Can My Eye Asymmetry Be Improved By A Blepharoplasty?

Q: Dr. Eppley, I’m getting in touch to enquire about a possible consultation regarding noticeable eye asymmetry that I’ve had for as long as I can remember. I’m currently trying to understand whether this is primarily skeletal (orbital bone positioning) or if it may be largely soft tissue-related — or a combination of both. I have attached an assortment of photos both relaxed, squinting and with my eyes shut. What’s interesting is that at least in my eyes, the asymmetry diminishes significantly when I am squinting & when I shut my eyes. Is it possible that it could be a combination of both skeletal & soft tissue and as a result, squinting or shutting my eyes improves the symmetry some what? I have quite prominent eyelids (genetic, my dad has the same) and one of them seems lower than the other. 

If soft tissue is indeed a factor, would anything improve the symmetry or appearance in general of my eye area, such as a blephoraplasty? I plan on getting a CT scan soon. Appreciate your insights. 

A:Thank you for sending your pictures. You have classic vertical orbital dystopia (VOD) of the left eye. (see attached imager) it only looks better when you squint or shut your eyes as you simply see less of the eyeball and thus it looks better for less asymmetric. While there is a soft tissue component to it (the upper and lower eyelids are positioned lower just like the eyeball) a blepharoplasty we’ll not provide any form of a correction. This is a foundational issue in which the entire left orbital box is positioned to lower. This requires a combined orbital floor/rim augmentation with overlying eyelid adjustments.

Dr. Barry Eppley

World-Renowned Plastic Surgeon