I have too much upper eyelid space. What can I do? (photo)

Question

I have way too much upper eyelid space. What can I do to resolve this? Also, who should I visit and do I have ptosis? Thanks.

Kenneth D. Steinsapir, MD · Answer

You really have only one problem and that is bilateral upper eyelid ptosis.  The ptosis is drooping of the upper eyelids and this causes a compensatory elevation of the forehead and eyebrows in an effort to open the eyes.  The elevated eyebrows also elevates the tissue just below the eyebrows which includes the upper eyelid fold or subbrow tissue.  This makes the upper eyelid sulcus look very hollow.  When you fix the upper eyelid position, the forehead will relax and the upper eyelid space will not look so hollow-this is bread and butter oculoplastic surgery.  In fact there is a test that can be done at the time of consultation that previews the effect of ptosis surgery and often with this test, you can see the effect that raising the upper eyelids will have on the brow and upper eyelid hollow.  I would recommend getting several opinions from fellowship trained oculoplastic surgeons before committing yourself to a particular treatment approach.  I do not agree that upper eyelid fillers are right for this situation.

John J. Martin, Jr., MD · Answer

You do have some ptosis of the upper lids.  Because of this, you will tend to hold your brows up to open the eyes.  And when you do this, the upper sulcus will appear deeper.  Lifting the lids should help the appearance of the sulcus and help to lower your brows so you should look better.  IF you are still a little hollow you could add some filler to the upper lids at a later date.  See an oculoplastic surgeon for an evaluation.

Mehryar (Ray) Taban, MD, FACS · Answer

There are two problems that I notice:  1) you do have upper lid ptosis (droopy) and may be a candidate for ptosis surgery;  2)  you have hollow upper eyelids and would benefit from filler injection (I have published on this topic and you can find link to the manuscript on the link below).  Best to see an oculoplastic specialist in person for evaluation.

Christian L. Stallworth, MD · Answer

The supra orbital hollowing that you mention can arise from multiple factors- can definitely be from brow compensation for an underlying ptosis, can be result of previous reductive surgery or trauma and could even been genetic. I would recommend visiting with an Oculoplastic or Facial Plastic surgeon well versed in eyelid correction to see what options are available. You may benefit from surgical ptosis correction, filler or fat grafting to restore volume, or both, depending on the cause.

Kenneth E. Morgenstern, MD · Answer

Your photo shows contraction of your forehead muscles, likely because your upper lids are ptotic, and you are trying to compensate for the low lid position. This brow/forehead elevation results in increased "show" of your upper lid skin.While a formal evaluation would be necessary, I suspect addressing the ptosis would likely be most beneficial for you. Schedule an evaluation with an experienced oculoplastic surgeon to discuss your options.

George Sanders, MD · Answer

Yes, you have ptosis that accounts for the increase in upper eyelid space as well as the drooping of your upper eyelids. An oculoplastic surgeon will be able to help you.

Curtis Wong, MD · Answer

can suggest ptosis of your lids.  See a local oculoplastic or plastic surgeon for options as they can be tailored to what your goals are.

I have too much upper eyelid space. What can I do? (photo)

Answers (7)

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