Thank you for your question.
You submitted a photo showing just the front view of your eyes and you state that you are
18 years old and since you were a toddler, you are aware of the unevenness of your eyes.
You mentioned that your father has the same exact situation so it is not disease related.
It is a genetic related issue and you want to know what you can do to avoid surgery.
Well, I can certainly guide you with this question.
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 and complex issues
in the eyelids is the very definition if what we do in oculoplastic and oculofacial plastic
surgery.
So I’m going to help you first by giving you some guidance to what I see just from
the photos alone.
Now, what we refer to comparing the left eye to the right eye the upper lids and lower
lids, it appears that you have something called eyelid retraction.
And what is left upper eyelid retraction and then the left lower eyelid retraction?
Now, what I can tell from the photos is if the projection or the prominence of the eyes
is different, I think it is reasonable to assume that it may not be but certainly a
proper physical exam, that’s one of the things that is measured is the relative prominence
of the eyes.
In a situation when it is genetic or congenital, I can tell you first of all is that there
is clearly an anatomic issue.
And so in that situation, there is really a good non-surgical alternative for you.
When I see patients like you, what I decide is to help them by explaining what I do for
patients who have something called thyroid eye disease.
In thyroid eye disease, it is an autoimmune process which affects the eyes and the thyroid.
And what happen is the eyes can bulge.
The eyelids can retract.
The eye can look very open.
It can affect both eyes but there is basically a strategy that is to bring the upper eyelid
downward for example and similar to your situation by addressing certain anatomic factors.
So I explain to patients like you that we have to have plan A, B and C. And basically
plan A, I work behind the eyelid to reduce and separate and remove a muscle called muller's
muscle.
This is a muscle that is responsible for about 2 millimeters of height.
And beyond that, we can also do something with the levator muscle, the muscle that lifts
the eyelids to the front but that is getting ahead of ourselves.
But essentially, there is really a surgical option in your situation.
Now, the same principles I also do apply to the lower eyelid.
In lower eyelid retraction, we can do various types of procedure from minimal procedures
to procedure where we are putting grafts on the inside of the eyelid.
In situation like yours, I probably would consider correcting the upper eyelid first,
trying to get the eyelid down to a position which is comparable to the other eye, allow
things to heal and see how you like it.
In fact in our practice, what we do routinely is we will sit people up during surgery whether
it is for drooping eyelids or for eyelids that are too high just to see how the eye
looks with gravity.
This is an art and there are many different ways to address these issues but when you
get down to it, we are talking about an anatomy issue.
And so, if you are not ready for surgery then wait until you reach a point where you are
ready for surgery if this continues to persistently bother you.
Meet with qualified experts in this area who have done a lot of these procedures, in particular
have familiarity with situation like yours, a congenital situation.
But since this is fairly actually uncommon, the principles of other situations related
to eyelids and retraction can be applied because it is always about correction anatomy.
So learn more about your options and meet with doctors.
And once you are comfortable, move forward with a plan that makes sense with you.
So I hope that was helpful, I wish you the best of luck and thank you for your question!