Best way to correct tired-looking, uneven eyes? (Photo)

Hi, I'm 37; I've always had uneven eyes from a smaller right eye socket, a lot of prolapsed fat and lower right eyebrow. 8 years ago I had lower blepharoplasty, but the surgeon was a too conservative removing the fat pad from both eyes (right especially). I'm wanting upper and repeat lower blepharoplasty, but no brow lift. What would be the best way to fix the upper lid asymmetry without pulling the right eyebrow down, & what is a realistic outcome for obtaining symmetry and no bags in my case?

Doctor Answers 9

Eyelid asymmetry

Thank you for your question
correction of your upper eyelids would be relatively straightforward with an upper blepharoplasty incorporating tarsal fixation with a little more skin trim on the right than left. The lower lids look baggy due to some protrusion of the lower lid fat pockets as well as loss of fullness in the upper cheek making the lid and cheek look seperate. A fresher more youthful appearance results when the lid and cheek blend gently into one another rather than having a hollow(the tear trough) in between. This can be achieved with a combination of repositioning the orbital fat excess into the tear trough as well as adding to the cheek fat pad using micro fat grafting. I don't think any fat should be removed. The photos do not show enough detail to determine if augmentation of the cheek bones with implants would help as well but a full assessment should include this possibility and you should discuss it with an experienced plastic surgeon (or two) to get a clearer idea of what is possible as well as the risks and downtime associated with the various options.

Revision lower lid blepharoplasty and upper lid blepharoplasty.

Hi there,

Thank you for your question.

For your upper lids, a blepharoplasty incorporating tarsal fixation and accounting for your natural asymmetry will provide a good correction. It's fairly straightforward. Your brow position will remain stable, it won't be "pulled down".

Your lower lid is more complex. There has been previous fat removal, there is asymmetry, your cheeks are flat and there is a distinct tear trough.  Rejuvenating your lower lid needs to be considered holistically as "the lid cheek complex" rather than as the lower lid itself. I would recommend considering, for a definitive correction, a concentric malar lift (or upper cheek lift) along with lower lid surgery, and probably a subtle cheek augmentation, to improve the freshness of your appearance. I don't believe working on the lower lid alone will freshen your appearance particularly well.

I hope this helps.  There are some very good plastic surgeons in Sydney, so carefully do your research and see more than one for consultations.

All the very best

Howard Webster
Plastic Surgeon

4 lid bleph

You should do well with a 4 lid blepharoplasty.  For the upper lid, excising the excess skin should make the creases more even without pulling down the brow.  For the lower:  you want to save that fat and not remove it.  This is done with a fat repositioning surgery to move the fat down into the tear trough.  This helps to prevent hollowing post-op.  See an oculoplastic surgeon who does this procedure.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

Best way to correct tired-looking, uneven eyes?

The tired appearance is mainly from under eye bags but also somewhat from hooded upper eyelids. You are a good candidate for lower blepharoplasty (transconjunctival with fat redistribution) and upper blepharoplasty. See link below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 62 reviews

Asymmetry

You have a wonderful chance of achieving a beautiful result. Not to be too negative but you look as if you haven't had surgery.  You can fix all of this with proper surgery with an eyelid specialist.  Most patients have asymmetry and thus surgery must be designed to make up the difference between the two sides.  The Brows should be left alone and you should have upper and lower lid surgery.  Don't give up and best of luck.

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

#blepharoplasty

Hi

I don't think your brow will change with properly designed and executed surgery.  I think you need a conservative skin only bilateral upper lid blepharoplasty taking slightly more on the right to even them up.  My advice would be to then have a transconjunctival (inside the eyelid) removal of fat from the lower lids with no skin resection.

Regards

Damien

Best way to correct tired-looking, uneven eyes? (Photo)

Thanks for posting
You may have a mild ptosis ( droopy eyelid) that may need correction at the time of the upper blepharoplasty. This may explain the uneven eyelids and eyebrows. If you had a lower blepharoplasty 8 years ago, you may have a 'weak' under eye/ cheek bone and may be treated with fat transfer or fillers in addition to lower eyelid surgery. A  consultation with a Plastic Surgeon would be a reasonable first step. 
Best wishes

Eyelid surgery

I usually do  my eyelids where there would be perfection after the job done.  From picture I thought you had nothing done!  The procedure is simple in my hands.  Performed transconjunctival.  No cuts on skin no suture.  Healing in few days.  Upper lid has some ptosis which needs repair and also excess skin.  Brow wont change and is fine.  Price around $4000 for all

Afshin Farzadmehr, MD
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 34 reviews

Revision/enhancement of prior blepharoplasty

 Thank you for posting your question and photographs. You require four eyelid blepharoplasty to treat your problem. See a specialist in eyelid surgery for comprehensive evaluation and discussion of treatment plan. It should not be a problem to make you more symmetrical and less tired looking. Good luck. 

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.