Tips to Determine Cause and Fix for Drooping Eyelids

"Heavy" eyelids can have Medical or Cosmetic Causes — Plastic Surgery Offers Repair Options for Both

Apr 04, 2013, 09:45 ET from New York Group for Plastic Surgery

TARRYTOWN, N.Y., April 4, 2013 /PRNewswire/ -- The reasons for drooping upper eyelids can be medical or cosmetic in nature but either can affect vision and self-esteem, and both can be repaired with relatively uncomplicated plastic surgery procedures. Medical, or functional, eyelid drooping results from a problem with the working of the eyelid skin and muscle, while cosmetic eyelid drooping is typically a result of weakened or saggy skin due to the effects of aging.

Ptosis is a medical, or functional, situation in which the upper eyelid blocks too much of the iris, the colorful part of the eyeball that regulates light levels and vision. Ptosis becomes more common with aging, and can be caused by a weakness in the eye's levator muscle, which is responsible for the eyelid opening and closing. Blepharochalasis is another medical condition, in which the upper eyelid is properly located on the iris, but excessive skin causes the drooping lids. These two conditions sometimes occur together. 

The cosmetic reason for drooping eyelids can be hereditary, or more commonly aging-related. Sometimes the eyelid skin stretches or the levator muscles become lax, or weakened. Fat deposits may also develop above and below the eye. A drooping upper or lower eyelid can result in a person looking tired or older than their age.

"Besides affecting vision, having drooping eyelids can affect the way a person feels emotionally," says Nebil Bill Aydin, M.D, assistant professor of Surgery at the New York Medical College, attending surgeon at the Westchester Medical Center, and a Reconstructive and Cosmetic Surgeon with the New York Group for Plastic Surgery. "Hearing from people how tired you look can negatively affect feelings about yourself, and you may indeed start to feel drained and downcast."

How can you tell if your eyelid ptosis is cosmetic or functional? A medical specialist can determine if eyelid drooping is due to medical or cosmetic causes, but Dr. Aydin offers some signs that it's more likely a medical, or functional, rather than a cosmetic issue:

  • Pinch — don't lift — the upper eyelids. If vision is unchanged, the problem is likely functional.
  • Look in the mirror, or ask a friend, to see if there's a discrepancy between the two eyelids, with one drooping significantly more than the other.  (Normally, the lower eyelid sits just at the level of the limbus — the edge of the iris — whereas the upper eyelid should just barely cover the iris.) If so, the problem is likely functional.

"I believe that 'the eyes are the windows to the world' but the eyelids are the curtains, and if the curtains don't sit well on the windows the world does not look right," says Dr. Aydin. "Fortunately, there are common plastic surgery procedures that can repair the eyelids to unblock vision and improve appearance."

The goal of medical, or functional, eyelid ptosis surgery is to position the eyelids in their appropriate position. If the eye's levator muscle is lax, it's tightened; if the levator muscle is separated from the eyelid, it's reattached. Ptosis surgery is usually done while patients are awake so they can blink, and open and close their eyes, to give the surgeon a good approximation of how the eyelids should be properly positioned.

For a cosmetic eyelid droop, a plastic surgery procedure is performed to lift the eyelid; drooping skin and excess fat can be removed from the upper and lower lids.  This can be done while patients are either awake or under anesthesia. The procedure lifts and evens out the eyelids, and can also improve bagginess or puffiness under and around the eyes.

About the New York Group for Plastic Surgery

The New York Group for Plastic Surgery is comprised of highly trained reconstructive and plastic surgeons certified by the American Board of Plastic Surgery (ABPS) and recognized for their specialized medical and cosmetic surgical skills and personalized patient care.  The New York Group for Plastic Surgery serves patients from communities in the entire Hudson River Valley, New York City, Northern New Jersey, Eastern Pennsylvania and Western Connecticut, as well as patients who travel from across the United States and internationally for their expertise.

Andrea Ziltzer
AZ Healthcare Communications                                                    

SOURCE New York Group for Plastic Surgery