November 2021 Issue
By Ken Gleitsmann, M.D., MPH
Many adults complain about their droopy eyelids. Their complaints can be cosmetic (my mirror keeps telling me I look tired), functional (my droopy eyelids are limiting my side vision), or both. Droopy eyelids are typically the result of increasing skin laxity, fat pad exposure, or weakening of the muscles that help position and elevate the upper eyelids. All these factors are present to some degree as we age and are commonly family traits.
Pronounced laxity can markedly affect the delicate skin of the eyelids and is aggravated by sun damage and smoking. The fat pads, which line and protect the eyes, can become visible and more pronounced as the skin laxity increases, allowing the fat pads to come forward. These prominent fat pads yield the “spare tire” look that appears to encircle the eyes. Weakening of the upper eyelid positioning muscles may be the result of genetics, trauma, or even previous eye surgery.
Whether cosmetic and/or functional, a comprehensive eye exam is required to fully assess the patient with droopy eyelids. Rarely, a serious neuromuscular issue may be involved. Often there are tear film abnormalities that may affect the treatment plan. There may be other more complex eyelid positioning abnormalities diagnosed that must be addressed.
Treating droopy eyelids, after careful examination, is commonly done by performing a blepharoplasty on the upper eyelids. The surgeon in this procedure, aided by local anesthesia with mild sedation, removes the excess skin and reshapes the offending fat pads of the upper eyelids. A conservative approach must be taken in order not to interfere with complete eyelid closure and tear function, especially in patients with previous dry eye conditions.
If upper eyelid muscle weakness contributes to droopy eyelids, the muscles must be repositioned to achieve a satisfactory result. Recently, a new eye drop medication has been approved and may be appropriate for use in certain patients. Surgical procedures to reposition these muscles are commonly performed, usually at the time of the blepharoplasty. Achieving symmetry between eyes is a desirable goal of these surgical procedures. Most patients have minor limitations of their activities for several days and have stitches in their eyelids removed after a week. Moderate degrees of bruising and swelling are to be expected, and the recovery is typically without pain.
Many patients are also concerned about the appearance of their lower eyelids. Again, skin laxity and fat bulging are the common culprits. In addition, there may be lower eyelid laxity, which must be addressed. No medications have been shown to be useful in improving the appearance of the lower eyelids. Lower eyelid surgery may be done through the skin or, more commonly, through the inner lining of the lower eyelid. In the latter approach, the incisions heal without sutures, and the excess skin may be resurfaced with the LASER. This technology allows the removal of the very top layer of skin, the stimulation of new collagen synthesis, which effectively rejuvenates the lower eyelid complex. This resurfacing process takes three to four weeks, does not interfere with most routine activities, and can lead to a pleasing and refreshed appearance.
Drooping upper eyelid surgery may be considered functional and may be a covered expense by your medical insurance carrier. Your eye doctor should be able to aid in directing this inquiry. Typically, lower eyelid surgery is considered an elective surgery and is not covered by medical insurance.
Blepharoplasty surgery is a very commonly performed procedure and can offer many years of improved function and appearance. Contact your eye care provider to take the first step in improving your daily morning interaction with your mirror!
Dr. Ken Gleitsmann has been practicing ophthalmology in the Lowcountry since 1995. He is a Fellow of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery. In addition, he holds a Masters in Public Health (MPH) in Epidemiology and Biostatistics. Dr. Gleitsmann provides the latest evidence-based ophthalmology practices and technologies available, which he applies to each patient in a kind and compassionate manner.