The answer to this question will depend on what we mean by droopy eyelids. People may use the term to refer to one of several conditions: excess eyelid skin, a low eyebrow, or an eyelid position lower than normal. Some patients will have one of these conditions as the leading cause of their droopy eyelids, while others may present two or all three components. Therefore, the best treatment options will vary from patient to patient.
Laxity of eyelid skin as a cause of “droopy eyelids”
Excess eyelid skin, known as dermatochalasis, is a relatively common cause of droopy eyelids, though less frequent than previously thought. Eyelid skin laxity is related to aging, so dermatochalasis is generally seen in older individuals. The best surgical option is an upper blepharoplasty, an outpatient operation performed under local anesthesia. Young men and women with “droopy eyelids” do not usually have dermatochalasis, so seeking the right cause is essential to arriving at a proper diagnosis. Most commonly, these patients will have droopy eyebrows or eyelid ptosis.
Low eyebrows: the main cause of eyelid hooding in young individuals
A low brow is perhaps the most common cause of eyelid hooding in young people. Many have identified a close family member with “droopy eyelids” and began noticing this symptom early in life. These patients can display their desired results using their fingers to raise their eyebrows in front of a mirror. Raising an eyebrow is more complex than performing a blepharoplasty, but the results are longer lasting.
Two main surgical techniques exist: the open and the closed approach. The open approach is ideal for patients with high foreheads and severely low brows, while the closed, or endoscopic approach, works best on low to average forehead heights.
Eyelid ptosis: a droopy eyelid by definition
Finally, a droopy eyelid may be a sign of eyelid ptosis. Ptosis is the right medical term for an eyelid that has dropped to cover part of the cornea. It may involve one or both eyelids and may appear in childhood or later in life. Eyelid ptosis is more apparent in photographs and when the patient is tired. Ptosis surgery corrects the droopiness.
As with an eyebrow lift, there are two approaches to ptosis repair surgery: through the inside of the eyelid (Müller’s muscle resection, or CMMR) or via a skin incision. The first and most important step to treating eyelid ptosis is making the correct diagnosis. Distinguishing between the different causes, i.e., dermatochalasis, low brow, and ptosis is key to offering patients the proper treatment to meet their expectations. A complete oculoplastic exam is vital to safely achieving natural and long-lasting results.
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