A significant number of patients with unequal double eyelids actually have ptosis (droopy lid) making the double eyelid on the affected side higher. This ptosis may be compensated by overaction of the eyebrow which helps to lift the eyelid and therefore masks the droopy eyelid.
This patient complains of unequal double eyelids and asking for the left double eyelid to be made higher. However, examination shows her right eyebrow to be higher. When the eyebrow was lowered by stopping the forehead muscle from lifting it the right eyelid appears lower. The correct procedure is to lift the right eyelid instead of making the left double eyelid higher.
Patient complains that the left double eyelid is lower than that
of the right. Note the right eyebrow is higher. When the eyebrow
is lower, the right eyelid appears droopy.
Before the ptosis operation the patient was given sedative, in
the relaxed state both eyebrows are of equal height and the right
droopy eyelid became obvious with high double eyelid.
A posterior approach mullerectomy was performed to lift the right eyelid.
24 hours after the procedure the right eyelid was slightly over lifted.
4 weeks after the surgery, both double eyelids
and eyes now appear equal.