Several times a week, clients use the words “droopy eyelids” to describe why they’re seeking my help. I proceed to evaluate their eyelids/face, define the problem, and devise the best possible solution. My explanation always starts out with: “when we talk about droopy eyelids, there are actually THREE things that can droop…” This is when I get a look of surprise and dismay; they’re thinking “I thought I just had the droopy eyelid problem, now you’re telling me I have THREE things wrong with me?!” In this article, I will demystify the THREE components of the “droopy eyelid.”
As we age, our forehead skin becomes more lax and we lose volume and three-dimensional projection in our eyebrows, creating the phenomenon of eyebrow ptosis (sagging eyebrows). Sagging eyebrows weigh the eyelid skin down and clients often perceive this as “droopy eyelids” because the appearance of excess skin is what bothers them the most.
This man’s “droopy eyelids” are actually due to eyebrow ptosis. The top panel shows sagging brows pushing the eyelid skin down onto his lashes, worse on his right side, causing him to look tired and asymmetric. The solution to this is not necessarily eyelid surgery but rather a forehead lift. Bottom panel shows the same client after forehead lift surgery. No eyelid surgery was performed but he looks more relaxed, symmetric, and no longer has skin sitting on his lashes!
This is the type of “droopy eyelid” that clients notice most frequently. True dermatochalasis (excess upper eyelid skin) often obscures the platform of the eyelid, making a person look tired and/or angry, and making the eyelids feel heavy. Not to mention it becomes pretty much impossible to wear eye make-up because the skin just hides and smears eyeliner, mascara, and eye shadow. I can’t tell you how many times I’ve heard a client say “I’ve given up wearing make-up altogether…”
This woman with beautiful blue eyes hated her “droopy eyelids” because people always commented on how she looked tired and angry. Notice that her eyebrows are in good position and, although her eyes look smaller in the top panel, it’s because the excess skin is draping over her lash line and obscuring part of her eyes! After blepharoplasty surgery (removing the excess skin and sculpting the deeper fat), we see that her eyelid opening is actually ideal and symmetric. Removing the excess skin unveiled her striking blue eyes and makes her look more energetic and approachable. Confession: I did give her some Botox® to help with the angry “eleven” lines.
Okay, we can’t get through this next part without a little anatomy lesson. The eyelid has a platform, called the tarsus, that is made out of collagen and gives the eyelid it’s structure and rigidity. Two muscles attach to the tarsus, one on the front side (levator muscle) and one on the back side (Muller muscle). Together, these thin sheets of muscles lift the eyelid the way a garage door opens.
With age, eye rubbing, eye surgery, contact lens wear, etc…, these thin sheets of muscles can become stretched out so that they no longer lift the eyelid effectively. This results in true eyelid ptosis (the most accurate description of a “droopy eyelid”) where the eyelid itself rests in a lower position.
This woman has some eyebrow deflation (volume loss) but no actual eyebrow ptosis. And she doesn’t have dermatochalasis (excess eyelid skin). She has true eyelid ptosis, worse on her left side, where the eyelid resting position is just too low (top panel). After ptosis repair, her eyelids are more open and she no longer looks sleepy!
Just when you think you’ve mastered the components of the “droopy eyelid,” here’s a curve ball. The THREE components of a “droopy eyelid” can occur in any combination. But I hope I’ve been able to give you an idea of what I’ll be looking for when I examine you in the office. And now that we’re on the same page, we can better define the problem and work together to come up with the best individualized solution for you!