I just got a note from a patient who I saw almost 20 years ago. “As you can see my eyebrows are different by almost one quarter of an inch. I have noticed this happening for the past two years. I have not had injections or surgery.” Why is this happening?
People are inherently asymmetric, but the reason I see this most commonly is due to AGING.
What do I mean? As you age, your eyelid skin loosens. I tell patients that your eyelid is like a window shade, and as you age, your window shade becomes too long for the window. When that happens, you can’t see as well, so your body compensates. This is usually done by RAISING YOUR FOREHEAD. When you raise your forehead, you are raising your eyebrow to help get your eyelid out of the way.
Why is it on one side? Because people tend to have a DOMINANT EYE. You do most of your seeing with this eye. So subconsciously your muscles over that eye will contract more to “open” that eye up more so you can see.
- This gets worse as you age because you need to compensate more. Your eyelid skin gets looser as you age, so you need to lift the forehead on that side more to see.
- You will frequently see more wrinkles on that side of your forehead.
- Sometime the extra eyelid skin isn’t visible to you- it isn’t “hanging over” the eye but instead goes backwards into the eye socket. It doesn’t matter. Extra window shade = must compensate more to see.
- You will notice your eyebrows seem more even in the morning. That is because overnight your forehead relaxes (because you aren’t trying to see anything, read, drive, etc).
- Why did it get worse now? Because as long as you can see, your forehead doesn’t have to compensate. It is when you get to a critical excess of window shade that you have to start to compensate.
How can I get them more even? This needs an evaluation, but common treatments are:
- Upper eyelid blepharoplasty. When you fix the upper eyelid excess skin, so the window shade is the right length, the forehead naturally relaxes. I show photos of this to my patients in clinic of prior bleph patients. EYELID SURGERY
- You can do a tiny whiff of botox above the high eyebrow eye. This doesn’t let the forehead muscle on that side contract as much, which will drop the brow down. Be careful though! Usually you are doing this because you need to do it to see better.
- Browlift. Is the low side too low? You may need a browlift to fix the other side. This is a much less common issue- usually people age quite symmetrically.
If you have had prior eyelid surgery, how could this happen now? Because aging does not stop.
- If I do an upper blepharoplasty (upper eyelid surgery) on someone, the first surgery I may take out 10-15mm of skin. If that patient comes back to me 10 years later, they may have 2-3 mm of extra skin. You continue to age.
- If you had just the eyelid done, your eyebrow was not addressed. Think of your eyebrow as where the window shade starts. As you age, due to skin laxity and loss of volume, the eyebrow falls. This contributes to the issue on the upper eyelid. You may need a browlift.
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
