Asymmetry

Symmetry and Asymmetry



We see patient almost every week who have concerns about asymmetry of their eyes.  While every patient is different, there are a few general things that we have found.

  • We can usually see the asymmetry that you see.
  • Once identified, some patients find it difficult to accept that their asymmetry may not be fully correctable. 
  • A balanced face does not require the two sides to be identical.
  • It is sometimes difficult to decide which is the “better side”.
  • There are often other facial asymmetries that a patient may not be aware of.
  • The goal of treatment of asymmetry is to make things better.  Perfection is rarely achieved.
  • More than one procedure may be required on one or both sides for ideal results.  Most patients decide not to pursue additional procedures because “better” is good enough and balance does not require the two sides to be exactly the same.
  • Asymmetry in “dynamic” expression, such as your appearance when you smile, is not surgically correctible, although Botox can sometimes be helpful.
  • We probably treat only half of the patients that we see for asymmetry, often because we agree that the results of treatment will be modest. We would rather not treat a patient than disappoint them.
  • The vast majority of the patients whom we treat are very happy with the improvement that they see.
    We feel that it is better to proceed cautiously than to  risk overcorrection.

You will find photographs of patients with asymmetry from different causes. In the past, I resisted posting these pictures of asymmetric patients with their results because I prefer my website to show my most “perfect” results, and few of these results are perfect. Some patients had more than one procedure. Most of these patients are candidates for additional surgery or procedures (commonly a filler such as Restylane) but they have chosen not to do more. The “end point” for procedures is when the patient is satisfied, and making my patients happy is what my practice is all about.

Peter S. Levin MD 

Before and After Gallery

Topic: Asymmetry

38 year old woman with asymmetry from ptosis of the left upper eyelid (pre-op left photo). She had right ptosis repair (post-op right photo).   Note:  This patient has done very well with excellent symmetry after surgery.

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

38 year old woman with significant asymmetry of the lower eyelid (pre-op left photo).  She had lower blepharoplasty with fat repositioning.  Her results (post-op right photo) show improved overall appearance and reduced by not perfect symmetry of the lower lids.

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

This patient had volume loss in the “upper sulcus” and ptosis following retinal detachment surgery (pre-op left photo).  Skin, muscle, and fat was removed from the right upper eyelid.  The right upper eyelid fat was placed under the skin of the left upper eyelid and the levator aponeurosis tightened (post-op right photo). 

Asian Blepharoplasty eyelid surgery Asian Blepharoplasty eyelid surgery

Topic: Asymmetry

We do not know why this patient’s lower eyelids are so different. (pre-op left photo).  She was treated with lower lid fat removal from both lower eyelids (transconjunctival) with our judgment on how much more to remove on the more affected left side.  Post-operatively, (post-op right photo) great improvement has been achieved. 

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

This patient presents with asymmetric lower eyelids that are bothersome. There appeared to be differences in the muscle and fat in the lower eyelids (pre-op left photo). She is shown after lower blepharoplasty with fat repositioning (post-op right photo) without muscle manipulation. The symmetry is improved.

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

This patient has asymmetry between the eyes and brows (pre-op left photo). She had right upper blepharoplasty (post-op right photo). She shows improvement and she appears to elevate her eyebrows less. Right browlift or left upper eyelid filler might give her further improvement in the future should she wish additional improvement

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

46 year old man with differences in the upper eyelid folds and brows but without true ptosis (pre-op left photo). He was treated with left ptosis repair only (post-op right photo).

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

This patient had very different upper eyelid folds and volume (pre-op left photo). Her initial step was bilateral blepharoplasty. On the right eyelid only skin was removed—which had the effect of filling the upper lid modestly. On the left eyelid, skin, muscle, and fat were removed (post-op right photo). Options for further improvement include filler in the central and inner right upper eyelid and additional tissue removal on the left.

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

21 year old woman seen months after an automobile accident with right orbital fracture and a sunken in right eye (enophthalmos). Shown before and after orbital reconstruction.

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

Patient with long standing asymmetry of the bony eye socket, brows, and upper lids. (pre-op left photo) She is shown after staged right browlift and bilateral upper eyelid surgery with “debulking” of the right upper eyelid, and skin removal only of the left upper eyelid (post-op right photo).

Asymmetry Before After Eye Surgery Asymmetry Before After Eye Surgery

Topic: Asymmetry

Patient with long standing asymmetry of the bony eye socket, brows, and upper lids. (pre-op left photo) She is shown after staged right browlift and bilateral upper eyelid surgery with “debulking” of the right upper eyelid, and skin removal only of the left upper eyelid (post-op right photo).

Asian Blepharoplasty eyelid surgery Asian Blepharoplasty eyelid surgery

Topic: Asymmetry

31 year old man with asymmetric upper eyelids and eyebrows before (left) and after (right) eyefold surgery on both upper eyelids without brow surgery. Note:. Asymmetry is fairly common, particularly when eyelid creases (double eyelids) are different. This can often be improved with a single eyelid operation. Additional surgery can sometimes improve things even more.

Asian Blepharoplasty eyelid surgery Asian Blepharoplasty eyelid surgery

Topic: Asymmetry

29 year old man with facial (VII) nerve palsy with eyes open and closed before (left) and after (right) placement of Gold weight in upper eyelid and elevation of lower eyelid.

Topic: Asymmetry

This patient had a fracture of the left eye socket with damage to the left eye. The left socket is deeper set than the right. The left eye shows ptosis. Fat is bulging on the right lower lid compared to the left. (pre-op left photos ) He had right lower fat removal, bilateral upper blepharoplasty (with volume preservation on the left) and left upper ptosis repair (post-op right photo). Like so many patients in this section, he appears better—but not perfect.