Drooping Eyelid or Ptosis

What is a droopy eyelid?

Droopy eyelid also known as  ptosis, which is a term to describe the appearance of the upper eyelid when the eyelid lash margin is a constantly at a lower level than what is normally expected

What causes a drooping eyelid?

The upper eyelid muscle that is responsible for lifting the upper eyelid and keeping it open becomes overstretched and loses its elasticity and tone similar to an overstretched rubber band. It is unable to lift the upper eyelid and hence the eyelid lash margin sags or droops.

Levator muscle weakness may be present at birth (when it is called congenital ptosis). However, in majority of cases the cause is acquired or due to ageing changes.

With age, the muscle that opens the upper eyelid stretches and loses its elasticity. The laxity of the skin and eyelid muscles, combined with changes to the muscles around the eyes (the muscles that lift the eyelid) and the fat distribution in those areas, can lead to saggy, lazy, baggy looking eyelids, under eye shadows, vision impediment and tired-looking facial appearances.

Other causes of droopy eyelids are frequent rubbing of eyes, use of contact lenses, cataract operation, repeated episodes of eyelid swelling due to allergies, and eyelid trauma can also cause overstretching of the levator muscle and cause eyelid ptosis or droopy eyelid. 

“It's important to note that if forehead wrinkles associated with drooping eye lids are treated with muscle relaxant injections, the eyelid droop may become more obvious.  But most people don’t understand the inter-connections between different signs of ageing; including the relational dynamics of eyelid skin ptosis and lines across the brow.”

The commonest cause of droopy eyelids

• Overstretching and disinsertion of the muscle and the tendon that opens the upper eyelid due to age related changes

Other causes include

• Eyelid growth, tumours or swelling
• Muscular and neurological problems
• Nerve damage in the eye muscles.
• Trauma to the eyelid structures including nerve injury
• As a complication of Botox injections.

Why do droopy eyelids affect the way you look and the way you function? 

Droopy looking eyelids together, with laxity in the eyelid skin and muscles around the eyes leads to a puffy, aged appearance and a tired or sleepy look. 

Gradually it begins to impact your vision and/or leads you to frequently and constantly raise your brow to function. Often, but not always the excess eyelid skin droops and falls over the eyelid margin and restricts your vision.

As a response, forehead wrinkles often develop when there is skin laxity around the upper eyes. In fact, deepening lines across the forehead area can be one of the earliest signs of drooping eyelids; as these skin folds deepen due to constantly raising your brows to combat the drooping eyelid skin. 

It’s often done subconsciously and you’re not even aware you’re doing it, but if you’re showing signs of eyelid ageing and your brow area is being impacted by lines, it’s likely a combined effect from puffy eyelids.

Can a 30-year-old have droopy eyelids?

Although it is not common, it is possible to suffer from droopy eyelids in your 30s.

Typically, these patients are born with a mild form of congenital eyelid ptosis that is not severe enough and hence not a visible concern for the patient. However, as patients get older it becomes more obvious because the surround soft tissues that were strong in youth begin to become weak and less supportive.

What is the best treatment drooping eyelids? 

Fortunately, Plastic surgery of the eyelids can correct droopy eyelids by tightening the overstretched levator muscle and removal of excess skin above the eyes. There are no non-surgical options such as injections, skin tightening devices that can fix droopy eyelids

Why do people have  droopy eyelid surgery?

The facial appearance due to droopy eyelids makes people self-conscious of the appearance. Often, they get asked if they are ‘tired’ ‘sleepy’ or in extreme cases ‘drunk’ or ‘stoned’ which often leads to social isolation. Patients with droopy eyelids do not like to pose for photos or selfies because their eyes look half closed in photos. Droopy eyelids will restrict the field of vision which in turn will affect your ability to work efficiently

People have surgery to correct the problems listed above, primarily lax skin that impedes vision or leads to puffiness and a tired, aged facial appearance; or to help reduce the impact on the brow muscles that leads patients to suffer headaches and facial muscle fatigue.

