- Eye-related Conditions
Droopy eyelids (ptosis) and hooded upper eyelids (dermatochalasis) can not only interfere with your vision, but can make you look older, sleepy and also makes your eyelids feel heavy. Bags under the eyelids can make you look old and can affect your confidence because of the appearance. As a specialist periocular cosmetic surgeon, I can assure you that you are in safe hands when it comes to the intricacies of surgery in and around the eyes.
Ptosis is a droopy eyelid. In adults the most common reason for ptosis is slippage of the levator muscle of the eyelid from the tarsal plate (the firm cartilage like plate of the upper eyelid). This causes one or both eyelids to droop down, more so towards the end of the day or when one is tired. This may interfere with your vision or may be cosmetically unacceptable. Ptosis may be age related, could be the effect of wearing contact lenses, especially the RGP contact lenses or could be related to muscle or nerve problems.
Ptosis (droopy eyelid) can be corrected by surgery after confirming that there is no underlying problem that needs addressing. It is performed under local anaesthesia, with the patient being awake for the operation and on a day case basis, i.e one does not need to stay in the hospital overnight.
There are two main ways in which I correct the ptosis, either by opening the eyelid via a skin crease incision (so the scar is well hidden within the skin crease) or via an incision on the under surface of the eyelid, by flipping the eyelid over. The muscle is then repositioned or tightened so as to lift the eyelid to the required height.
Sometimes, if the function of the levator muscle (the muscle that opens the eye) is very poor, a sling operation may be required, where the forehead muscle is used to transmit its movement to the eyelid via a sling.
Ptosis occurs in children too and it is often congenital i.e present from birth. In children often the muscle itself is weak and fibrotic as opposed to a normal but slipped muscle in an adult. The surgical procedure is still very similar to that in an adult, but needs to be performed under a general anaesthetic, when the child is put to sleep for the duration for the operation.
There are risks in any surgical intervention ranging from infection, bleeding and scaring to more specific risks of over or under correction of the eyelid height, there may be a mismatch in the contour or the symmetry of the two eyelids, and the result may not entirely match the patient’s expectations, but these risks are rare and generally 80% of patients are very satisfied with the outcome of their surgery.
Please do bring an old closeup photograph of you in your youth, to help me understand what your eyelid, eyebrow as well as facial and peri-ocular structure was like previously to help plan your surgery.
Excess upper eyelid skin can cause hooding of the eyelids and this in turn can make your eyelids feel heavy and make you look older. The excess skin can obstruct the field of vision especially on the sides of your vision and could make your eyes feel tired and look aged. Hooded eyelids develop due to stretching of the eyelids and weakening of the muscles and connective tissue in the eyelids. This stretch causes excess folds of skin to hang over the eyelid margin. Sometimes the fat that sits behind the connective tissue of the eyelids bulges forwards.
Hooded eyelids can be corrected by surgery. The operation is called a Blepharoplasty and involves removing excess, skin, muscle and sometimes fat. It can restore your peripheral vision and make your eyes appear younger and more alert.
The result of surgery can be titrated to your preference, by altering the position of your upper eyelid skin crease and deciding how much fat, muscle and skin to remove.
As with any surgery there are risks, which range from infection, bleeding and scaring to more specific risks of taking too much skin out or not enough. Leading to inability to close the eyelids especially while sleeping or some extra skin still being present. There may be a mismatch in the symmetry of the two eyelids, and the result may not entirely match the patient’s expectations, but these risks are rare and generally more than 90% of patients are very satisfied with the outcome of their surgery.
Lower eyelid bags are also a sign of aging. As the skin around the eyes stretch and become saggy and the muscles and connective tissue weaken, the fat behind the eyes begin to bulge forwards and give the appearance of bags under the eyes. This can make you look old and feel less confident about your appearance. Depending on what is more pronounced, excess skin, bulging fat or a combination of both, several procedures can be done to improve the appearance of the eyes and make you look younger and more alert. The operation may be done through the skin of the lower eyelid or from the inside of the eyelids.
Again, as with any surgery there are risks, which range from infection, bleeding and scaring to more specific risks of taking too much skin out or not enough. Leading to retraction of the eyelids and an inability to close them fully or some residual skin or fat remaining. There may be a mismatch in the symmetry of the two eyelids, and the result may not entirely match the patient’s expectations, but these risks are rare and generally more than 90% of patients are very satisfied with the outcome of their surgery.
One has to remember that with lower eyelid blepharoplasty one cannot eliminate wrinkles and hence it may be necessary to have additional peels or laser to the skin to get a smooth skin appearance.
It’s natural to feel anxious when it comes to treatment and surgical procedures especially in relation to your eyes. I encourage you to ask questions about your condition, so I can help you to be better informed of your condition, the treatment options available and allay any fears that you may have. During the consultation I will explain the procedures to you and help you to make positive choices, and remember there is always the option of doing nothing, so you have nothing to worry about.