By Nebil Bill Aydin, MD, New York Group for Plastic Surgery
I firmly believe that “the eyes are the windows to the world.” But I would add that in turn the eyelids are the curtains, and if the curtains don’t sit well on the windows…the world does not look right!
Drooping eyelids can present as a functional or cosmetic problem. Ptosis (silent “p”) is a medical condition where the upper eyelid blocks too much of the iris (the colorful part of the eyeball), and can be common with aging. On the other hand, blepharochalasis is when the upper eyelid has excessive skin, but functionally the eyelid is in proper location on the iris. These two conditions can also present together to a varying degree and can be a point of confusion.
Ptosis can affect vision because the eyelid actually blocks the iris. Just as important, eyelid ptosis can also affect the way you feel inside. Perhaps people have been saying, “You look so tired, are you okay?” Hearing how tired you look can negatively affect the way you feel about yourself, and you may indeed start to feel tired and downcast.
How can you tell if your eyelid ptosis is cosmetic or functional? A doctor can tell you for sure, but here are some signs that it’s more likely a functional rather than a cosmetic issue:
- When you pinch — don’t lift — your eyelid skin, your vision is not changing from how it was.
- There’s a discrepancy between your 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.
We use a surgical procedure to fix functional eye ptosis. The goal of surgery is to position the eyelids in their appropriate position. If the eye’s levator muscle is lax (slack), we take out the laxity, or tighten it up; if the levator muscle is separated from the eyelid, we reattach it. Ptosis surgery is usually done while the patient is awake so we can ask you to blink and open and close your eyes to get a good approximation of how your eyelids should be positioned.
There are no bandages put on after surgery. You will need sutures (stitches), which are removed 3-5 days after the procedure. You can typically return to work in a week with just some mild swelling or bruising. Recovery is usually complete at two weeks after surgery. Often this procedure is covered by insurance.
For a cosmetic eyelid droop, we can do a relatively simple, common plastic surgery procedure to lift the eyelid. We remove drooping skin and excess fat from the upper and lower lids. This can be done while you are either awake or under anesthesia. The procedure lifts and evens out your eyelids, and can also improve bagginess or puffiness under and around your eyes.
You will have sutures, which are removed 3-5 days after surgery. Recovery is not complicated, but you will have some bruising and swelling that takes about 10 days to resolve. We typically ask that you avoid certain strenuous exercises and activities for a couple of weeks after surgery. The result can be very impactful, and you’ll look—and probably feel—very “refreshed!”
Dr. Aydin, a board certified plastic and reconstructive surgeon, is Assistant Professor of Surgery at the New York Medical College and Attending Surgeon at the Westchester Medical Center. He is a partner with the New York Group for Plastic Surgery.