Eyebrow Asymmetry: Causes and Treatment

Asymmetric eyebrow height is common patient complaint. It can range from being subtle to obvious. There are various causes, with nonsurgical and surgical treatment options.

Causes of eyebrow asymmetry

The eyebrow asymmetry could be due to congenital facial bony asymmetry, with side of the face being smaller than the other. The brow on the smaller side of the face will be lower than the larger side. Bony facial asymmetry is a very common finding present in almost everybody, ranging from subtle to very significant obvious asymmetry. Please click on this link for an article published by Dr M. Ray Taban on facial asymmetry.

Another common cause of eyebrow asymmetry is due to underlying upper eyelid droopiness (ptosis). The brow on the side with more ptotic eyelid will be higher. This happens because the brain sends (involuntary) signal in order to raise the brow on that side in order to help lift the droopy eyelid, in order to see better.

Other causes of brow asymmetry include muscle or nerve weakness on one side (example facial or Bell’s palsy), prior surgery or trauma, among other things.

Treatment

Nonsurgical: The brow height is determined by the action of its elevators versus its depressors. Botulinum toxin (Botox, Dysport, Xeomin) can be used to weaken either the elevator or the depressor muscle in order to either lower or elevate the brow, respectively.

Surgical: If the underlying cause of the brow asymmetry is eyelid droopiness (ptosis), then fixing the ptosis will help alleviate the eyebrow asymmetry. Otherwise, there are various surgical techniques to lift the brows (eyebrow or brow lift, forehead lift), including direct brow lift, pretrichial brow lift, and endoscopic brow lift. They each have their advantages and disadvantages.

Who should you see for this problem:

An oculoplastic surgeon is best equiped to understand the underlying cause of eyebrow asymmetry and treat it. An oculoplastic surgeon, with membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), is an ophthalmic plastic reconstructive surgeon who specializes in cosmetic and reconstructive surgery of the eyelids and surrounding structures. Dr. M. Ray Taban is triple certified by the American Society of Ophthalmic Plastic Reconstructive Surgery (ASOPRS), American Academy of Cosmetic Surgery (AACS) and American Academy of Ophthalmology (AAO).


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