asymmetry of the eyelids would be a poor surgical result, even after the incision lines faded.

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 169 reviews

Symmetry

As an eyelid specialist my goal is too make the result as symmetric as possible between the two eyes. That being said almost everyone has some asymmetry. I intentionally make the two incisions different inorder to make up the asymmetry in the surgery.  It usually isn't the incision that make the results asymmetric. They actually heal almost invisibly. It's the lack of removing the right amount of skin from each lid that creates the asymmetry. Us eyelid surgeons measure to within .5 mm when we are outlining our surgery. This is a very different approach from other types of surgeons. I always warn my patients that their incisions are going to look different on both sides right after surgery but this leads to similar distances from lash to lid fold and most importantly the same arching shape of the eyelid fold. Hope this helps.

Katrinka L. Heher, MD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 8 reviews

Asymmetrical eyelids

Every one has some degree of asymmetry regarding their eyelids. Some patients have significant asymmetry. When performing upper and lower eyelid surgery, we attempt to make the eyelids look more symmetrical by differential placement of the incisions including the length and height, and the amount of tissue that is removed which includes skin, muscle, and fat in an attempt to make asymmetrical eyelids lookmore symmetrical. For many examples, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 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.