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Why Do Eyelids Droop? Common Causes and Contributing Factors
Interviewer: Noticing that your eyelids may be drooping? Whether it be from aging, genetics, or another cause, it can be pretty frustrating. Some patients say that it can make you look tired, impact your confidence, and in some cases actually affect your vision. But what options do you have as a patient to correct this?
Today we're joined by Dr. Dana Johns, Associate Professor at the at 亚洲自慰视频 of Utah 亚洲自慰视频, to discuss some of these causes and some of the treatment options available. Dr. Johns, let's start, what are some of the more common causes of droopy eyelids?
Dr. Johns: So the most common cause of droopy eyelids is going to be aging. There can be a genetic predisposition. So some people, depending on ethnicity, can be born with more upper eyelid or lower eyelid skin. But the main factor that we see is that as we age, just like everywhere else on our face, the skin loses some elasticity, the deeper ligaments holding things where they belong start to relax, and everything slides south on our face a bit. And so this can affect both the upper and the lower eyelids and is the number one reason that we see people coming to address the appearance of their lids.
Interviewer: So it's mostly aging. Are there other conditions that might cause this type of condition?
Dr. Johns: Yes. So from an overall standpoint, there can be some congenital issues with eyelids, where the eyelids don't function quite as well and can be a little bit droopier. Those are a little bit different in how we approach and address them. And then there can be some factors to do with things like sun exposure. We know that sun exposure to the face in general affects the health of the skin and can make things a little bit droopier and give you a few more wrinkles around the area.
Functional Impacts of Droopy Eyelids
Interviewer: So when it comes to droopy eyelids, is there anything else that it can be? It can impact function rather than just appearance?
Dr. Johns: Absolutely. Upper eyelids, particularly. Obviously, when you think about eyelids, there are both upper and lower. And I think most people probably think about the upper more so than the lower. But as the upper eyelids get a bit droopier and fall down, they can actually affect your peripheral vision. And so you can lose some of the ability to see out of the sides of your eyes, and this can affect day-to-day stuff, but certainly things like driving, where you need that peripheral vision to really be a safe driver. And so that's something that patients come in complaining of is the inability to sort of see in that periphery.
Non-Surgical Options for Eyelid Rejuvenation
Interviewer: I got you. I can imagine that would be really frustrating for someone. If there is someone who is maybe having these effects, doesn't like the appearance of their eyelids, etc., what are some of the nonsurgical options? Let's start a little less invasive. What are some of the nonsurgical options we have to, what is the word, rejuvenate the eyelid?
Dr. Johns: Absolutely. So we can start sort of at the we call it the reconstructive ladder, so to speak, so at the bottom of it. I think that the most important thing is that doing some preventative skincare can be helpful when you're a bit younger, making sure that you're keeping well moisturized and making sure that you wearing sunscreen when you're out in the sun. There can be topical creams that can help to do a little bit of tightening for the skin, so like Retin-A, for example. And so there's different topical things that can help a little bit in those early stages of skin laxity.
Once you start to get a little bit more severe, whether it's you're just getting a little older, or you have a little bit more sun damage, there are other nonsurgical ways to address the eyelids. And this mostly can happen with things like chemical peels or lasers. Both of these modalities help to tighten the skin of the face, and the eyelids are no exception. There are varying levels of both of these things and kind of the depth at which they penetrate the skin and the amount of tightening that you're going to get. But they are nice sort of segues before surgery, if surgical intervention isn't quite what you need or want.
Interviewer: Just for my own information, how long do these types of nonsurgical treatments last? Are they like a forever thing? Or is it just more temporary before we move on to surgical?
Dr. Johns: It's more temporary. But they do take a few years off, so to speak. So we think about these noninvasive ways, they can definitely turn back the clock a few years, tighten things up, and give you a little bit more time. I mean, surgery itself isn't technically permanent, but it does set the clock back a lot farther than perhaps some of these less invasive modalities.
Surgical Solutions: Who is a Good Candidate for Eyelid Surgery?
Interviewer: Understood. So when we come to surgical options, let's start with who is a good candidate and what kind of options they have.
Dr. Johns: So upper eyelids are the ones that obviously have the functional component, meaning they are the ones that can cause a block on your peripheral vision. A good candidate for it, and it can truly be . . . It depends on what you're looking for. If you're really looking for rejuvenation and cosmesis only, you don't necessarily need to meet the criteria for loss of peripheral vision.
But if you do meet that criteria, insurance will cover your upper lid surgery, which is called an upper blepharoplasty. So if you're looking for that insurance coverage aspect of it, then you're going to need to have enough blockage of your peripheral vision in order to get that covered. And we send you for what's called a Humphrey visual field test with the eye doctor. Basically, they see what your peripheral vision looks like at rest. Then they tape your eyelids up, and they repeat the visual field and see if there's an improvement to see how much you're really missing with your eyelids where they're at. So that might be something that you would end up needing to get if you're going the insurance route.
So lower eyelids are generally more considered cosmetic. They can have a functional component to them if you're really having trouble with lower eyelid laxity, meaning as we age, so our eyelids have a cartilage piece in them called the tarsal plate, and that can get kind of loose as we age and the eyelid kind of falls away from the eye. It can cause tearing. It can cause irritation of the eyelid. And there's a procedure that can help with the lower eyelids to tighten that in addition to removing excess skin and fat, which sometimes is necessary. More often than not, it is cosmetic. People sort of get that tired under-eye look, where they have some excess skin.
