Thank you for
your question!
Your question with the photos you submitted is that your right eyebrow arch is very different
from your left side and you’re asking is it because of the drooping of the right upper
eyelid. And your follow-up question is about whether you can fix both. Well, I can give
you some guidance and this is of course with the absence of a physical exam but with the
photos you submitted which are certainly very good and very helpful. I can explain to you
a little bit about how I approach this problem in my practice every day for someone like
yourself.
A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice for over 20 years in Manhattan
and Long Island and dealing with complex as well as cosmetic issues around the eyes is
an area I work a lot in. And so, I think that your question has a lot of logic to it.
Before going there, I will first talk about a little bit of terminology. The first term
I’m going to help you with is referring to the right upper eyelid. The right upper
eyelid is lower compared to the left upper eyelid. And that condition is what we refer
to as ptosis. Ptosis means droop and in the case of eyelid drooping, it’s eyelid ptosis.
Within the normal population, looking at anybody around you, you can probably appreciate that
it is within a normal range to have an eyelid slightly lower than the other eyelid. As long
as it is within 1-2 millimeters, most people don’t really recognize it or doesn’t bother
them. in your situation, you are clearly noticing it and certainly there is a difference. Now
whether or not it is justifiable to do something about it, that’s understanding the risks
and benefits of performing a ptosis procedure.
So understanding that, when you talk about the arch of your brows, you are probably on
the right track in the way because in my practice, when people have acquired ptosis or age-related
ptosis, as their eyelids droop more, they tend to raise their eyebrows and it’s an
unconscious reflex. Basically, what they don’t realize is that their eyelids are getting
lower and lower, their brain is actually activating whatever muscles they can to try to open the
eyes so that they can see better. Very often, people come in with horizontal forehead lines.
With that concern about the lines and I’ve seen many patients who went to a dermatologist
to treat the lines across the forehead and not realizing that it was a compensatory mechanism
for drooping eyelids, the doctor injected Botox™, relaxed their forehead and then
they were upset because they have all this extra skin over their eyes and that’s a
different topic altogether.
I think that with the photos you submitted, your eyebrow asymmetry is probably more associated
with bone structure. The human face is not perfectly symmetric. There’s one side that
is always more prominent than the other and therefore it can affect the shape and position
of the eyebrows and it’s extremely common. So although these anatomic issues you have
identified very well, they are not usually related. In other words, the eyebrow arch
is not necessarily because of the eyelid droop. Again, this requires a physical examination.
You know with physical examination, I actually relax the eyebrow where I’m putting the
hand on the forehead and see how the eyelid position changes. There are a lot of things
we do to evaluate eyelids and eyebrows that can’t be done with photos alone.
So that being said, I would recommend you meet with a qualified experienced specialist,
someone who really understands eyelids and eyebrow position. Typically this would be
an oculoplastic or oculofacial plastic surgeon. Learn about your options. Figure out if it
is worthwhile, if the eyelid droop is significant enough for you to pursue treatment.
Briefly, when we perform ptosis surgery in our office, we do this under local anesthesia
with LITE™ sedation. We have the patient open and close their eyes during surgery.
We sit them up during surgery. It’s a very dynamic process. Now, that is something to
be factored in because your goal is to achieve a certain level of symmetry but with that
comes a set of risks and benefits that you have to understand before you pursue this
type of option.
So I hope that was helpful, I wish you the best of luck and thank you for your question!