Evening Eyelid Asymmetry on a Partial Crease on One Eye with Non-Surgical Treatments

A gentleman has asymmetric eyelids. He wants to know the right procedure to make his eyelids more symmetrical.

Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years. He specializes in cosmetic surgery of the eyes and face and he has a particular specialty focused on Asian eyelid surgery.

One of the most popular surgeries that is desired is Asian eyelid crease surgery. 50% of people of Asian origin have an eyelid crease, while 50% do not. There are many different ways to do Asian eyelid surgery for different situations. For this gentleman, the fibers of the levator muscle that are attached to the skin pulls the skin inward to create this partial crease. However, on the other side, there aren’t any good strong attachments and therefore, he has a more constant fold.

From Dr. Prasad’s experience, he generally discourages anybody to do surgery that tries to detach the eyelid crease in order to get a fold. Every time any kind of surgery is done in the space around the eye called the orbit, patients are at risk of losing some tissue. This will give them a potentially deeper crease and not an intended crease like when creating a specific type of height and shape in an incisional or non-incisional Asian eyelid surgery. In situations like this, it might be worth trying a filler like in a hyaluronic acid family such as Restylane. This will create some volume in the space that would create the fold. Unfortunately, fillers are not permanent and they need to be maintained. In addition, with fillers, it needs to enter the skin with a needle and patients could end up with a bruise or some swelling.

In some people before fillers were around, Dr. Prasad used to do fat grafting. He did that mostly for patients who had previous Asian eyelid surgery and they had too much hollowing or volume loss. It was almost like their eyelids were the shape of a letter A and their eyelid crease went up. He would not recommend that in this gentleman’s situation as it would be unnecessarily traumatic and the risk and benefit don’t make sense.

If the eyelid position or the eyebrow position is responsible for creating the crease or the brow is low and the fold stays more constant, this gentleman might want to consider just doing some Botox in the forehead. He is young and it’s unusual or atypical to have Botox because that’s usually for fine lines and wrinkles. However, since his eyes make him uncomfortable, then these less invasive experiments are worthwhile for him to try.

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[DevinSymone]

I didn't know fillers restore volume, thank you!