Should I have surgery for my asymmetric eyelids?
Cosmetic upper eyelid surgery is often requested by people who feel they
have asymmetric upper eyelids causes for
asymmetry can include differences in bone structure the amount of skin and
fat over the eyes the eyelid height and the appearance of the eyelid crease I’ll
discuss how I evaluate patients concerned about asymmetric eyes in my
practice I’m Dr. Amiya Prasad 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
as a specialist in eyelid surgery I perform all types of eyelid cosmetic and
reconstructive surgeries every day in my practice including revision surgery to
correct cosmetic eyelid surgery procedures originally performed by other
doctors I also perform non-surgical eyelid procedures every day including
fillers botox PRP lasers and radiofrequency technology treatments
some people notice that their upper eyelids are slightly different in height
Eyelid Height
and expressed concern oftentimes this is something only they are aware of and
it’s not something that other people notice I explained that it is normal to
have a 1 to 2 millimeter difference in the height of the eyelids generally
unless there is a more than 2 millimeter difference in height between the two
eyelids most people looking at you don’t notice anything
if the eyelid height difference is within this normal range surgery is
usually not recommended if there is a greater than 2 millimeter difference
between the eyes one eye may be too or too high of course there are
conditions where both thighs are too low or too high or combination where one eye
eye is too high and the other eyes too low when the eyelid is lower than it
should be the term to describe his condition is eyelid ptosis eyelid ptosis
refers to two types of conditions congenital ptosis which means ptosis you
were born with and acquired ptosis which is ptosis that occurs after you were
born when a significant amount of acquired ptosis occurs a proper
eyelid ptosis
ophthalmologic and neurologic examination may be necessary to rule out
a neurologic cause for the ptosis when surgical correction of ptosis is being
considered that type of surgery I perform is based on the degree of ptosis
and a strength and function of the levator muscle which is the muscle
responsible for most of the upward movement of the eyelids I routinely
perform procedures to treat mild to moderate ptosis from the underside of
the eyelid by shortening a muscle called Mueller’s muscle I also perform
surgeries such as levator muscle advancement which is done from the front
of the eyelid through the upper eyelid crease in select situations such as
congenital ptosis with minimal to no levator muscle function I perform a
procedure called a frontalis sling where I create a connection between the eyelid
and the muscle above the eyebrows called the frontalis muscle this allows for the
action of raising the eyebrow to open the eyelid another variable which is not
bone structure
typically thought of as contributing to asymmetry is bone structure if you look
at both halves of your face you’ll notice that the face is not perfectly
symmetrical even celebrities and models who are known for their symmetrical
features do not have perfectly symmetrical faces
the cheekbones can be appreciated as being different in terms of projection
when one side of the face is compared to the other bone structure determines a
shape as well as the relationship of the eyebrows to the eyes there are times
when this variable is not fully appreciated when a surgeon performs
upper eyelid surgery which can result in upper eyelids looking hollow I often
address the situation by placement of a long-lasting hyaluronic acid filler at
the bone level to restore fullness in a way that looks more natural and
symmetric the same applies when no prior surgery is performed but the upper
eyelid area appears asymmetrically hollow because of genetics or aging the
upper eyelid skin can also look a symmetric between the two eyes in
several ways such as the amount of hooding in the relative amount of
fullness in Asian eyelid anatomy one eyelid can have multiple creases while
the other has one or no crease these situations are typically managed with
cosmetic upper eyelid surgery or upper eyelid blepharoplasty I approach these
situations with a customized strategy which is specific to the individual’s
Anatomy for example the amount of skin and fat contouring I would perform would
be different between the two eyes in a situation such as where multiple creases
in an Asian eyelid are present I would consider performing a procedure such as
a non-incisional Asian eyelid surgery to create a more stable and symmetric
eyelid crease filler placement is routinely performed in my exam rooms
with blunt cannulas resulting in minimal to no bruising and minimal swelling I
perform upper eyelid surgeries such as upper eyelid blepharoplasty and ptosis
surgery and frontalis sling using local anesthesia with LITE intravenous
sedation in some ptosis surgery procedures I have my patients sit up so
I can assess the eyelid height and shape with the patient in a natural and
upright position this approach has been easier for the
patient as they avoid the nausea and the opioid drugs used which are more
associated with general anesthesia our patients usually return to work in about
a week when the surgery is performed before deciding if upper eyelid surgery
is appropriate for your concern about symmetry it’s important to differentiate
natural and subtle asymmetry from significant asymmetry when surgery or
non-surgical options are to be undertaken the surgeons experience an
aesthetic style is critical to achieve natural-looking results eyelid surgery
particularly for the purpose of achieving maximal symmetry is very
precise to the point that millimeters really matter I hope you found this
information helpful thank you for your question