What procedure is needed for upper eyelids sagging downward? (Photo)

Question

The outer corners of my upper eyelids are sagging downward and it’s making me look tired/dull. I want to open up my eyes, look more refreshed, and possibly have a more upward tilt. I’m wondering what the best approach is to correct this issue in the simplest way. I’m not sure I want a brow lift . I’m wondering if a bleph/canthoplasty is the right move.

Jason Emer, MD · Answer

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on the situation.

For less significant upper eyelid skin excess or more mild improvement, there are nonsurgical treatments: Radiofrequency (Thermage or Venus Legacy/Viva), injectable fillers, and a Botox brow lift can help contour the eyebrows and lift the eyelid skin.

Surgery (browlift and/or upper blepharoplasty) is a great option for more significant improvement- for example if the hooded eyelids have more excess skin present.

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best, 
Dr. Emer

Andrew Miller, MD · Answer

It is certainly possible to perform a limited upper eyelid surgery. It is important that you are confident that the surgeon will not be too aggressive with the upper eyelid skin excision, though, because it could limit the ability to do other procedures that may be needed in the future. See a facial specialist for consultation.

Michelle Zweifler, MD · Answer

Upper blepharoplasty removes the extra upper eyelid skin to help refresh the eyes.  The canthopexy or canthoplasty will tighten the the lower eyelid with restoring a more upward tilt to the out eyes.  The canthopexy is often performed from the upper eyelid incision.

Carmina Cardenas, MD · Answer

I agree with you about not needing a Brow lift. Your brows are perfect. 
Your upper eyelid is perfect in the inner and mid portion, it is just the lateral part of the eyelid. The external canthus is perfect in position, so no need of canthopexy. 
I consider just a lateral upper blefaroplasty will be enough. An outpatient procedure, only skin, respect the muscle. 
Dr. Cardenas.

Zoran Potparic, MD · Answer

This procedure would address the issue of position and shape of lateral eye commissure and lower eyelid. In person consultation with a board certified plastic or Oculoplastic surgeon is recommended. Good luck.

Nelson Lee Novick, MD · Answer

If you are looking for simple, quick and minimally invasive, check out "The Ten Minute Eyelift." However, instead of needing it to treat the entire upper lid, as is the usual case in older individuals, you would need it for a very limited area, which would literally make it the Two Minute Eyelift. And, of course, healing would be that much quicker. The procedure requires no scalpel cutting nor the use of stitches and the downtime is typically negligible. To give you some idea, I performed a full Ten Minute Eyelift on myself for saggy upper lids a number of years ago and six hours later was on an 11.5 hour international flight. . You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Mats Hagstrom, MD (license on probation) · Answer

The corners of your eyelids are anchored in your skull by the canthal tendons. Resetting the insertion of the upper and lower eyelids is not something to be taken lightly.
I suggest you either choose the position of the eyelid or the shape of your eyelid, but not both.
Your question and wishes are complex and outside the realm of what’s appropriate by posting on this website. IMO
I suggest scheduling in person consultations with oculoplastic surgeons in your community.
I would recommend constraint when it comes to trying to create substantial changes from what your baseline anatomy is.
Consider having just an upper eyelid blepharoplasty as a reasonably good place to start esp if a brow lift is out. 
I recommend against virtual consultations and instead recommend relying exclusively on in person consultations.
Best,
Mats Hagstrom MD

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