Thank you for your question.
You submitted your question with a close-up view of your eyes. And you ask in your question
about your perception that your right eye appears to be considerably smaller than your
left. And that you notice it in particular when you take photos and you’re asking what
are your options. Well, I can certainly share with you what my impression is in the absence
of a full physical examination but I think I can give you some guidance as to how I approach
this type of situation in my practice.
A little bit of 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 with their eyelids especially when it comes to more advanced
eyelid procedures such as Asian eyelid surgery has been a very big part of my practice. And
I think that when I look at your photos, I can just give you some basic principles that
are applicable that can help guide you as to what is probably the option that will fit
best for you.
So to begin with, this situation, what I see is in the left eye you have a crease and the
fold of skin is actually above the crease. When you look at the right eye, you don't
see a crease. You see a fold overlying the eyelid margin. And this is actually a very
common situation. You see, there is a certain anatomic variation that is specific of Asian
descent and it has to do with the absence of a crease or a presence of a crease. And
it is due to an attachment between the muscle called the levator muscle, the muscle that
can also sound like the word “elevator” or look like the word elevator without the
letter “e”. It’s the muscle that lifts the eyelid. Well, from the front of that muscle
are these fibers that attach to the skin. And when they’re attached very firmly, you
get a crease. When they’re not attached, you don't have a crease and the skin folds
over.
When the skin folds over, it creates the perception of the eye being smaller. And essentially
what it is, is that the fold is defining the shape of the eye and so generally speaking,
a relatively straightforward issue. What the key is to try to create that connection between
the skin and the muscle, the levator muscle and that is the entire basis of Asian eyelid
surgery.
Now when you learn more about Asian eyelid surgery, you learn that there are non-incisional
procedures and incisional procedures. A non-incisional procedure is basically defined by essentially
making small openings in the skin and attaching the skin to the muscle underlying the levator
muscle and creating that fold. I would say that it is more than likely that in your situation
that you would probably benefit from that procedure again, in the absence of a physical
exam and seeing how much overlap of skin there is. But when I make this decision, I basically
look between the choice of doing a non-incisional and incisional procedure.
In an incisional procedure, I’m either removing some skin or addressing a certain amount of
fat in order to create that crease and fold. And so in a situation like yours, where all
I see is a little bit of folding over the skin, I can actually visualize the placement
of the sutures that would result in a crease that would create some balance.
Now of course there are pluses and minuses to every surgery and risks etc, but I think
that when you get down to why your eye is looking smaller, the right eye than the left,
it is because of the fold of the skin. It is very straightforward. In fact in our practice,
what I routinely do is use something like a Q-tip just to create a crease and push the
skin in a way that mimics what would happen if I were to attach the skin to the muscle
with the surgery. And basically, you can then see what it would look like. Like I said,
the procedure itself is fairly straightforward.
In our practice, we do this procedure under local anesthesia with LITE™ sedation. Especially
if it’s a non-incisional procedure, it’s actually fairly straightforward. It’s done
pretty quickly. It’s done with local anesthesia. It’s just a matter of allowing the time
for the skin to heal over the course of several weeks. But most people go back to work in
about a week. And as far as swelling, with Asian eyelid surgery, the area between the
crease and the eyelid margin, is an area that can linger for several months but does progressively
get better. And it is usually a little bit less swelling in my experience with non-incisional
compared to incisional.
So I think it’s probably the next appropriate step for you is to meet with qualified, experienced
eyelid surgeons who have a lot of experience with Asian eyelid surgery and learn about
what your options are based on this particular issue of the absence of a fold resulting in
overlapping skin. And of course a proper examination would reveal any other issues that would potentially
be useful to address at the time. But again, as I said, my impression is this is basically
a matter of getting that skin to fold in so that it matches as closely as possible with
the other eye.
So I hope that was helpful, I wish you the best of luck and thank you for your question.