Thank you for your question.
You’re 20-years-old and you submitted a single photo, a close up of your eyes.
And you state that you went to several doctors before your teens regarding the unevenness
between your two eyes and it was explained to you during these doctors’ visits that
your vision was normal and that you didn’t need surgery.
And now in the age of 20, you are asking about having your eyelids look more even.
Well, I can certainly give you my opinion based on the limitations on the photos you
submitted.
A little bit of 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.
As a cosmetic oculofacial plastic surgeon, I do a lot of procedures to help people have
more even-looking eyes.
So I’ll be able to give you some guidance as to the terminology related to your situation
and the basis for delaying any procedures and what your options are at this point.
So to begin with, when I look at your photos, I note that the right upper eyelid is lower
than the left upper eyelid.
Now the term for an eyelid that’s low is we use the term called ptosis.
Ptosis means drooping and if we refer to eyelids, we call it eyelid ptosis.
Now specifically, in a situation where someone is born with it which appears to be the case
for you is referred to as congenital ptosis.
Congenital ptosis means that the muscle called the levator muscle, the levator palpebrae
superioris muscle, is the muscle that didn’t fully develop and therefore, it doesn’t
contract like a normal muscle nor does it relax like a normal muscle.
So when we perform a ptosis evaluation, we look at the level and degree of ptosis and
we also look at the muscle function and that’s a proper evaluation.
Now before the age of 6, ptosis has to be monitored in a way to ensure that the vision
develops appropriately.
Basically, if the ptosis is blocking vision or in any way minimizing or disproportionately
reducing vision in one eye, then that eye can have permanent loss.
We refer to that as amblyopia.
What your doctors were able to establish through proper ophthalmologic examination was that
your vision wasn’t affected.
And since your vision wasn’t affected, they advised to defer surgery and I think that’s
very reasonable.
With this type of surgery, if you can wait until your face has grown and your face has
developed more, then that’s ideal.
If however there is a vision issue and visual development is in question, then you do a
procedure to lift the eye.
So at the age of 20, you now have the opportunity to now have a ptosis operation.
So what is involved in ptosis operation?
Well, at this stage in your life, you can undergo this procedure, what we would do in
our practice with someone like yourself is, first we have to decide what kind of ptosis
operation is necessary, again, with proper examination.
But essentially, there are two types of surgery: one is where the muscle is shortened to get
the eyelid to open and one with the muscle is bypassed which is referred to as frontalis
sling.
Now after the evaluation, we figure out what operation would be ideal but what is practically
good with dealing with someone who is a little bit older is that you can get their cooperation.
Ptosis surgery is deceptively complex.
It’s actually a very delicate operation that requires optimizing the shape, the height,
the contour and the symmetry.
So what we do routinely in our practice when we are doing this surgery is we actually sit
someone up and look at them sitting up and the staff and I look together.
We look at the eyes to make sure they look good, look balanced and look bright and that
type of finesse maximizes the success for outcomes.
However, there’s always a percentage of patients who might get an over correction
where the eyelids are too open or under correction where the eyelids are too low.
So you have to basically get a proper examination and evaluation and you have to understand
what the best procedure is at this stage.
Understanding that the muscle is not normally a functioning muscle is something to accept
so that you go in with an understanding that your eyelid can look symmetric but usually
in the primary gaze, when you are looking at somebody and sometimes it might be with
poor levator muscle function when you raise your eyebrows and engage the muscles needed
to keep that eye open.
But again, this is without examination, there are some details that can’t be determined
to further make more recommendations.
So again, in summary, you have congenital ptosis, have an evaluation and see typically,
an oculoplastic surgeon or oculofacial plastic surgeon, someone who did eye surgery and then
specialized in plastic surgery of the eyelids and face and learn about your options.
So I hope that was helpful, I wish you the best of luck and thank you for your question.