Hi, I'm a 37 y/o male. I have always had a small aysmmetry in the eyes when smiling. However, in the last few years (ageing) I have developed mild ptosis in the right eye which worsens in the evening. This happens when not smiling i.e. resting face (see attached photos). Possibly, my right eyebrow has sagged as well. What would it take to make my eye area more symmetrical?
Hello, I think the position of your left eye globe is a little lower than the other side, this creates the impression that is the eyelid is lower ( ptosis).
I think this issue should be proven or rule out with an CAT SCAN, before attempting any eyelid or forehead lifting.
Yes, by your photo's it looks likeleft upper eyelid ptosis. You will require an examination to determine exactly what is going on with your left eye. Consider an ASPS member that does Occuloplastic Surgery in your area. Here are some photo's to review before your consult: https://garyculbertson.com/facial-plastic-surgery-before-and-after/ .
Gary R Culbertson, MD, FACS
Your left forehead bone volume is narrower than the right providing less support for your brow and thus a lower brow position. Your upper lids appear to require assistance from the forehead/brow complex to elevate the upper lid margin above the pupil line.
Your situation requires a medical evaluation(for upper lid weakness) and may require either a brow and or upper lid surgery.
See below, upper lid ptosis adjusts brow compensation.
Based on the pictures posted, you do have two elements contributing to your eye aperture. Your upper lid is ptotic, can see that by the light reflection of the pupil s to the level of the upper lid margin. Also the brow is slightly lower, the braw arch is different. This can be determined by physical examination by holding the brow in the proper level and determine the excursion of the lavator muscle of the upper eyelid. Then a determination of the type of surgery needed to correct the upper lid ptosis. Then decide if the brow needs to be lifted at the arch. During the examination will determine if the boney structure needs any work (Doubt it). Consult a Board Certified Plastic Surgeon and after proper examination can discuss the proper surgery needed. You have about 2-3 mm upper lid ptosis, I doubt this is interfering with your field of vision , but can test for that.
Everybody has some asymmetries of the face and the whole body and this is normal. Most people are not going to notice your problems unless trying to look for it. For now forget about the eyebrows as they look just fine. As in everybody, they will continue to droop with age and then you may consider something. Your biggest problem now is a little ptosis of the left upper eyelid. It may or not get worse with time. There is a treatment for this and has to do with shortening the levator muscle in some fashion. It is a relatively simple procedure that all plastic surgeons are familiar with but many do not perform this procedure. There are plenty of ABPS surgeons in Philadelphia and I would start by calling some and asking if they perform ptosis procedures and then get a consultation from one of them.
You have orbital dystopia. The left orbit is inferiorly displaced relative to the right. This results in pseudo-ptosis of the upper eyelid. That is to say, your left eyelid is down because your left eye is posteriorly and inferiorly positioned. Finally, your left eyebrow is slightly low. You could be treated with unilateral brow lift and elevation of the left eye. Once the eye is up and forward, you could reassess the position of the left eyelid.
From yout given photos, you have left upper eyelid ptosis. You have to consult with occuloplastic surgeon about full physical examination and treatment. Anyway you can do ptosis correction surgery with muscle suturing to adjust left upper eyelid level.