Heavy upper eyelids — blepharoplasty, brow lift, and/or ptosis repair
If your upper eyelids look heavier than they used to, you may be considering eyelid surgery. Before deciding on a procedure, it helps to understand which part of the area around your eyes has changed. Excess eyelid skin, a lower eyebrow position, and a drooping eyelid can create similar concerns, but they call for different surgical approaches.
A consultation should give you a clear explanation of your anatomy and how it relates to the change you would like to see. That explanation is the foundation of a useful treatment plan.
When excess skin is the main concern
Upper blepharoplasty addresses excess upper eyelid skin. Loose skin can create a fold that obscures the natural eyelid shape. It does not change the actual eyelid shape or eyelid opening / aperture.
For someone mainly bothered by a heavier fold of skin, upper blepharoplasty may be an appropriate option. An important question to ask is: “How much of my concern comes from skin on the eyelid itself?”
When eyebrow position contributes
The eyebrow and upper eyelid are closely related. When the brow sits lower, it can contribute to hooding above the eye. A brow lift addresses brow position, and it may be considered on its own or alongside eyelid surgery. Oftentimes patients will come into my office and say they want an eyelid lift and lift up their eyebrow with their finger. That is different than an eyelid lift.
This does not mean that everyone with hooded eyelids needs a brow lift. It means that brow position belongs in the assessment. If a brow procedure is recommended, ask your surgeon to explain which part of your concern it would address and what improvement eyelid surgery alone could reasonably provide.
When the eyelid itself droops
Ptosis is a drooping of the upper eyelid itself. It is different from an overhanging fold of skin. Ptosis repair and blepharoplasty are distinct operations, even though both involve the upper eyelid. Blepharoplasty is a skin procedure. Ptosis surgery is a muscle tendon procedure. Ptosis surgery can open the aperture of the eye.
Understanding that distinction can help explain why the phrase “eyelid lift” is sometimes confusing. Ask whether the proposed treatment addresses excess skin, the opening of the upper eyelid, or both. You should leave the consultation understanding what each part of the plan is intended to change.
Choosing a plan that fits your goals
Bring specific concerns to your consultation. You might be bothered by hooding, the appearance of one eye relative to the other, or a change you notice in photographs. Describe what you would like to improve and what features of your appearance you would like to preserve.
Useful questions include:
What is contributing most to the heaviness I see?
What would the proposed procedure change?
What concerns would remain afterward?
If you recommend more than one procedure, what does each add?
What are the risks and recovery requirements for my plan?
There should be room to discuss alternatives, including choosing not to have surgery. A recommendation is most useful when you understand its reasoning and feel comfortable with the tradeoffs.
Understanding the risks
Like any other surgery, eyelid surgery carries risks. These include but are not limited to bleeding, infection, inflammation, swelling, dryness, and a possible need for additional surgery. Your surgeon should discuss the risks relevant to the specific procedure being considered. The decision should account for both the improvement you hope to achieve and the recovery and uncertainty you are willing to accept.
Taking the next step
If you are considering treatment for heavy upper eyelids, a consultation can help clarify whether excess skin, brow position, eyelid drooping, or a combination is contributing. Come prepared to discuss your goals and ask how the proposed plan addresses them.
To explore your options, schedule a cosmetic eyelid consultation with Dr. Copperman.
