How can I fix my uneven eyes? They a noticeably unequal. (photos)

Question

I don't know what's wrong, but  I'm desperate to fix this. The unevenness of my eyes really bother me, I'm so painfully self-conscious and I need to fix this no matter what it takes. I understand that all faces are asymmetrical, but my eyes are just extremely lopsided. What is wrong? How can I fix this? Thanks.

Amiya Prasad, MD · Answer

Thank you for your question. You submitted 3 photos of close-ups of your eyes, and understand that everyone’s face is asymmetric, but you’re bothered by the lopsidedness of your eyes. You’re seeking guidance about what to do.
I can share with you my approach to concerns like yours in my practice.  A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people improve their appearance of their eyes has been the foundation of my career. We have a lot of new options over the course of this 20-year adventure. I’ll first give you some sense of my assessment in the absence of a physical exam.
When I look at your eyes, I start from the top at the eyebrow level. Between the eyebrow and the eyelid, you noticed there’s a fold of eyelid skin on the right side, and a relative hollow in the left side. I would conclude there’s a difference in the fat projection in that area that can be reflective of a difference in the bone structure of the eye socket, or orbit. That area can be addressed in a way that can improve the symmetry. Focusing on that area, we’re dealing with a relative difference in the fat volume, and a difference in the bone projection. We can strategically place a hyaluronic acid filler below the brow in a way to help close that space and restore some volume in that area. This procedure can be done with a little local anesthetic in the office to address, to a degree, the difference in the relative hollow.
When you look at your eye position from the photos, it looks like the left eye is slightly lower, not the eyelid, but the eye itself. This is probably reflective of the difference in the bone structure between the two eyes. I’m sure you have no visual symptoms such as double vision, but that’s an important variable to understand when we discuss what is probably bothering you in the lopsided appearance. 
The eyelid level of the left eye relative to the eyelid level to the right eye, we look at the eyelids relative to the center of the pupil. This is how we differentiate the presence of something called eyelid ptosis versus pseudoptosis. When we look at the two eyelids, it appears that the left upper eyelid is slightly lower than the left upper eyelid. It does appear to be within 1-2 millimeters of the other eye. It is a challenge when someone like yourself comes to our practice to discuss an option to create more symmetry, and for that we discuss the options for ptosis surgery. Ptosis surgery addresses the underlying cause of the drooping of the eyelid typically associated with the levator muscle, the muscle that elevates, like the word elevator, the left upper eyelid. That muscle can be adjusted, as well as a muscle behind the eyelid called Mueller’s muscle to shorten the muscle length so the eye is slightly more open. 
When people have slight degrees of ptosis, I talk to them about the relative risks of ptosis surgery because subtle is very difficult to achieve when you are dealing with muscles that are very sensitive. It is possible, and certainly worth considering when you have an evaluation. We can do procedures where we bring up the eyelid one or two millimeters, and with minimal trauma by doing the work behind the eyelid. However, it’s important to understand you can get overcorrected where the eyes are too open, or worst case scenario, undercorrected with the eyelid is actually droopier - it’s less likely, but it’s always possible. 
In summary, you basically have a bony orbital difference between the two eye sockets, so you’re dealing with the soft tissue results of that. You can improve symmetry in two ways: adding volume to the sub-brow area and getting a little more symmetry that may end up satisfactory to you; also exploring the possibility of ptosis surgery. 
At this point, I suggest you meet with qualified, experienced oculoplastic or oculofacial plastic and reconstructive surgeons. This is a technically focused procedure in the eye area, so you want the top level specialists in this area, and have a proper examination. You can at least have a perspective of the relative risks and benefits of any intervention. I would predict you may want to start with something small like an injectable filler, see how you like it, then consider the other options beyond that. There are other more aggressive things to do such as add volume to the orbit from underneath the eye complex from the bone, but that’s something we generally do not do unless there’s a more obvious asymmetry. I would say that subtle may be the way to go. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Paul Nazemi, MD · Answer

Thank you for your question.  You are correct in that the two sides of the human face are not exact mirror images.  The most notable finding is ptosis or droopiness of the right upper eyelid.  This can be corrected to improve the overall symmetry between the two sides.  See an oculoplastic specialist for a comprehensive exam and to learn more.

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