Following surgery, patients often report that the heaviness they felt around their eyes has been lifted or lessened form the surgery. They indicate opening their eyelids feels easier, e.g. requiring less effort (feeling they have a more natural facial expression). 

Is eyelid surgery to correct droopy eyelids classified as functional or cosmetic.

Droopy eyelid surgery or correction of eyelid ptosis is mainly functional because it improves the visual field and symptoms such as headaches, heaviness of the eyes, decreased productivity due to the above. 

Benefits of ptosis surgery

Droopy eyelid (Ptosis) surgery has functional, medical, psychological and cosmetic benefits as it improves vision, quality of life activities, productivity and appearance following eyelid surgery.

Find out if you are the ideal candidate for droopy eyelid surgery.

You are an ideal candidate for Droopy Eyelid Surgery if you have:

• Over hanging excess upper eyelid skin or eyelid hooding
• The hooding or excess skin restricts your visual field or causes heaviness in the eyelids
• Droopy or weak eyelids that make you look tired or sleepy
• Eyebags or Fatty bulges in the under-eye area that make you look tired

What happens during the consultation with Dr Naveen Somia?

The in-clinic eyelid surgery consultation usually lasts about 45 – 60 minutes and is an interactive process to help you determine whether eyelid surgery will address your concerns and more importantly, whether you trust me as your Surgeon.

I take a detailed medical history followed by evaluation of the structure, function and aesthetics of your eyelids and how they relate to your face. This is followed by clinical photography which is an important record. All these help me to determine whether you are a suitable candidate. Bringing a couple of photos from your 20s or 30s will help.

This is followed by a discussion of all risks and benefits of the proposed surgery. I expect you to have questions and there will be ample time to ask them. After the consultation you will be given information that describes the eyelid surgery procedure, lists the risk factors and complications of eyelid surgery and the costs of eyelid surgery.

It is standard practice that we schedule a second consultation which provides you another opportunity to clarify the doubts and ask questions and be reassured of your safety.

Is surgery for droopy eye lid covered by Medicare or private health fund

Upper eyelid surgery may be partly covered by Medicare and private health fund if it classified as medical by fulfilling certain criteria. If the upper eyelid changes affect your vision as proven by a visual field test done by an Optometrist, your surgery may be eligible for cover. 

How long does the operation take?

Droopy eyelid surgery is performed in a licensed facility and usually takes between 1.5 to 2 hours, but this can vary from patient to patient depending on the additional procedures performed.

What happens after the operation?

Immediately after the operation you will spend some time in the recovery ward where you will be closely monitored till you are fully awake. There will be no bandages on the eye, and you will be able to open and close your eyes. You will need regular lubricating eye drops, eye ointment to the suture line and ice packs over your eyes. 

It is desirable to stay overnight for regular monitoring because during the first 12 hours after eyelid surgery, there is a risk of bleeding, pain, nausea and vomiting due to the anaesthetic and general drowsiness due to a slow recovery from the anaesthetic leading to an increased risk of bleeding. In addition, the blurred vision following surgery can make the patient anxious.  Staying in hospital where you will be monitored, and your eyelids looked after 

How long is the healing process?

Healing and recovery vary from patient to patient but on average, the healing process takes two (2) weeks or more. Please ensure you allow adequate healing time after eyelid surgery and follow all the helpful healing instructions and don’t try to do too much too soon; you will need to rest your eyes a lot during those 2 or more weeks of healing.

What results can I expect after surgery for droopy eyelid

Generally speaking, eyelid surgery will get rid of the visible signs of ageing and give you a fresh, rested and youthful look in both your upper and lower eyelids. Although most changes are noticeable straight away, we recommend waiting for a good 6-12 weeks for all the temporary changes including swelling to resolve to experience the final result. 

Upper eyelid surgery will get rid of loose and excess eyelid skin, tighten and lift droopy eyelids to give you a fresh look. If you have eyelid hooding, it can be corrected. If you notice that your “eye shadow space” is no longer visible and your eye shadow smudges, upper eyelid surgery to get rid of the excess and over hanging eyelid skin can help.

