Heavy Upper Lids: Ptosis and Excess Skin

When you have heavy upper lids, it can affect your vision and visual field greatly, effectively cutting your vision off in half by the lid blocking the top (superior) portion of your vision. You may also assume that the cause of a heavy upper lid is because of excess skin blocking your view, and that the fix for that problem is to simply have the skin removed. However, many times, this problem is more complicated.

The causes of heavy upper lids can be grossly broken down into three causes, excess skin (dermatochalasis), the lid itself being physically low independent of the lid skin (we call this blepharoptosis or ptosis for short) and finally the eyebrow being too low. You may have heard from friends or family who had heavy upper lids that they just had the skin removed and it was an easy fix. But, as we mentioned above, removing the skin will only correct one of the causes of this problem. Most commonly someone who has a heavy upper lid has a combination of each of these problems contributing to their symptoms, and each problem is corrected with different but related surgeries that are frequently performed together.

Am I a candidate for surgery?

When a heavy upper lid begins to affect your vision or its appearance bothers you, you can consider surgical correction. If these issues can be shown to reduce your peripheral vision, surgical correction is covered by most insurance plans. Proving that it affects your vision requires photo documentation and specialized testing (visual field testing), which can be performed in the office. If it is not as severe (does not affect vision), it is considered elective surgery and can be corrected as a cosmetic procedure. Below, we will briefly explain how we correct excess skin (dermatochalasis) with an upper lid blepharoplasty and how we correct blepharoptosis (ptosis) with ptosis repair. How we correct brow ptosis is explained here.

Upper Lid Blepharoplasty

Blepharoplasty, or eyelid rejuvenation is one of the most commonly performed aesthetic procedures today. An upper lid blepharoplasty is done to remove excess skin and fat from the upper lid. It is performed to restore the eyelid platform in the upper lids, making the eyes appear fresher and more alert, and alleviating any heavy skin resting on the lashes that may be obstructing vision or causing irritation.

The incisions are placed within the natural creases of the upper eyelid and usually heal without noticeable scarring. Modern surgical techniques can help to reduce intraoperative bleeding, postoperative bruising and swelling. Excess skin and fatty tissue is removed, and sutures are placed in the skin to close the incision

Blepharoptosis (Ptosis) Repair

Ptosis drooping is due to weakness in the muscle that is responsible for lifting the upper eyelid. It can occur in children and adults. Children with ptosis are generally born with the condition due to the muscle not developing properly prior to birth. Adults with ptosis generally acquire the condition when the muscle becomes overstretched through time. Adult ptosis is generally due to aging, excessive eye rubbing, long-term use of contact lenses and certain diseases can also cause this condition. Ptosis drooping is corrected by an eyelid surgery called ptosis repair. Depending on the type of ptosis one has, there are different methods of correction.

The most common way is an incision in the skin and tightening the muscle from the front. This technique is often combined with removal of skin if the patient desires. One can also tighten the muscle on the backside of the eyelid which avoids any incision. The final way to tighten the lid when the ptosis is extremely severe is with a frontalis sling, a method frequently employed in children with congenital ptosis.

Regardless of the technique, the goal of ptosis repair is to not only lift the lid to a position where it clears the pupil, but to also achieve symmetry between the two eyelids

How long is the surgery?

30-60 minutes

What anesthesia is used?

Local with sedation

What is the recovery time?

2 weeks

Will insurance cover my surgery?

Case by case basis

FAQs

  • Like all surgery, there are risks with blepharoplasty and ptosis repairs, but these are relatively rare. Some of the most pertinent risks include asymmetry, under or overcorrection, worsening of dry eye, inability to completely close your eye (lagophthalmos), and like all surgery bleeding, scarring and infection. Your surgeon will fully discuss the risks of surgery at your initial consultation visit.

  • Although the degree of bruising and swelling after blepharoplasty or ptosis repair varies between patients, it is best to expect at least 2 weeks of bruising and swelling after surgery. Using ice and sleeping with the head of the bed up or using pillows to keep your head above your heart will help with this.

  • It can take up to three months for the eyelid to reach its final position after surgery. This means the lid can change in height and symmetry over those three months, and we typically wait until after those three months to do touch ups to allow the lid to complete its healing.