My eyes became uneven. What can I do about it? (Photo)

Question

My eyes have started to become uneven, as a woman it really affect my self confidence. I Don't know if it's because of a poor botox or it because of the M.S. I'm Willing to do whatever it takes to correct it. I Read the other article about the same issue; I thought my picture would explain more.

Patrick Simon, MD · Answer

Your left eye appears to have ptosis.  Ptosis may arise from several different sources, one of which may be Botox.  Diffusion of a neurotoxin like Botox to the levator muscle can result in the upper lid not lifting symmetrically.  This is likely the source of your problem if it has occurred within a week of Botox to the glabella.  This can be partially corrected with an eye drop called Apraclonidine.  Contact your Botox provider for a prescription.If this has developed gradually or not in temporal relation to administration of Botox then you will need to be evaluated by a physician to differentiate the other potential contributing etiologies.

Amiya Prasad, MD - Account Suspended · Answer

I’m a board certified cosmetic surgeon with background training in
ophthalmology or eye surgery, plus oculoplastic surgery of the eyelid, orbits
and lacrimal system. From your photo, it appears that your right eye is more prominent and becoming a little wider compared to the
left eye. My concern is whether or not you have thyroid-related immune
orbitopathy otherwise referred to as Graves' Disease or thyroid eye disease.
Graves' Disease/thyroid eye disease is something that I treat a lot. This has
to do is with an antibody, and the fact that you have MS which falls in the
autoimmune category means that there is a possibility it is an immune-related
issue.

Before you consider any kind of cosmetic procedures, I suggest that you
see first your medical doctor as well as an ophthalmologist and even an
endocrinologist to determine what is going on with your thyroid, in any
addition to any ophthalmic issues. You may also need imaging studies. You
cannot pursue any cosmetic procedure given that there is a shift and change in
your appearance. Unfortunately, I can’t say what degree of change you have
because you submitted a single photo. If you submitted a photo of you 5 years
ago, a year ago, and this photo so a clear change is seen, it would more sense.
The fact that there’s a real change in the eyes that’s not typical or
age-related, it’s important to get the medical work-up first.

We’ve treated a lot of thyroid eye disease and we’ve been able to help
people in their inflammatory stage. We then do definitive surgery to help with
issues related to eyelid retraction where the eyes are too open. We even do
surgery behind the eyes to get the eyeball to push inward. At this point, it’s
more important that you get yourself properly diagnosed and get proper medical
management before you do something surgically. When it comes to thyroid eye
disease, we typically wait 6 months to a year after the eye position has been
stabilized before we do any kind of surgery. I hope that was helpful, I wish yu
the best of luck, and thank you for your question.

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R. Stephen Mulholland, MD (retired) · Answer

Dear sanaz13,

It does appear from the photograph you have submitted that
your left upper eyelid is exhibiting what is called eyelid ptosis or eyelid
droop.  This can be a hereditary
condition or developmental.  There can be
a traumatic separation of the muscle that elevates the lid of the eye or from
neurologic conditions such as multiple sclerosis (you did mention MS).  Botox is probably the most common cause as
diffusion of the Botox, which is a muscle weakening chemical over the edge of
the eyebrow on to the upper lid can lead to a lid droop.Fortunately, this is a self-limiting process
and should resolve over the next 3 to 16 weeks. 
Topical drops can help open the eye, but you should visit your Botox
physician to rule out Botox as a cause of this concern.  If it persists following the Botox wearing
off then you may need to visit a plastic surgeon that focuses on eyelid ptosis
repair.  One such surgeon is Dr. Derek Ford
on Avenue Road who can provide expertise in this area, as well as Dr. Edsel Ing
at Sunnybrook Hospital.

With patience and time this eyelid asymmetry should improve
especially if the primary cause is Botox. 
Perhaps seeking another Botox provider if you’ve lost confidence in your
first Botox provider would be warranted although levator ptosis can happen even
in the hands of the most experienced and expert injectors.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

My eyes became uneven. What can I do about it? (Photo)

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