Patients often come to our office complaining that their eyes look tired, heavy, or asymmetrical. While excess skin is frequently part of the problem, it is not always the entire story. The upper eyelid region is actually a complex anatomical area involving the brow, eyelid skin, muscle, and the eyelid’s lifting mechanism.
One common contributor to an aged appearance is excess upper eyelid skin. This condition is effectively treated with an upper eyelid blepharoplasty, during which redundant skin and, when appropriate, small amounts of underlying tissue are removed. Another contributor may be a low or descended brow. In such cases, a brow lift may be recommended to elevate the eyebrow to a more youthful position.
However, neither a blepharoplasty nor a brow lift directly corrects true eyelid ptosis.
Ptosis refers specifically to drooping of the upper eyelid margin itself. The eyelid edge may sit lower than normal, sometimes partially covering the pupil. Patients often notice that one eye appears smaller than the other, that they must raise their eyebrows to see better, or that they look chronically tired even after adequate rest.
The most common cause of adult ptosis is stretching or weakening of the levator aponeurosis, the tendon-like structure responsible for lifting the upper eyelid. Ptosis can occur naturally with aging, following eye surgery, after trauma (e.g. from wearing hard contact lenses), or occasionally from neurologic or muscular conditions.
Modern ptosis repair typically involves tightening or advancing the levator mechanism through an incision hidden within the natural eyelid crease. The procedure can sometimes be performed under local anesthesia with sedation, allowing the surgeon to fine-tune eyelid position during surgery. When appropriate, ptosis repair can be combined with upper blepharoplasty and occasionally with a brow lift to address all components of upper facial aging simultaneously.
