Thank you for your question.
You've submitted a photo and a question about the situation with your eyelids.
And you state that you've always had asymmetrical eyelids, and you want to know if you can have
surgery done on one eyelid to improve the symmetry.
You've stated that it's been present since you were a child, and you also question whether
or not this is related to lacrimal gland ptosis.
So I think I can help you with this question.
To give you a little bit about my background, I'm a Board-certified cosmetic surgeon, certified
by the American Board of Plastic Surgery.
I'm also a Fellowship-trained oculofacial plastic surgeon, certified through the American
Society of Ophthalmic Plastic and Reconstructive Surgery.
This is an organization that trains physicians in specialized and more advanced eyelid surgery,
because there is a clear need for that specialty in the broad field of plastic surgery.
This, in contrast, just to give you a little distinction between a general plastic surgeon
who is not specialized, who has done a two-year residency and learned a little bit about everything
from head to toe, but unless they do a specialty fellowship, doesn't have much experience before
training as an oculoplastic surgeon, just to make a distinction of the types of training
there is in this field.
I have been practicing in Manhattan and Long Island for 20 years and as an expert in eyelid
surgery, I can tell you that, first of all it is possible to do one eyelid in order to
optimize the symmetry.
But I can give you a little bit more information about the anatomy as I see it from this photo.
The right upper eyelid just appears to be hooded, and the left upper eyelid has a more
high crease, at the same time there is a little fold of skin.
So what I suspect is that the case, in some ways, is similar to Asians who have asymmetry
in their creases, is that the eyelid on the right side doesn't have that good a connection
between the skin and the muscle called the levator muscle, which defines the crease in
the eyelid, as compared to the left upper eyelid.
There also maybe some asymmetry in the volume of fat.
Now, to address the question about the lacrimal gland ptosis, well, the lacrimal gland is
on the outermost, or lateral aspect of the eyelid, where it sits in a place called the
lacrimal fossa.
When it prolapses, or goes down, it can contribute to fullness on the outer aspect of the eyelid.
Now in order to really be able to tell that, you have to do a physical exam and in addition,
to make that distinction, I always have the patient look straight and have them raise
their eyebrows, and you can often see the outline of the lacrimal gland.
Sometimes it's something we see in surgery, as an incidental finding that helps us customize
the surgery.
One of the things we actually do is we resuspend the lacrimal gland.
A common technical error made by less specialized doctors is they’ll often cut out the lacrimal
gland or they'll ignore it altogether, and the patient will still have some prolapse
and wonder why they still have fullness on the outside.
We've seen this many times.
So, from the photo, it doesn't appear that you have an obvious, significant lacrimal
gland prolapse.
But again, a physical exam is necessary to make that distinction.
I would say that it may be worthwhile for you to consider bilateral surgery, or surgery
on both upper eyelids, because with the right upper eyelid, you can create a nice smooth
platform and it might make the left upper eyelid look like it has extra fold.
It would still make you look like you still have a bit of asymmetry.
So this is something that requires a proper examination by a qualified specialist.
I would say that its best for you to meet with a qualified, experienced doctor who specializes
in eyelid surgery who can make this distinction.
I would also say lean towards people who particularly specialise in cosmetic—there is a distinction,
like someone like myself, who specializes in cosmetic oculofacial plastic surgery.
My practice is very different, a more broader-based oculoplastic surgeon who deals with a lot
of functions and deals with a lot of older patients versus younger more aesthetic focus
patience.
So it's just a matter of you feeling comfortable, ultimately.
So I hope that was helpful I wish you the best of luck and thank you for your question.