One of the causes of double eyelid asymmetry is the levator muscle. This is an eyelid muscle that helps to elevate the eyelid.
One of the reasons why you may have a double eyelid on one eye could be the levator muscle. When the levator muscle becomes weak, it can cause your eyes to appear asymmetrical. When the monolid is surgically changed to a double eyelid, the skin on the eyelid is attached to the deeper layer – such as the levator aponeurosis or the tarsus. However, if one of the levator muscles is weak, then the double fold will appear larger than the other eyelid.
When the weight of the eyelid skin is connected to the levator muscle double lid surgery, the weak muscle cannot support the excess weight. Not only will the double-lidded eyes look asymmetric, but the eyelid with the weaker levator muscle will feel heavier to the patient. The way to correct this asymmetric double lid is to perform a ptosis surgery. Ptosis surgery can be performed at the time of the double fold eyelid revision surgery.
Another reason for asymmetric eyelids is a disbalanced brow. One side of the brow can droop more than the other side – making the eyelid fold appear smaller than the other side.
Even though the double fold was set at exactly the same height, the asymmetric brow descent will make the eyes appear asymmetric. The way to correct this problem is either to perform a forehead lift or a brow lift. This procedure will lift both brows to the same height and correct the asymmetric double-fold eyelid.
One other method to address uneven double-fold eyelids is to perform a sub-brow lift on the side where the brow is droopy. By excising the skin immediately below the brow, the plastic surgeon effectively lifts the eyelid skin to show more of the double fold eyelid.
How to Correct Double Eyelid Asymmetry?
If you have a double eyelid on one eye, several options are available. To treat double eyelid asymmetry, the first thing a plastic surgeon must do is to check to see if the double eyelid fold height is the same.
If eyelid fold height is different, the plastic surgeon may make the lower double-fold eyelid higher by creating a higher positioned fold. By creating a new double lid, the lower fold will not be seen and the newly created higher double eyelid fold will be visible.
If the double-lidded eyes have the same height, then the plastic surgeon should inspect the eyebrow. Often, the side with the smaller visible double lid has brow hooding. In order to create more symmetrical double lidded eyes, many plastic surgeons are tempted to remove excess skin of the eyelid on the hooded side. However, this will lead to more puffiness or fullness of the upper eyelid with the brow hooding. Therefore, the optimal way to correct this asymmetric double-fold eyelid is to remove the thicker brow skin. This is an essential part of the blepharoplasty for Asian eyes. More specifically, it is a technique that was pioneered by Korean plastic surgeons who use this method to correct these asymmetries.
The Causes of Double Eyelid Fold Asymmetry
Eyelid asymmetry is caused by two main factors. One is double eyelid fold asymmetry. When the double eyelid fold is uneven, the double eyelid fold will obviously be uneven. This can be corrected by resetting the double eyelid fold evenly.
The second cause of double eyelid fold unevenness is due to eyelid elevating muscle asymmetry.
One can determine if eyelid fold asymmetry is due to muscle asymmetry by looking at the patient’s iris (the color aspect of the eye). In patients with eyelid ptosis (weakness of the eyelid elevating muscle), the amount of iris exposed will be different. In the eye with eyelid ptosis, the iris will be seen less. In addition, the brow will be more elevated on the side with eyelid ptosis. That side of the forehead muscle (frontalis muscle) will be activated to compensate for the weak eyelid muscle function. Therefore, one needs to examine the cause of double eyelid fold asymmetry (unevenness) and correct it appropriately by correcting the cause.
Correction of Asymmetric Double Eyelid Folds
In a scenario where there are asymmetric double eyelid folds, patients often wonder whether one eyelid or both eyelids should be operated on. For example, there can be a case where there is a low double eyelid fold in one eyelid while there is a higher double eyelid fold in the other eyelid.
Before answering the question of one eyelid or two, one must also consider the tension of the double eyelid fold rather than just simply the fold’s height.
If we increase the double eyelid fold height in the smaller fold, the surgically created fold or crease does not have the same tension or the depth of the fold as the non-operated eyelid on the other eye.
The best option is to operate on both eyelids to make the double eyelid fold tension the same.
If we were to only operate on the smaller eyelid fold, then the natural higher fold on the non-operated eye may loosen. Calibrating the eyelid tension on both eyelids at the time of double eyelid surgery is the most prudent way to maintain long-term stability of the double eyelid fold height and tension.
Bone Asymmetry’s Effect on Double Eyelid
When patients look at themselves in the mirror or photos, they do not look at their facial asymmetry. We often think that two eyes are the same but they are not. There are various reasons for face and eyelid asymmetry. One is variation of skin thickness. The other is muscle function asymmetry. And the third is bone asymmetry. The latter is because the eye is in the bone socket and the eyelid is covering the bone surrounding the eyes. And patients often have bony asymmetry. This is something that we don’t notice but is present.
What does bony asymmetry have to do with double eyelid surgery? When the bone is positioned more outward, the eye looks more protruding. But when the bone is positioned more inward, then the eye looks more deep set.
We often do not recognize asymmetry until we start looking for it. It is easier to recognize eyelid asymmetry because when we look in a mirror, we look at eyes first and then we look at the overall face, hair, make-up, etc. For example, patients often do not recognize their nostril asymmetry unless one has had nose surgery. And patients often do not recognize their facial bony asymmetry.
Eyelid Ptosis and Uneven Eyes
Eyelid ptosis is one of the main causes of eyelid asymmetry or unevenness. It can also be why you have a double eyelid on one eye.
Many patients believe that their eyes are uneven because of uneven eyelid skin or fat. However, the weakness of the eyelid elevating muscle (levator muscle) is the main cause of unevenness.
The way to correct eyelid muscle weakness or eyelid ptosis is by performing eyelid ptosis surgery. When the eyelid elevating muscle (levator muscle) is weak, the eyes look smaller and sleepy or tired. The weaker eyelid muscle side will have larger or higher double eyelid fold. In correcting uneven eyes, it is important to correct both eyes to get an even correction.
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