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A woman’s eyelid is bigger than the other eye. She wants to know if this is ptosis. Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon. This means that his first area of specialty training was in eye surgery and then he went on to do specialized training in cosmetic and reconstructive surgery of the eyelids, the orbits, and the lacrimal system. He is also board-certified in full body cosmetic surgery by the American Board of Cosmetic Surgery. He has been in practice for over 20 years, and lesions around the eyes and ptosis or drooping of the eyelids are things he deals with every day in his practice. After looking at this woman’s photo, Dr. Prasad says that the left eye in the inner aspect appears to be lower compared to the right eye. When he makes observations, he wants to ask further questions in a consultation. In his practice, he asks about history and if she looked at previous photos of her and saw that difference. He tries to differentiate if this drooping is congenital or she were born with it, or if it is acquired or something that has occurred later. If this woman was born with the drooping eyelid, at certain points of her life, that drooping eyelid can be a little lower. Sometimes patients compensate for the asymmetry naturally, and eventually there’s a little further descent. This descent can only be a millimeter but it can make enough of a difference. Within the normal population, it’s normal to have a difference between the two eyelids of about 1-2 millimeters. The human body is asymmetric so it is generally tolerated without it drawing attention. When it’s greater than that, it usually prompts people to seek a professional opinion. Dr. Prasad suggests that she would need proper examination and diagnosis. In his practice for over 20 years, he has performed all kinds of ptosis surgeries from congenital or people born with it, for helping people with vision and acquired or myogenic ptosis, or muscle-related ptosis. These are all different types of ptosis and there’s always a difference in the way they are approached based on some objective parameters that are determined during physical examination. Clearly, she needs to meet with a doctor in order to get the proper evaluation. Generally, people first see an ophthalmologist or someone from Dr. Prasad’s specialty, an oculoplastic surgeon and try to determine what the cause is. He also wants to rule out neurologic causes which can be done by a neuro ophthalmologist. As long as she finds one specialist to evaluate her, she should be led from that one point forward in the right direction. As far as the lesion is concerned, although this is not a high resolution photo, Dr. Prasad believes she is referring to a lesion in left lower eyelid along the margin. Although he can’t see exactly what it is from the limited photo, it appears to be from a general perspective a nevus, which is a bump-like freckle that she is born with. Again, without a physical examination and without a 3-dimensional view, it’s really not appropriate to diagnose it without qualifying it. Again, meeting with a specialist is important to get the proper diagnosis. For more information about ptosis surgery, please visit our website: http://prasadcosmeticsurgery.com/pras...