Thank you for your question.
You submitted 3 photos of close-ups of your eyes and you state in your question that you
understand that everyone’s face is asymmetric but you’re considerably bothered by the
lopsidedness of your eyes.
And you’re seeking some guidance as to what to do.
Well, I can certainly share with you my approach to concerns like yours 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.
And helping people improve their appearance with their eyes has been the foundation of
my career.
And certainly, we have a lot of new options over the course of this 20-year adventure.
So I’ll give you some sense first of what my assessment would be and again, it’s still
in the absence of a physical exam but I can help show you how I look at the appearance
of your eyes.
To begin with, when I look at your eyes, I start from the top at the eyebrow level.
And between the eyebrow and the eyelid, you noticed that there’s a fold of eyelid skin
on the right side and there’s a relative hollow in the left side.
So I would conclude that there’s a difference in the fat projection in that area and that
can be reflective of also a difference in the bone structure of the eye socket or the
orbit.
Now that area can potentially be addressed in a way that can improve the symmetry.
So let’s focus on that area specifically and what does that mean?
Essentially, if we’re dealing with a relative difference in the fat volume as well as a
difference in the bone projection, well, we can strategically place fillers below the
brow in a way to help close that space to a degree and restore some volume in that area
using a filler such as a hyaluronic acid filler.
Now this is a procedure that can be done with a little bit of local anesthetic in the office
and that can address, to a degree, that area where there’s a difference in the relative
hollow.
Now when you look at your eye position, from the photos, it looks like the left eye is
slightly lower, not the eyelid, but the eye itself, which is probably also reflective
on the difference in the bone structure between the two eyes.
Of course, I’m sure you have no visual symptoms such as double vision but that’s an important
variable to understand when we discuss the next part of what is probably causing you
to be bothered by the lopsided appearance.
And the other is the eyelid level, now the eyelid level of the left eye relative to the
eyelid level to the right eye, when we look at the eyes, we look at the eyelids relative
to the center of the pupil and that is how we differentiate the presence of something
called eyelid ptosis versus pseudoptosis.
So when we look at the two eyelids, it appears that the left upper eyelid is slightly lower
than the left upper eyelid.
Now however, it does appear to be somewhat within 1-2 millimeters of the other eye.
And so it is a challenge when someone like yourself comes to our practice to discuss
an option to create more symmetry and for that, we would discuss the options for something
called ptosis surgery.
Now ptosis surgery is basically surgery to address the underlying cause of the drooping
of the eyelid and that typically is associated with the muscle called the levator muscle,
the muscle that elevates, like the word elevator, the left upper eyelid.
Now that muscle can be adjusted as well as a muscle behind the eyelid Mueller’s muscle
and it can be used to shorten that effective muscle length so that the eye is slightly
more open.
Now, when people have slight degrees of ptosis, I talk to them about what the relative risks
are of ptosis surgery because subtle is very difficult to achieve when you are dealing
with muscles that are very sensitive.
It is possible and it certainly is worth considering when you have an evaluation.
And we can do procedures where we can bring up the eyelid one millimeter or two millimeters
and with minimal trauma by doing the work behind the eyelid.
However, it’s important to understand that you can get overcorrected where the eyes are
too open or sometimes, the worst case scenario, you can be under corrected with the eyelid
is actually droopier, less likely but it’s always possible.
So I think in summary, you basically have bony orbital difference between the two eye
sockets and so you’re dealing with the soft tissue results of that and you can improve
symmetry in two ways: one being adding volume to the sub-brow area and getting a little
more symmetry and that may end up satisfactory to you.
And you can also explore the possibility of ptosis surgery.
At this point, I would suggest that you meet with qualified, experienced, I would say,
oculoplastic or oculofacial plastic and reconstructive surgeons.
I think that this is a more technically focused procedure that really is in the eye area and
I think you want the top level specialists in this area and have a proper examination.
Then you can at least have a perspective as what the relative risks and benefits are in
any intervention.
And I would probably predict that you may want to start with something small like an
injectable filler, see how you like it and then consider the other options beyond that.
There are other more aggressive things to do.
You can add volume to the orbit from underneath the eye complex from the bone but that’s
a little bit more aggressive and usually something that people would generally not do unless
there’s a more obvious asymmetry.
So I would say that subtle may be the way to go.
So I hope that was helpful, I wish you the best of luck and thank you for your question.