A droopy upper eyelid is usually caused by one of two things: excess, stretched skin folding over the lid (dermatochalasis), or a weakness of the muscle that lifts the eyelid so the lid margin itself sits too low (ptosis). Excess skin is treated with blepharoplasty; true ptosis needs muscle repair, which is often carried out by an oculoplastic surgeon. A sudden droop with double vision, headache or facial weakness is a medical emergency.
Excess skin (dermatochalasis)
With age the upper-lid skin loses elasticity and stretches. It can fold over the crease and, in more advanced cases, rest on the lashes. The edge of the eyelid (the lid margin) is still in a normal position; it is just hidden. Many people describe feeling that their eyes look tired or that eye make-up smudges. Heavy skin can also restrict the upper field of vision. A low brow often contributes to the heaviness.
True ptosis
In ptosis, the lid margin itself sits lower than normal because the levator muscle, or its tendon, has stretched or detached. The most common type in adults is age-related (aponeurotic) ptosis, which can also follow long-term contact lens wear or eye surgery. Ptosis can be present from birth, or be caused by nerve or muscle conditions. A typical sign is that the eye looks ‘sleepy’ and people may raise their eyebrows to see better, causing forehead lines.
How to tell the difference
- Where is the lid edge?: if the edge of the lid covers more of the iris than the other side or than usual, ptosis is likely.
- Lifting the skin: if gently lifting excess skin reveals a normally positioned lid margin, the problem is mainly skin.
- Both together: many people have a combination, which is why an examination is essential.
Mr Nassab will measure the lid position, muscle function and brow height to identify which problem, or combination, is present.
Red flags: when to get urgent help
Call 999 or go to A&E immediately if an eyelid droops suddenly together with any of the following:
- Double vision: or a change in the size of one pupil.
- Severe or unusual headache: especially if it came on suddenly.
- Facial weakness, slurred speech or arm weakness: which may indicate a stroke.
A droop that varies through the day and worsens with tiredness, or is accompanied by difficulty swallowing or weakness elsewhere, should be assessed promptly by your GP, as it can be a sign of a neuromuscular condition. If breathing or swallowing becomes difficult, call 999.
Treatment for excess skin
Upper blepharoplasty removes a carefully measured strip of skin, and sometimes a little fat, through an incision hidden in the natural crease. It can be done under local anaesthetic or general anaesthetic. The aim is a lighter, fresher upper lid without an operated look. Upper blepharoplasty costs from £5,000 under local anaesthetic (£6,500 under general anaesthetic). Upper and lower together cost £9,500. The £150 consultation is separate.
Treatment for ptosis
Ptosis repair tightens or reattaches the levator muscle to raise the lid margin. It requires fine judgement of lid height and symmetry, and is often performed by an oculoplastic (eyelid) surgeon. If your assessment shows significant ptosis, Mr Nassab will explain this and can advise on onward referral. Blepharoplasty alone will not correct true ptosis and, if ptosis is missed, results may be disappointing.
Recovery and risks
After blepharoplasty, bruising and swelling usually settle over one to two weeks, and many people return to desk work within about ten days. The scar typically takes several months to mature. Risks include asymmetry, dry or irritated eyes, difficulty closing the eyes fully in the early period, infection, bleeding and, rarely, vision problems. Cosmetic eyelid surgery is for adults aged 18 and over.
Frequently Asked Questions
Can blepharoplasty fix ptosis?
No. Blepharoplasty removes excess skin; ptosis requires repair of the lifting muscle. Some patients need both.
Is a droopy eyelid serious?
Gradual drooping is usually due to ageing. A sudden droop, especially with double vision, headache or facial weakness, is an emergency.
Can droopy eyelids affect my vision?
Yes. Heavy skin or a low lid can block the upper field of vision. An optician can carry out a visual field test.
Will I need a general anaesthetic?
Upper blepharoplasty is often performed under local anaesthetic, though general anaesthetic is available.
Does anything non-surgical work for droopy eyelids?
Some people use anti-wrinkle injections to lift the brow slightly, but nothing non-surgical removes excess skin or repairs a stretched muscle.
