This patient wanted to even out his unequal double eyelids (skin creases) and had seen plastic surgeons who recommended creating a higher double eyelid for the left eye. However, the patient wanted the right double eyelid to be lowered. Examination revealed that his right eyebrow is higher than the left. Further history revealed that the double eyelids was equal in height until he developed a right eyelid infection from stye 7 years ago.
Right double eyelid (skin crease) and
the eyebrow were higher than the left.
Eyelid examination (see below) showed he actually had a right droopy eyelid and this was masked by the compensatory lifting of the right eyebrow. If surgery were done to make the left double eyelid higher, the difference in the eyebrow height will become more marked and the patient was unlikely to be happy.
Patient lifted both eyebrows widely.
The right eye appeared smaller than the left eye.
The right eyebrow was stopped from lifting
and the right eye became smaller.
The correct diagnosis was right droopy eyelid (ptosis). This was most likely to result from dehiscence of the muscle (levator muscle that opened the eye) from the eye infection that he had 7 years ago. The treatment of choice was right ptosis operation. However, he was sceptical about the diagnosis as the two plastic surgeons he consulted both recommended left double eyelid surgery. To convince the patient, two jabs of botox were injected into the forehead to lower the eyelid.
2 X 4 units of botox were injected into the frontalis
just above the eyebrow (red spots).
When seen two weeks later, there was an obvious right mild ptosis. The patient was now happy with the diagnosis and agreed to a right posterior approach ptosis operation.
Right eyebrow was lowered with botox.
The right eye became smaller due to ptosis.