Uneven Eyelid folds - How to fix this? (photo)

Thank you for your question. You submitted a question with a single photo showing a close-up of your eyes, stating you have a fold in your right upper lid that is lower than the left upper eyelid. You noticed there is a relative fluctuation where there may be a crease at one point of the day, then it changes. Essentially, you are asking about symmetry and how to achieve it, or trying to create an appearance similar to your left eye which is more stable and constant.
I can help you understand the way I approach patients who have similar issues. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and Asian eyelid surgery is a significant part of my practice.  This type of scenario is actually fairly common so before explaining my typical solution, I first want to help you understand the basis for that solution.
When you learn about Asian eyelid surgery, you will come across 2 basic approaches: the incisional and non-incisional approaches. Regardless of the type of surgery, there is one basic principle to to achieve a double fold or an Asian eyelid crease, that is to connect the skin to the muscle that lifts the eyelid called the levator muscle. This is the muscle that has the connection for those born with a natural crease. People who don’t have the crease don’t have these little connections responsible for creating the crease, so in surgery we create those connections.
What helps me determine to do incisional surgery where I’m typically removing skin, or non-incisional surgery?Basically, is there a presence of excess skin? Is there a presence of excess fat? Usually with someone with your anatomy, and in the absence of a physical exam, I typically use a non-incisional approach. Non-incisional means we are not making any incision across the eyelid, or removing extra skin. We’re making strategic little entrance points in the outside of the eyelid and in the skin to pass stitches to engage the levator muscle to connect it, and create a crease. Even if it is called non-incisional, we are making little incisions, but not making a long one.
The non-incisional procedure is typically more appropriate for younger people. This includes people with a scenario like yours where the anatomy is almost there, but it just needs a little reinforcement. This procedure is typically done under local anesthesia, sometimes with a little sedation to help you relax. It’s fairly straightforward with just a matter of placing these stitches, but so much of this procedure is in the planning with a lot of measuring and placement of the right critical points in the eyelid to engage the muscle. The crease is formed nicely and holds up very well.
There is always a question debated in this field about which approach is longer lasting. As a general rule of thumb, we look at the statistics from countries such as Korea, China, and Japan, where the non-incisional surgery is very popular, and with a good track record. Again, it’s really about the individual surgeon’s perspective and approach. I perform the full range of Asian eyelid surgeries, so I’m very comfortable with this non-incisional technique, and I would most likely recommend it for someone like yourself, again this is in the absence of a physical exam.
I recommend you meet with qualified, experienced cosmetic surgeons who have a lot of experience doing Asian eyelid surgery and learn about your options. Once you’re comfortable with the doctor and you like their results, and understand some of the other elements of how to determine the best type of surgery move forward.The other factors that come into determining the style involve determining whether you want a parallel crease, or a nasally-tapered crease, but basically you want to try to match the other side. Often it’s very straightforward because once you put a little pressure on the skin, it almost creates the crease that you want. Many people put a little piece of tape to create the crease, so most likely whatever critical points on the lid to get that crease formed to match the other side will accomplish what you want. 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.

Hello kcp91, thank you for your question.  This is actually not an uncommon problem when one eyelid appears to have a more prominent supratarsal crease while the other either has a monolid or a faint hidden crease.  Depending on your anatomy, you may be a candidate to undergo a minimal incisional blepharoplasty just on the right eyelid to create a crease comparable to your left eyelid; or you may need a full incisional blepharoplasty on both eyelids to create better symmetry.  Please consult with a board certified plastic surgeon who specializes in Asian blepharoplasty for an in-person consultation.  Good luck!

The asymmetry can be corrected with an Asian blepharoplasty.  See an oculoplastic specialist to learn more.  Good luck