How to Determine if Blepharoplasty or Ptosis Surgery is Needed for Asymmetrical Eyelids

Author: Amiya Prasad, M.D.

Can a blepharoplasty be performed to correct asymmetrical eyelids? Info about me: I am Asian and 18 to 21 years of age. Both parents have the double-eyelid fold. My left eye does not feel natural and eyelashes curl inwards. Thank you for your question! You submitted a question and you identified yourself between the ages 18-21 and you have asymmetric eyes. You mentioned that your parents have double eyelids and that your eyelashes are turning inward in the left eye. Although you mentioned only one photo, I'll tell you a little about what I do in my practice.

I've had a lot of experience in eyelid surgery and I'm an oculofacial cosmetic surgeon. I've had a lot of experience in ptosis surgery and I'm explaining why I'm mentioning this. When we look at a person who is concerned with asymmetry, there are two critical aspects when deciding whether blepharoplasty on what is the right thing for you. First is determining the eyelid height. When someone has a lot of skin overhanging the eyelid, it can make the width of the eyelid or the height between the margin of the lower eyelid or the bottom part of the iris to the margin of the upper eyelid. Now that height is called the interpalpebral fissure and what we want to determine by measuring that height is whether or not there's a condition called ptosis. Ptosis means drooping and we talk about eyelid ptosis that's how we refer to it.

When we talk about other parts of the body such as breast, we talk about breast ptosis. When you have eyelid ptosis, it's a different surgery from blepharoplasty. When you have eyelid ptosis, we evaluate the levator muscle. It's like the world elevator without the letter e. It means we have to do something to advance the muscle or shorten the muscle to get the height to be equal.

That's part of the extensive evaluation and when we do this evaluation, we look at the eyes both in primary gaze and forward and looking down and up to determine the muscle function. The other part of the equation is the skin fold. You mentioned that your eyelids are turning inward.

How to Determine if Blepharoplasty or Ptosis Surgery is Needed for Asymmetrical Eyelids

This is relatively a frequent condition of the asian descent. Very often the lower eyelid, the condition called epiblepharon and this means that there's a fold of skin that pushes the eyelashes and when the eyelashes already touches the eye, a correction has to be done to prevent irritation of the eye itself. In your situation, you might be well served with limited blepharoplasty to address the fold of skin thay is causing your eyelashes to turn inward.

Essentially, although you submitted a question about the asymmetry and you have a relatively descent photo, the photo does limit of how much opinion you can get without a proper examination. So I recommend that you meet with a qualified experienced surgeon. Typically if there's an issue with ptosis you would be going to an oculofacial plastic surgeon and get an evaluation of all the things I mentioned. The proper evaluation of ptosis and the fold of skin over the eye.

Once you are comfortable with the doctor you meet with then you can make a decision of preceding with your surgery. Be also aware that when people are concerned with asymmetry, asymmetry is not only limited to the soft tissue of the eyelids such as skin and levator muscle. Sometimes it is related to the natural underlying bone structure. The human face is not perfectly asymmetric and if you look at your face long enough, you can notice the subtle asymmetry of the two sides. But specifically, with your issue, there sounds to be a real difference with the skin fold of your eyelid. I think meeting with a qualified experienced cosmetic surgeon will be in your interest.

I hope that gave you some guidance, I hope that was helpful and thank you for your question!.

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