People use the phrase “droopy eyelids” as a general term to describe a tired or sleepy appearance, especially when it relates to excess skin on the upper eyelids. Practically speaking, it is easy to use this terminology because it points out directly, though subjectively, what is undesirable about a person’s appearance. However, from a medical perspective, it is essential to establish objectively the root of these symptoms and what the person sees in the mirror to determine what is truly bothering the patient and treat it accordingly. Otherwise, an incorrect assessment of the underlying cause may lead to unwarranted remedies.
Exploring the three leading causes of “droopy eyelids.”
In reality, eyelid ptosis is the true and only category of droopy eyelids in medical terms. Nevertheless, there are two other conditions that can produce such an appearance, and the same expression is often used to refer to them as well. Below is a quick summary of each condition and the proper procedure to treat it.
Eyelid ptosis: the true definition of droopy eyelids.
Ptosis, or more specifically, blepharoptosis, is the correct medical term that speaks of a condition in which one or both upper eyelids are located at a lower height than is considered normal, which is more or less 1 mm below the cornea of the eye. Ptosis can be classified according to its cause, such as traumatic, congenital, or age-related. A helpful analogy to understand ptosis and its different causes is that of an electric roller garage door. Any difficulty opening the door, i.e., the eyelid, may be due to a defect in the door itself (the muscle), a malfunction of the roller mechanism (the tendon), or damage to the door engine (the nerves).
In most cases, treatment of eyelid ptosis is surgical. Eyelid plastic surgeons have extensive training in ptosis management. Once the diagnosis and cause of the ptosis have been determined in the office, the right surgical approach can be implemented to fix it.
Dermatochalasis: excess eyelid skin encroaching on the eyelashes.
Another common eyelid condition that most often receives the label of “droopy eyelids” is dermatochalasis. However, dermatochalasis is not really a droopy eyelid, but rather excess eyelid skin caused by skin laxity and degeneration of collagen fibers. If we think of our eyes as windows, under normal conditions, our upper eyelids would be curtains made of a lightweight material used to filter light only as we close our eyes. Think of dermatochalasis as heavy drapes obstructing vision when the eyes are open.
Excess eyelid skin can be treated with a surgical procedure known as upper blepharoplasty. Blepharoplasty not only involves cutting skin but also addresses muscle degeneration, reduces the volume of fat in the eyelid, and creates a continuous and well-defined eyelid crease.
Droopy eyebrows: an overlooked cause of hooded eyes.
A low eyebrow is arguably the most common cause of “droopy eyelids,” but one that is often overlooked. In fact, many patients with droopy eyebrows consult a surgeon for a blepharoplasty, not realizing that the issue is not with their eyelids but with the position of their eyebrows.
Using a similar analogy of a window and curtains, we can think of droopy eyebrows as the equivalent of a slanted or low-positioned curtain rod descending over the window and causing the curtain (the eyelids) to bunch up at the bottom.
Botulinum toxin application to the brow depressor muscles, in the crow’s feet and frown lines, is the best non-surgical option to raise the eyebrows, although temporarily. A more lasting alternative is to perform a surgical brow lift. Various techniques have been developed for different patient types according to the severity of brow descent.
Diagnosis is essential for proper treatment.
Some people may have only one of these causes of droopy eyelids, while others may have two or all three.
Accurate diagnosis is the most important step to achieving a good result when treating a tired or sleepy appearance. Once the surgeon has determined which of these causes is responsible for the symptoms, the correct treatment can be offered.
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