Age 35 - Asymmetrical eyes as I've aged. What's causing this and how can it be fixed? Botox? Surgery? (photos)

Question

I’m only 35. One of my eyelids is looking more and more asymmetrical as I age. It never used to look like this. Do I need bleph surgery or is it more muscle related? I used to raise my right eyebrow a lot when using facial expressions. I am wondering if over time this has changed the shape of my eye and Botox will fix it. Or is is more eyelid shape/skin/sagging that is causing it? One eye looks normal -the other (the one on the same side as the single eyebrow raise) is open and bigger in height.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as i can see from the photos your right eyes area are very downward this is the reason for the asymmetry between your eyes. I suggest you endoscopic brow lift. This way the symmetry will be much better than now. Please keep in mind that %100 symmetry is not achievable.Best Regards!

C. Blake Perry, MD · Answer

You have a slight ptosis (drooping) of the right upper lid. This creates a larger tarsal platform show and makes the eyes appear uneven. This can be fixed surgically to make the eyes more symmetric.

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

Zoran Potparic, MD · Answer

Based on these photos, you are developing condition known as eyelid ptosis (sagging eyelid). It would be in your best interest to address thiss issue with a board certified plastic or oculoplastic surgeon in your area. Good luck.

Kenneth D. Steinsapir, MD · Answer

Your ptosis is worse on the right side than the left. You have bilateral upper eyelid compensatory eyebrow elevation that is stronger on the left side. The type of ptosis you have is central levator disinsertion ptosis. This requires aesthetic ptosis surgery which is very hard to find where you live. It is not addressed with blepharoplasty which is cosmetic eyelid surgery that removes skin, muscle, and fat. It is not fixed by Botox or a forehead lift. The type of eyelid surgery that you need is crease lowering, upper eyelid fold reconstruction, anterior levator resection ptosis, and anchor blepharoplasty. That will correct the position of the upper eyelid and store your upper eyelid folds. Be skeptical of anyone who wants to schedule surgery based on a zoom call. You need an in person, detailed assessment. Your eyes can be your best feature.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi Christine
Firstly the asymmetry you point out is very mild but I agree it is noticeable. I dont think any nonsurgical options are going to help.  Your main problem causing the asymmetry is that you have mild ptosis (or droopy lid) on the left and moderate on the right. This means the Right eye is droopier and the ocular aperture (opening of the eyes) is not as wide as the left. This secondarily means the eyelid crease is also asymmetrical.  In addition you have a small amount of excess skin on both sides that could be addressed at the same time as the ptosis.
Regards
Damien

Thomas Spalla, MD · Answer

Overall, the 2nd and 3rd pictures give the most information.
It looks like the orbit (the bone space) is lower overall on the right. That being said, you appear to have some ptosis (droop) to the right eyelid which is lengthening it in appearance. I'd start with an ophthalmology evaluation to document ptosis and rule out a condition such as ocular myasthesia gravis.

Camille Cash, MD · Answer

From your photos it appears your asymmetry is a result of a droopy upper lid (ptosis).  This would need surgery in order to correct it.  Botox will not address it.  Visit with a board certified oculoplastic surgeon for a consultation to learn more.

Cengizhan Ekizceli, MD · Answer

Thank you so much for your question, dear Christine! Based on your pictures you can perfectly benefit from Upper Eyelid Blepharoplasty and Eyebrow Lifting. It will open your look and give you youthful and fresh appearance. Hope it helped!

Age 35 - Asymmetrical eyes as I've aged. What's causing this and how can it be fixed? Botox? Surgery? (photos)

Answers (9)

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