Revision blepharoplasty for asymmetrical eyes 2 years post-op? (Photos)

Question

I had upper Blephoraplasty 2 years ago. My eyes are very asymmetrical. I need to know if I can fix / improve this bad job I had. And what can be done to make my eyelids more even. Thank you

Kenneth D. Steinsapir, MD · Answer

You have upper eyelid margin contour peaking and upper eyelid crease asymmetry as well. Front the described syndrome features, you have upper eyelid ptosis, high upper eyelid creases, and hollsow upper eyelids. The left upper eyelid crease appears to be cut higher than the right and there is a peak in the right upper eyelid contour and lateral flare in the left upper eyelid. In addition, the horizontal width of both eyes seem short suggesting partial disinsertion of the lateral canthus. A very detailed in person assessment is beneficial is establishing what resources are likely to available in your eyelid to make your repair. Unfortunately, while there are some excellent oculoplastic surgeons where you live, I am not aware that they are doing the type of revisional blepharoplasty work you need to improve your eyes. You need a crease lowering surgery with fold reconstruction. During that surgery, the insertion of the levator aponeurosis needes to be repositioned to address the eyelid margin contour issues. There is no substitute for a detailed in person assessment. Your eyes can be your best feature.

Mats Hagstrom, MD (license on probation) · Answer

To make an accurate assessment regarding the outcome of a plastic surgery procedure we need to see a complete set of proper before and after pictures. All individuals have some degree of facial asymmetry, and for most people, the degree of asymmetry is really substantial. Sometimes people don’t notice the asymmetry, until after they’ve had cosmetic surgical procedures when they for the first time in their life, begin looking at themselves from a critical Perspective. 
It looks like your left upper eyelid has mild ptosis. Assessing eyelid position is more of a dynamic process because how you tilt your head has a big impact on the position of the eyelids.
The first picture you posted. It looks very good. I don’t think the result is all that bad and there may be issues visible and preoperative pictures. They could help explain why your results look at the way they do.
If you don’t have a proper before and after pictures, then ask your provider to forward the pictures they took. If your provider isn’t giving you the care you need, then schedule if you in person second opinion, consultations with other plastic surgeons, facial plastic surgeons, or oculoplastic surgeon in your community. For a second opinion, consultations patients should always come prepared bringing with them a complete set of before and after pictures and a copy of your operative report. It would also be a good idea to have a copy of your consultation note to get the assessment of your first provider.
You can get copies of your medical records by requesting them from your current provider.
If you have unilateral ptosis, which it appears that you made on the left upper eyelid than suspension of the levator muscle might correct this. Correcting unilateral ptosis is a fairly complex procedure and should be done by individuals who have a lot of experience and a proven track record.
I always recommend patients have multiple in person, consultations before scheduling, permanent, irreversible surgical procedures. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patient who had similar facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. Being shown a handful of preselected images representing the best results of a providers career is insufficient to get a clear understanding of an average results look like in the hands of each provider or how many of these procedures they’ve actually done. 
Without seeing before, and after pictures, we can’t begin to make a good assessment.
Best,
Mats Hagstrom, MD

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