What causes drooping eyelids?
As we age, the muscles around our eyes weaken and the skin becomes looser. This can cause the upper eyelids to droop down over the eyes, making them appear smaller and more tired. Drooping eyelids are medically known as ptosis. Some common causes of ptosis include:
- Aging – The levator muscle which raises the eyelid weakens with age.
- Medical conditions – Such as diabetes, stroke, tumors, nerve damage or trauma.
- Medical treatments – Some medications can cause temporary ptosis.
- Genetics – Some people are just born with droopier eyelids.
Ptosis can affect one or both eyes. Mild ptosis may be barely noticeable, while severe ptosis can block vision. If ptosis starts suddenly, see an eye doctor as it may signal an underlying neurological issue.
Non-surgical treatments for droopy eyelids
Before considering surgery, there are some non-invasive ways to lift droopy eyelids:
Eye exercises
Just as we can exercise muscles elsewhere in the body, there are exercises to strengthen the levator muscle responsible for raising the eyelids:
- Looking up and down – Start by looking down at the floor then slowly roll your eyes up towards the ceiling. Repeat 10 times.
- Looking side to side – Look as far left as you can, hold for 5 seconds. Then look as far right as you can, hold 5 seconds. Repeat 10 times.
- Blinking – Blink eyes quickly for 30 seconds.
- Eye lifts – Use your index fingers to gently lift the upper eyelids up and hold for 5 seconds. Release and repeat 10 times.
Perform this routine twice daily. It may take weeks or months to see results. Be patient and consistent.
Eye patches/strips
Special medical tape or patches can be applied to the skin on the eyelid to create a temporary lift:
- Eye tape – Special medical tape is applied along the brow bone to pull up droopy eyelids.
- Eye strips – Adhesive strips with tiny microneedles are placed on the eyelid. The small needles trick the skin into producing collagen for a temporary tightening effect.
These provide an instant but temporary lift of 15 minutes to 8 hours. Effects must be maintained through regular use.
Makeup tricks
Makeup techniques can also visually lift the eyes:
- Use light matte shadows on the eyelid to add fullness.
- Apply highlighter along the brow bone and inner corner of eyes to create an uplift effect.
- Use white or nude liner on the lower waterline to open up eyes.
- Curl eyelashes and apply volumizing mascara to make lashes look lifted.
- Fill in and define brows for a more awake look.
Avoid dark or shimmery shadows on the eyelid which can close the eyes off.
When is surgery recommended for ptosis?
If non-surgical methods do not adequately improve vision or appearance, there are surgical options to lift droopy eyelids. Surgery is generally recommended if:
- Ptosis is impairing vision
- Non-surgical treatments are ineffective
- Eyelids are obstructing pupils by 2mm or more
- Ptosis causes chronic headaches from overusing forehead muscles
Surgery is also a good option for severe ptosis cases for cosmetic improvement. As we age, droopy eyelids can make the eyes appear tired, sad or angry even when we feel bright and cheerful inside. Surgery can rejuvenate facial appearance.
Surgery for ptosis – blepharoplasty
The surgery to lift droopy eyelids is called blepharoplasty. It aims to remove excess eyelid skin, tighten muscles and sometimes reposition fat to recreate a crease.
What happens during blepharoplasty?
Blepharoplasty can be done under local or general anesthesia. The surgery takes 1-3 hours depending on whether one or both eyelids are addressed. The steps include:
- Small incisions are made along the natural creases of the upper eyelids.
- Excess skin, muscle and fat are removed or repositioned.
- The levator muscle may be tightened.
- Incisions are closed with fine sutures.
Lower eyelids can also be addressed at the same time if needed. Bruising and swelling is normal after surgery. This will subside within 1-2 weeks.
Recovery after blepharoplasty
Post-surgery care helps minimize swelling and complications:
- Use antibiotic eyedrops to prevent infection.
- Apply cold compresses to reduce swelling.
- Keep head elevated on 2-3 pillows while sleeping.
- Avoid strenuous activity for 2 weeks.
- Wear dark sunglasses outside to protect scars from sun exposure.
Most people can return to work within 7-10 days after surgery. Stitches are removed in 1 week. Swelling may persist for 6 weeks or longer before final results are visible.
Are results permanent?
For many people, blepharoplasty results can last for years. However, aging, sun damage and gravity can still cause eyelids to re-droop over time. On average, a blepharoplasty maintains results for:
- 5-7 years for people in their 40s
- 5-10 years for people in their 50s and 60s
- 10-12 years for people in their 70s
A touch up surgery may be desired after several years if drooping recurs. Good skincare and sun protection can help prolong results.
Potential risks and complications
Like any surgery, blepharoplasty carries some risks including:
| Risk | Likelihood | Management |
|---|---|---|
| Infection | 2-5% risk | Antibiotics, wound care |
| Asymmetry | 10% risk | Additional surgery |
| Dry eyes | 20% risk | Lubricating drops |
| Scarring | Rare | Steroid injections, laser therapy |
Choosing an experienced surgeon can help minimize risks. Be sure to discuss your medical history and expected results ahead of time.
Cost of blepharoplasty
According to the American Society of Plastic Surgeons, the average cost of blepharoplasty in 2022 was:
- Upper eyelid surgery – $3,076
- Lower eyelid surgery – $3,244
- Both upper and lower – $4,280
Many factors affect the cost such as the surgeon’s fees, location and extent of the procedure. Eyelid surgery is considered cosmetic and not covered by insurance unless visual fields are impaired. Ask your surgeon about payment plans.
Non-surgical eyelid lift options
For those seeking eyelid rejuvenation without surgery, there are some non-surgical options:
Botox
Botox injections into the muscles around the eyes can provide a subtle brow lift and opening of the eyes. Results last about 3-4 months.
Ultherapy
This non-invasive ultrasound treatment heats the deep skin tissues, stimulating new collagen growth for tightening of the eyelid skin. Benefits can last 1-2 years.
Dermal fillers
Hyaluronic acid fillers like Restylane can add volume back to a sunken upper eyelid area. This provides lift by filling out hollows. Effects last 6-12 months.
Laser skin resurfacing
Fractional laser treatments remove outer layers of skin to improve texture, reduce wrinkles and tighten eyelid skin for a temporary rejuvenating lift. Multiple sessions are required.
Radiofrequency
Radiofrequency devices heat the deepest skin layers to promote new collagen and tightening. This can provide mild improvement in eyelid laxity when used over a series of monthly treatments.
These alternatives may provide subtle enhancement without surgery or downtime. However, results are not as dramatic or long-lasting as surgery. Most people still require a surgical blepharoplasty at some point for functional vision improvement or significant cosmetic changes.
Conclusion
Drooping eyelids are a natural part of the aging process. Initially, non-invasive treatments like eye exercises, eyelid tape and makeup tricks can provide cosmetic improvement. However, if eyelids become obstructed, vision is affected or a more youthful eye appearance is desired, blepharoplasty surgery is usually required. An experienced plastic surgeon can eliminate excess eyelid skin and recontour the area for an awakened, positive gaze. When performed skillfully, scarring is minimal. Results can last a decade or longer. Like any surgery, risks are involved but when chosen appropriately, blepharoplasty can rejuvenate the eyes and restore a bright, youthful outlook.
