A Delicate Way to Correct Uneven Eyes That Developed After Double Eyelid Surgery and Restore Balance

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In our face, the eyes are an important factor that determines the first impression.

However, when the size or shape of both eyes, or the height of the eyelids, looks different,

it is perceived as “uneven eyes,” which can make the overall impression seem somehow awkward

or make one eye look tired.

Uneven eyes can be congenital, but they can also develop later due to lifestyle habits, aging, trauma, and other acquired factors.

So today, we will be posting about correcting uneven eyes, whether congenital or acquired.

Some people visit us after double eyelid surgery, while others come before surgery because both eyes are closed unevenly,

or only one eye is closed.

In most cases like this, we measure eye size from photos for consultation, but at Baba Plastic Surgery,

*we use the Agnima program to determine accurate measurements and establish the surgical plan.

When analyzed with the program, if the difference between both sides is around 1 mm or more, non-incisional ptosis correction is usually difficult.

In such cases, ptosis surgery is performed through an incision, and if unilateral ptosis is corrected with a non-incisional ptosis procedure,

a precise correction is difficult and the possibility of recurrence is high, so we recommend the incisional method.

In the case of unilateral ptosis, where the two sides are not different but only one eye is affected, the surgical difficulty is higher than in cases where both eyes have ptosis. This is due to Hering’s law.

Hering’s law: If the eyes move independently or if the eyes follow Hering’s law of equal innervation,

it appears that Muller stimulation is refocused predictively.

If one eye is closed and one side is corrected through ptosis surgery,

it is necessary to perform a more precise procedure because the previously normal opposite eye may become closed instead.

Unilateral ptosis (before and after correction on both sides)

We will explain further while introducing a patient who visited us with this case.

Before visiting our clinic, the patient had already undergone non-incisional double eyelid surgery and non-incisional ptosis correction twice at another hospital.

Even after two rounds of ptosis correction and double eyelid surgery, the strength of both eyes had not been corrected at all and they still looked closed.

In particular, when looking straight at the eyes, the left eye clearly showed the light reflection in the pupil,

but in the right eye, the light reflection was not visible.

1st correction

In the first correction, only the problematic right eye (in the photo) was corrected,

but the patient felt almost no change compared with before surgery.

2nd correction

Two weeks after the first correction, a second correction was performed,

and after the second correction, differences in eyelid height, eyebrow position, and the sunken area

could be observed.

Problem after the 2nd correction

After some time, the patient returned because the left eye (in the photo) suddenly felt heavy.

Therefore, the left eye (in the photo) was also treated.

3rd correction

The symmetry improved to some extent, but as time passed, the right eye (in the photo)

affected by sunken appearance again and the strength of opening the eye weakened, so both sides were corrected simultaneously for the fourth procedure.

4th correction (final)

Bilateral eye correction

After the final correction, the previous heavy feeling on the right side was improved,

and the difference when opening the eyes was adjusted to 0.5 mm, which is within the normal range.

Dominant eye / non-dominant eye

In this case, it is not enough to correct only one eye; both eyes must be corrected at the same time.

The reason is that when ptosis is present in the dominant eye, Hering’s law appears more strongly.

The eye that you mainly rely on when receiving visual information from the two eyes is called the dominant eye,

and the opposite eye, which does not mainly handle visual information, is called the non-dominant eye.

If you do a simple self-test, when you look with the dominant eye, the position of the finger is not much different from when you look with both eyes.

But if you close the right eye and look with the left eye, the position of the finger changes significantly.

Statistically, most people are right-eye dominant.

After ptosis correction, the size of eye opening should be adjusted within 3 weeks after surgery for it to be considered accurately corrected. If it has not been corrected,

early correction should be performed, because if more than a month passes after surgery, tissues may clump together like rice cake during the recovery process.

Today, I wrote about how to correct uneven eyes. Even if uneven eyes are corrected multiple times, or if the asymmetry is severe, one side may be undercorrected, overcorrected, or the opposite side may become smaller.

Since this is a surgery with many variables, good results can be achieved only when performed by experienced medical staff with excellent surgical skill.

This has been Baba Plastic Surgery. Thank you.