How Can I Tell if I Have Uneven Eyelid Crease or Ptosis?

My right eyebrow has, as long as I can remember, been higher than my left. Recently though it seems as though it's higher than ever before and it's starting to affect my confidence. I look closely and see that the crease is a few mm higher than my left eye, but when I measure my eyelid opening, both eyes are identical. So is that ptosis or just an abnormal eyelid crease (height wise). I know ptosis can cause a lifted brow to compensate, but wouldn't my eyelid opening still differ? Thanks!

Doctor Answers 8

Uneven eyelid crease or ptosis

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Many patients have different heights to the eyelid crease, which just happens to be what they are born with.  This is usually due to one eyebrow being higher or lower than the other.  The upper blepharoplasty incision can be adjusted to make the upper lids appear more symmetrical. Asymmetric amounts of skin and fat can be removed to help make the eyelids appear more symmetrical.  Ptosis is a medical condition whereby the upper lid muscle is very lazy and the eyelid comes across the black pupil part of the eye.  Usually the opening of the eye is much smaller in the affected eye than the opposite side.

Uneven brows

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Uneven brows are very common and have nothing to do with ptosis, although one could try to compensate by elevating the brow. Yous hould have an evaluation by an oculoplastic surgeon or PS to determine what the issue realloy are.


Andrew Pichler, MD
Sacramento Facial Plastic Surgeon

Eyebrow asymmetry and eyelid sagging or ptosis

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It is very common to see one eyebrow higher than the other, especially the right one. This is not caused by or is a sign of eyelid sagging or ptosis. if your upper eyelid does not approximate or cover your Iris then you don't have eyelid ptosis. Brow ptosis or sagging as well as brow asymmetry can be improved with a browlift procedure.

Eyelid ptosis with brow compensation

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A photo is useful. It sounds like you have right upper lid ptosis (droopy), with brow compensation (trying to lift the eyelid higher to see better). This means the brow is not the problem and eyelid ptosis surgery can be helpful.  See an oculoplastic surgeon.

Brow ptosis or lid crease asymmetry

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If you push your right brow down to the same level as the left and the upper eyelids become symmetrical then most likely the brow is causing the problem. The brow can be lowered with Botox so I suggest that you should try this first. If the lids are still different then a blepharoplasty is in order.

How Can I Tell if I Have Uneven Eyelid Crease or Ptosis?

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Relax and look straight into the mirror.  If the colored portion of your eye(s) is blocked partially by the upper eyelid, this is true eyelid ptosis.  If you are concerned you should have an examination by an ophthalmogist.

Post a photograph and ask this question.

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Rona Silkiss is a highly talented oculplastic surgeon who has multiple offices in the bay area.  You might consider seeing her in consultation to answer this question.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eyelid asymmetry

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You may have a basic facial asymmetry, as do most people. If this is the case, you could have Botox injected in the lower eyelid in an attempt to achieve symmetry. See a board certified plastic surgeon who can evaluate you and assess whether there is ptosis or muscle weakness affecting the appearance of your eyelids.

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.