I Need Help for Hyperpigmentation Under my Eyes and I Have Ptosis on One Eye Too? (photo)

Doctor Answers 4

Factors to consider in ptosis and hyperpigmentation

Within the normal population, a 1-2 millimeter difference between the two eyes is natural. In order to properly assess ptosis, you have to be examined by an ophthalmologist and oculoplastic surgeon that may evaluate the level of ptosis or level of droop of the eyelid. It’s important that a proper ptosis evaluation be done so that any medical issue that could be associated with the ptosis is ruled out.

From the photo that you sent, I assess that there may be a slight difference, but I would like to further know if other people like your family are aware of the difference or if it is noticeable in your pictures. If that is the case, then you fall under the category called congenital ptosis which could be associated with swelling after birth. Something that you’ve always had does not need much further work-up. However, if the ptosis is new then a medical evaluation by an ophthalmologist or oculoplastic specialist is appropriate.

Ptosis surgery is a procedure typically done under local anesthesia with light IV sedation. Usually for someone who has a mild amount of ptosis, surgeons advance a muscle called the levator muscle. This muscle is responsible for lifting the eyelid. During ptosis surgery in adults, the patient must cooperate during the procedure so that the eyelid height and shape can be optimized.

A disadvantage of ptosis surgery is typically asymmetry. Even after a successful surgery or if the patient looks good at the operating table, the eyelid may still be too high or too low. Nobody who does ptosis surgery for any length of time gets it perfect every time because it’s a very tricky muscle. To avoid that from happening, you should find yourself a good specialist with an established reputation.

As far as the hyperpigmentation is concerned, your situation looks more of an ethnic hyperpigmentation. Patients who have pigment have a tendency of genetic darkness under the eyes. This is very common with people with any ethnic background. We have to distinguish the pigmentation that is genetic which basically we can’t do much about. People may try bleaching creams and eventually they stop because of the irritation of the delicate skin under the eyes. In our cosmetic surgery skin line, we have an eye rescue cream and it has some active ingredients and moisturizer that most of our patients seem to like.

In some people who have dark circles or if there is a lot of environmental and age-related changes, I recommend non-surgical procedures such as platelet-rich plasma.  This procedure uses your own blood with which we concentrate the healing factor called platelets to help stimulate collagen under the skin. This will help the skin quality and healing.  I hope this was helpful for you and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Eyelid hyperpigmentation

The hyperpigmentation eyelid problem mainly is from shadow effect from eyelid hollowness, which can be improved by eyelid filler injections.  You are also candidate for ptosis surgery. See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Mild ptosis with lid crease loss

The photo is helpful, but an in-person evaluation is more valuable. In general, there are three reasons why the skin around the eyes can be [or seem] darker:

1. The thin eyelid skin allows the darker muscle underneath to show

2. The hollowness around the eyes can create a shadow effect that exacerbates darkness

3. Skin pigmentation [sometimes from blood products from bruising, if you've had surgery]  If it is blood    product pigmentation, it could last months to improve.

Depending on which of the above is the issue, different modalities may be helpful [time, fillers, laser resurfacing, concealer etc].


The second issue here is your left upper eyelid ptosis along with the poorly formed eyelid crease. This can be nicely addressed with ptosis surgery and lid crease reformation along with a subtle blepharoplasty [skin removal]


If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Hyperpigmentation and Ptosis?

    I would definitely have an inperson consultation with a board certified plastic surgeon or oculoplastic surgeon to sort these issues out.  There are many considerations here, including eyelid position, bony periorbital structure, brow position, amount of skin in upper eyelids, and your skin pigmentation may limit the options available for you in improving the hyperpigmented areas.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.