When upper eyelid surgery may help

With age, the upper eyelid skin stretches and the tissues beneath it relax. Excess skin can fold over the eyelid crease, rest on the lashes and, in more advanced cases, hang over the edge of the lid and block the upper part of your vision. This condition is called dermatochalasis.

Upper blepharoplasty is considered when that excess causes:

  • a feeling of heavy or tired eyelids, especially later in the day;
  • a reduced upper field of vision, or the need to lift the brows to see;
  • irritation where skin rests on the lashes; or
  • a heavy appearance that does not match how you feel.

More detail is on our upper blepharoplasty page.

Three causes of a heavy upper eyelid

Excess eyelid skin

The classic finding that blepharoplasty treats: loose skin, sometimes with fat fullness, above the crease.

Brow descent

When the eyebrow sits low, it pushes skin down onto the eyelid. Removing eyelid skin alone may not solve this and can even pull the brow lower. See upper blepharoplasty or brow lift.

Ptosis

In ptosis, the eyelid margin itself sits too low because the muscle that lifts it has stretched or weakened. Ptosis is corrected by tightening that muscle, which can be combined with blepharoplasty when both are present.

What surgeons assess

An assessment typically includes:

  • the amount and distribution of excess skin and fat;
  • the height of the eyelid margin and the strength of the lifting muscle;
  • brow position, and whether you are lifting your brows to compensate;
  • eyelid closure, blink and tear film health;
  • symmetry between the two sides; and
  • your vision, including visual field testing where excess skin may be blocking your sight.

Factors that affect candidacy

General health, medications and eye history all influence planning:

  • Dry eye may be worsened by surgery, so it is assessed and treated first, and the amount of skin removed is planned conservatively.
  • Blood thinners and some supplements increase bleeding risk; never stop prescribed medication without guidance from the prescribing doctor.
  • Thyroid eye disease, previous eyelid or eye surgery, and some neurological conditions change the approach.
  • Smoking slows healing and increases complications.

Some patients are better served by addressing brow descent, ptosis or eye surface health first.

Functional or cosmetic?

When excess skin measurably reduces your field of vision, surgery may be considered functional rather than cosmetic. Visual field testing, with and without the eyelid skin taped up, helps document this. Whether a procedure is functional or cosmetic affects how it is billed, and your assessment will clarify which applies to you.

What the procedure and recovery involve

Upper blepharoplasty is usually performed under local freezing, sometimes with light sedation. A planned amount of skin, and sometimes a little muscle or fat, is removed through an incision hidden in the natural eyelid crease, which is then closed with fine stitches.

Swelling and bruising typically settle substantially over one to two weeks, and the final contour emerges over several weeks. Our upper blepharoplasty recovery guide explains what to expect.

Setting realistic goals

Surgery can lighten the eyelids, define the crease and improve the upper field of vision. It does not change crow's feet, fine lines at the corners of the eyes, brow position or under-eye bags. Bringing photographs from earlier years can help you and your surgeon agree on a natural target.

Questions to ask at your consultation

  • Is my heaviness from eyelid skin, my brow, ptosis or a combination?
  • Do I need visual field testing?
  • Are my eyes dry enough to change the plan?
  • How much skin would you remove, and how will that affect eyelid closure?
  • What will surgery not change for me?