As we age, the tissue that holds the fat compartments around our eyes, so both in our upper and our lower eyelids we have fat compartments. And when we're young, they're kind of nice and tight and underneath our eyeballs. And as we age and the tissue over them gets loose, they kind of pooch out, which is why you can get that puffy under-eye look. And so with a lower blepharoplasty, we're looking to address that puffiness, get rid of it, tighten up the skin, and also make sure that your eyelid is sufficiently tight to keep your eyes protected and have good tear film flow.
What Happens During Eyelid Surgery?
Interviewer: So when it comes to a blepharoplasty or a lid lift, what is being removed from the actual area to make the results that you're looking for?
Dr. Johns: So upper eyelid specifically, we're mostly removing skin. There are those fat pockets in the upper eyelid as well that we might cautiously remove. We generally don't tend to remove too, too much because you don't want that hollow, sunken-eye look. But if you have some of them that are particularly puffy, we do decrease that.
The other thing that's really important with the upper eyelid is that in addition to the eyelids having excess skin, the eyebrows themselves are also affected by age or sometimes by genetics and can contribute to the heaviness of the eyelids and that inability to see if your eyebrows are actually too low. And so sometimes we end up having to do a combination, where we do an eyelid surgery, a blepharoplasty and we do a brow lift in order to lift the eyebrows back up where they belong, take the heaviness away from the upper eyelid by doing that, and also removing excess skin and possible fat.
Recovery and Expected Results After Eyelid Surgery
Interviewer: When you remove something like that, in that kind of area, I'm sure a lot of patients are wondering what the recovery time looks like and what kind of results can they expect.
Dr. Johns: So for upper or lower eyelids, it's obviously a sensitive area, and it's a well-vascularized area, so you should be expecting a fair bit of swelling and bruising in that region. The reality is, from a pain standpoint, I think the swelling in the first few days is certainly uncomfortable. And once that's improving, pain-wise, it's not terrible. However, you do look pretty beat up just from the bruising and the swelling for the first couple of weeks after surgery. So if you have any important events, meetings, etc. coming up, you might want to make sure you're definitely three to four weeks before those to make sure that that bruising has time to resolve.
It can also give you dry eyes for a bit afterward. Anytime there's swelling around the eyelids, it can affect how the tear film flows. So your surgeon will give you some eye drops to use postoperatively to help with any dry eyes. But it is something that we do counsel you about because if you have dry eyes pre-existing before surgery, certainly this procedure can make them a little bit worse. So it's something to be aware of.
Interviewer: And what about when it comes to results? What are maybe some of the success rates? When can they expect for it to appear like the final product and maybe even how long that will last?
Dr. Johns: Yeah. So the expectation should be smooth, rejuvenated upper and lower eyelids, where you have enough skin to adequately open and close your eyes, but not any extra that's hanging down and over the upper eyelids. From the lower eyelid standpoint, it should smooth out all of that excess skin, get rid of any puffiness from the fat, and kind of tighten that lower eyelid region.
Realistically, I mean, final, final results, at least probably six to eight months for scars to go through their whole remodeling process. It can technically take up to a year for scars to go through the whole remodeling process. But the eyelids tend to kind of be a little bit quicker from that standpoint. Where the incisions are placed hide nicely in the creases of our eyelids. So by the time the color fades, which once again does take the better part about six to eight months, they're pretty imperceivable, unless you're looking really, really closely and trying to find them. And even then, sometimes it's hard to see.
From a time standout on kind of how long this lasts, we always say facial surgery generally turns the clock back a certain number of years. Generally speaking, we say about 10. So the reality is that your eyelids may never get as puffy or droopy as they were before, even 10 years later. But you're certainly going to continue to age. So over the course of the years, you're going to get some increased laxity. If we remove fat from the lower eyelids, even if you get a little bit of puffiness, it should never be as puffy as it was before. So there are some long-standing effects. But certainly, the aging process continues. So it's not a completely permanent result, so to speak.
Finding the Right Surgeon and Next Steps
Interviewer: All right. So if someone has been listening to this and maybe they are considering getting a consultation, what is some advice you would give for someone looking for a surgeon, or even what you would tell them if this is something they're concerned about but are not quite sure if this is something right for them?
Dr. Johns: I think the most important thing is doing your research on whoever it is you're going to see. Don't be afraid to get multiple opinions. This is your face, and you want to make sure you feel really comfortable and confident with who you're with. There are a couple of different specialties that are trained to do this. You can go through a plastic surgery or plastic surgeon route. You can go through the ear, nose, and throat and then do cosmetic facial surgery. Or you can actually go through ophthalmology and go through the oculoplastics route. So your surgeon could have a variety of training and still sort of end up in a sphere where they're doing these surgeries. I think just doing your due diligence and making sure that this is something they do on a regular basis and are well-trained.
If you don't know if you're a candidate or not, it doesn't hurt to come out and get a consult and get checked out. A lot of us will do our initial cosmetic consult as either free or minimally priced. And so you have a little skin in the game when you go to get this evaluated, but you at least get to sit down with an expert and have a chat about it and find out if you're truly a good candidate for it and what might be the best route for you.