Blepharoplasty for Inborn Crease Imbalance

The natural asymmetry in the crease shape, height and depth is not at all uncommon. As well as imbalance in the height and width of eyelid opening is known as “palpebral fissure”. During a study, eyebrow, eyelid and orbital measurement comparing in models with the average population and observed that moderate asymmetry around the eyes were common even with good looking faces.
Natural asymmetry is more common in Asian descent and may be influenced by some anatomic variables. Most of the patients believe their imbalance is due to difference in amount of skin and fat in the two lids, but this problem is quite related to weak natural crease fixation instead of tissue excess or deficiency.
It is advisable for exceptionable asymmetry to have blepharoplasty on both eyelids simultaneously, even if one eyelid already has acceptable natural crease. By undergoing blepharoplasty to both eyelids at the same time, surgeon has better chances to achieve balanced final match. When blepharoplasty performed only on one eyelid, it is more difficult for the surgeon during the operation to judge exactly how much to evaluate developing symmetry between the two eyelids.
In some rare cases, the presence of considerable ptosis affecting only one eyelid and the deficient eyelid may show no crease formation. For such cases, patient must undergo ptosis surgery along with double blepharoplasty for better improvement.
If asymmetry in crease shape is the cause of earlier double eyelid blepharoplasty surgery rather than inborn preexisting imbalance, surgical treatment can be especially challenging. Crease reformation for marked natural asymmetry or unacceptable surgery relies on advanced blepharoplasty techniques that are far more complicated and less expected than those used in normal double blepharoplasty surgery.