A common reason why people seek upper eyelid surgery is to correct droopy eyelids. However, not everyone means the same thing when they describe an eyelid to be droopy.
What causes Droopy eyelids?
The two most common conditions where an eyelid may be considered “droopy” are ptosis and lateral hooding.
It is when the upper eyelid droops over the eye. Here is more information: https://www.aao.org/eye health/diseases/what-is-ptosis
The left eye appears smaller than the other because it is not able to open completely. The muscle that pulls open the eyelid is the “levator”. There is ptosis when this muscle does not pull open eyelid fully.
A Ptosis correction can be done through the same incision as the one used for double lid surgery, but it will involve an additional step to shorten the levator muscle. There are many websites advertising for ptosis surgery.
What are hooded eyes?
It is when the excess upper eyelid skin drapes over the eyelashes, as illustrated in the sketch below.
Brow lift for hooded eyes
Excising a large amount of skin will not correct this. Instead, it will cause the eyebrow to descend and make the eyes look hooded. The eyebrows need to be lifted before the upper eyelid skin is removed; if not, the eyelids will
appear swollen after surgery.
Why is my upper eyelid swollen?
The loose skin at the outer corners of the eyes have not been lifted although a large amount of skin has been removed. Notice how much nearer the eyebrow is to the eyelashes. Some people describe this as having swollen eyelids.
The sketches below illustrate what having a brow lift together with an upper eyelid blepharoplasty may look like.
The eyebrow does not seem to have gone up very much. That is because it got pulled downwards when the skin of the upper lid was removed. It is like the brow lift “fixed” the eyebrow in place to prevent it from dropping further.
Brow lift surgery is unpopular among Asians. Most patients want the lateral hooding corrected but refuse to have a brow lift. When told that he/she needs a brow lift, the patient will move on to the next surgeon. These surgeons will tell them that a brow lift is unnecessary, and they will just excise a lot of skin from the upper eyelid, only to end up with a bad result.
What else to do if the patient refuses a brow-lift?
These are some of the results we noticed from patients coming to see us for a second opinion because they were not happy with their surgery.
High Crease and Botox Trick
We have seen patients having a high eyelid crease that is 8-12mm above the eyelash margin. This allows more height of the skin to fold over, but the high crease makes the eye look unnatural and sleepy.
Noticed that the corners of the eyes are lifted? This is achieved by injecting Botox in the Crow’s Feet area, but the effect is temporary.
Double Correction and Botox Trick
We had a patient that came in with a look like this:
The surgeon had shortened the levator to make the eyes open wider, excised a lot of upper eyelid skin and injected botox into the Crow’s Feet area. Notice the skin at the corner of his eyes still droops, the eye is round and he looks like he is staring. When the eyes are open, the space between the upper and lower lids (palpebral fissure) should be elliptical, not round. Only the eyes of anime characters are round.
We have an interesting anecdote about this. We once showed a photo of a patient with such round eyes after surgery (real photos, not the sketches above), who was operated on by a popular and successful surgeon, to another doctor (eye surgeon), who is a less commercially successful but has impressive credentials and specialist training. The eye surgeon was horrified by what he saw in that photo because it went against the established norms of proper surgery.
Why then is the surgeon who did the “wrong” thing more popular than the one who did the “right” thing? If patients like the look, why should the medical establishment decide that it is the “wrong” result?
Besides looking unnatural, rounded eyes may not close properly and may eventually result in dry eyes. While having big, round eyes is a K-Pop trend, this may lead to undesirable results when one turns old.
The distance between the eyebrows and the eyes are wider in young than old people. That is the rationale for lifting the brow. Lately, we have seen advertisements for removing skin under the brow. The stated reason is to avoid the scar of a brow lift.
However, this is opposite to the principles of rejuvenation because this will narrow the distance between the eyebrow and the eye. To prevent this, the brow needs to be fixed before the skin under the eyebrow is excised. If you take a look at the video below, notice that only the outer part of the eyebrow is lifted. Decide for yourself if you like the results of this procedure.
Plastic Surgery Singapore
Besides having a browlift, there are other ancillary procedures that can be done to correct the eyebrow. We invite you for a consultation and welcome any questions you may have for you to make a confident decision about undergoing an eyelid surgery.