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2019 Cosmetic Eyelid Surgery: Distiguishing a drooping eyelid from excess skin

One of the most common things that patients get confused about is the difference between ptosis and excess skin on the eyelid. Many patients desiring improvement of their eyelids have difficulty distinguishing the difference between the two eyelid issues.

What is ptosis?

Ptosis is in short drooping of the eyelid or the eyelid hanging low. There are many causes of ptosis of the eyelid. Some are due to aging. Some are neurological. Others are due to allergies, autoimmune conditions or even contact lens use. The patient below has a drooping eyelid in both eyes. The aperture of the eyelid is narrowed. After surgery, the eyelid is at a higher position. This is done through tightening the muscle of the eyelid.

When a patient has eyelid ptosis often the eyelid aperture is narrowed. They may notice the eyelid is difficult to open and blocks the eye when reading, driving or other life activities.

Ptosis is repaired with tightening of eyelid muscles often. There are two main muscles in the eyelid and ptosis is repaired via tightening those muscles. Which muscle is to be tightened is determined in the office via testing.

What is excess skin of the eyelid?

When a patient has excess skin of the eyelid, it appears as just that..excess skin. It can hang low and be droopy. It often makes the skin crepey and can even rest on the eyelashes. Blepharoplasty is commonly used to address this issue. As can be seen in the picture below, this patient just has excess skin of the eyelid. Once it is removed, it opens the eyes appearance. Careful examination will show that the eye is open the same amount before and after surgery.

denver blepharoplasty

Can you have both?

Yes. It is possible to have ptosis and excess skin. When that occurs both eyelid muscle tightening must occur along with skin removal. Some of those procedures are covered by insurance and some are not. In this patient below, there is ptois and excess skin. For a good cosmetic result, both the eyelids must be raised and skin removed. If only one had been performed, it would not be enough.

It is recommended if you have ptosis or excess eyelid skin, it is best to see an eyelid specialist or oculoplastic surgeon like myself who can carefully assess which of those issues are causing a problem and what needs to be fixed for a good appearance after surgery. Fixing just one of the two components will not give a good result if both are needed. Best of luck!

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