Risks of droopy eyelid surgery

Most droopy eyelid surgery or ptosis correction procedures are very complex operations requiring technical expertise and aesthetic finesse. That’s why it’s so important to choose a top eyelid surgery expert Plastic Surgeon, who has had extensive training and experience in eyelid surgery.

If your doctor gets your eyelid surgery wrong and botches your blepharoplasty, you could end up with some unwanted complications and appearance concerns – some of which won’t be able to be repaired easily. 

Be sure you choose someone with the Specialist qualifications of a Plastic Surgeon with FRACS and someone who has extensive expertise in getting a good eyelid surgery result.

Complications of eyelid surgery include: 

• constantly flowing tear ducts or watery eyes
• dry eyes
• very uneven eyelid appearances
• being unable to fully close your eyes or blink
• other surgery complications (you’ll be given a full list in your consultation)

Reducing risks of eyelid surgery

Healthy patients who choose a fully qualified Specialist Surgeon for droopy eyelid surgery, instead of a doctor who is not a Surgeon can reduce some surgery risks by:

• Making sure their surgeon is very experienced in eyelid procedures
• Carefully following instructions before and after surgery
• Not trying to do too much too soon
• Avoiding driving, and not wearing contacts or eye makeup, until your Surgeon has cleared you to do so after surgery

A botched operation can leave you with some serious eye lid problems it’s just not worth it and will cost you more in the long run. Instead, have a consultation with a real specialist Plastic Surgeon and find out what’s involved, including healing times, potential appearance enhancements and potential risks

“All eyelid surgery requires intensive planning around varying facial features, eye area anatomy and precision surgical techniques. That is why it’s so important to choose a fully qualified Specialist Plastic Surgeon, one who has extensive experience and expertise in eyelid surgery procedures.” 

Things to do to improve outcome of eyelid surgery to correct droopy eyelids

Before droopy eyelid surgery

• Book a consultation with Sydney’s eyelid specialist, Dr Naveen Somia
• Read the materials provided and discuss your surgery objectives, desired outcomes and facial anatomy including surgery costs, surgery schedules, time frames, recovery care, healing times and risks
• Consider the PROS and CONS of the surgery and what you want accomplished
• Ask any and all questions you have about eyelid surgery including risks and your ideal eyelid appearance after surgery
• Discuss your preferences for anaesthetic and which day surgery or hospital option you prefer for your Surgeon
• After doing your homework, decide to proceed 
• Schedule your surgery, work out your payment options and attend pre-consultations
• Follow Dr Naveen’s recommendations for pre-surgery preparation
• Stay healthy to enhance your healing period and help prevent healing delays

Immediately after droopy eyelid surgery

• Avoid wearing contacts for the designated time 4 weeks post surgery (ask Dr Naveen for specific information on stopping wearing contacts before your eyelid surgery)
• Before surgery, read and re-read your post-op instructions
• Have the post-operative eyelid care instructions laminated and place them by your bedside, using very large font sizes, for when you get home after surgery
• When you’re cleared for discharge, make sure you have someone to drive you home

After droopy eyelid surgery

• Stay out of the sun for the designated period of time
• Make sure you’re choosing good nutrition and drinking plenty of water 
• Rest your eyes and do not drive until you are cleared by your Surgeon
• Care for your eyes and sutures as instructed by Dr Naveen
• You may be asked to sleep in an elevated position 
• You may be able to use gently applied cool packs to minimise swelling, but check with Dr Naveen as these must be used only according to instructions
• You may feel your eyes appear swollen or your eyelids ‘tight-feeling’; you may have some bruising or discolouration around the eyes after surgery 
• Report any concerns or questions 
• Attend follow up appointments and have your sutures removed at about 8 days (this can vary slightly and frequently doesn’t hurt)
• In approximately two (2) weeks’ time, your eyelids should be mostly healed, however, the scar may take up to 12 months to fully mature
• Follow Dr Naveen’s scar minimisation instructions

For more information about Dr Naveen Somia visit his page on Eyelid Surgery in Sydney