Sagging Eyelids
Author: Sherman Winston Reeves, M.D., M.P.H.
What causes sagging eyelids?
Several disorders of the eyelids can occur which may cause the eyelids to appear to sag or droop.
The most common reason for eyelids which appear to sag is a condition called dermatochalasis. In this condition, the eyelids themselves do not actually sag, but rather, there is an excess of eyelid skin which may drape over the eyelids. This draped skin causes the eyes to look sagging and tired. If enough skin overhangs the eyelids, the vision may even become obstructed. Dermatochalasis is caused by aging changes in the skin. With time, the connective tissue of the skin becomes less tight and draping of the skin over the eyelids may occur.
In ptosis¸ the eyelid itself actually droops. Ptosis, like dermatochalasis, is usually related to an age-aquired laxity of the connective tissue of the eyelid. In this case, the connections of the eyelid opening muscle become loose or even completely detached from the eyelid plate, and a drooping lid occurs. The drooping eyelid may be cosmetically concerning or may even cause obstruction of vision. Occasionally, the eyelid may droop due to other reasons, such as scarring from a prior injury or childhood malfunction of the eyelid system.
What can be done for sagging eyelids?
The treatment for sagging eyelids, both due to ptosis and dermatochalasis, is typically through surgery. For dermatochalasis, small incisions are made in the eyelid crease and the excess eyelid skin is removed. For ptosis surgery, a small incision is made in the eyelid crease to reveal the eyelid plate and eyelid elevator muscle tendon, which has become detached from the eyelid plate. The muscle tendon is then reattached to the eyelid plate using small stitches. The skin is then typically closed after these surgeries with a very small, often self-absorbing sutures, which are typically barely visible in the eyelid crease.
What will I experience during eyelid surgery?
Eyelid surgery is typically performed on an outpatient basis. Some procedures, such as biopsies or removal of small growths, may even be performed in a clinic setting. Typically, a Valium pill is given, or sometimes intravenous drugs are used to make a patient feel calm and comfortable before the surgery. Then numbing anesthesia is given to the eyelids. This may sting briefly, like a bee sting, but typically only lasts 10-20 seconds. Then the surgeon will perform the Eyelid surgery. The procedure may last anywhere from 20 minutes to an hour or more, depending on the amount of surgery to be performed.
What is the recovery period like after Eyelid surgery?
Stitches are almost always required to help close the wounds after the surgery. Often dissolving stitches are used, which are absorbed by the body over the course of a few weeks. During the healing phase, your surgeon will likely ask you to use antibiotic ointment on the wounds several times a day to help them heal quickly with minimal scarring. Eyelid surgery scars are typically not noticeable, as the surgeon places them in the crease of the eyelid so they cannot easily be seen. Your eyelids may appear black and blue for a week or more after the Eyelid surgery, as bruising is common with this kind of procedure. Ice packs applied to the eyelids after the surgery can help limit the bruising. This bruising typically resolves within 2 weeks.
What are the risks of Eyelid surgery?
As with any surgery where incisions are made on the skin, there is a small risk of bleeding and infection with eyelid surgery. These complications are very rare, but could potentially lead to loss of vision or extremely rarely, loss of the eye. Scarring is also a small risk with eyelid surgery. Some scar will occur, but typically it is not noticeable. A small risk of scarring that adversely affects how the lids function is present, however. Finally, sometimes the desired outcome of Eyelid surgery is not achieved with the first procedure. This is especially true of ptosis surgery, in which the precise amount of lid raising can only be assessed after the surgery is done and all of the swelling has resolved. As such, sometimes a second surgery is needed to fine tune the outcome of the eyelid surgical procedure.
