Is this ptosis? (photo)

I noticed that my right eye lid keeps getting lower and lower for the past few years. Is this ptosis or do I just have extra skin? What do you all reccomend I do? Thank you

Doctor Answers 2

Your ptosis may be caused by the weakening of the eyelid muscle, or the volume of extra skin weighing on your eyelid

Thank you for the question. You submitted a single photo and ask if you have ptosis. You describe your situation where your right eye continues to become lower over time, so you want to know if it’s ptosis or extra skin.
I can certainly give you some guidance on how I evaluate patients like yourself in my practice. A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon practicing in Manhattan and Long Island for over 20 years. Eyelid ptosis is a very common issue I deal with in my practice. I can also guide you on how I evaluate a patient, and what ptosis means in addressing your cosmetic and visual concerns.
The definition of ptosis has to do with the relative position of the eyelid margin to the center of the eye. If somebody has an eyelid that’s lower than its normal position which is typically 2mm below the top of the colored part of the eye, or the iris, then below that level is technically ptosis. If someone has slightly low eyes, but they can see perfectly well, that is commonly referred to as bedroom eyes. People get accustomed to this natural look, which often runs in families. In your situation you are describing some progression of the eyelid getting lower, which is a common situation referred to as acquired ptosis. Acquired ptosis means that the onset of the drooping of the eyelids happens later in life, in contrast to congenital ptosis where you are born with ptosis.  You may want to look at some more photos to see if your eyelid were significantly higher than it is currently, or if it was slightly higher. Very often people are born with mild ptosis that’s unnoticeable, but as they get a little older, the eyelids droop down more noticeably.
In terms of whether or not it is extra skin, based on the photo it is likely the volume of skin over your eyelid is contributing to the degree of ptosis. When there is a lot of skin over the eyelids that puts a physical weight on it, we refer to it as mechanical ptosis. An acquired ptosis should be evaluated properly so no neurologic or medical issue can be associated with the ptosis.
The most common cause of acquired ptosis is called levator aponeurosis or aponeurotic ptosis. Acquired aponeurotic ptosis sometimes referred to as age-related ptosis because the reason it gets droopier is the levator muscle that lifts the eyelid. There is a tendon on this muscle called the levator aponeurosis. As people get older, and a variety of reasons like genetics, issues such as chronic eye rubbing or the wearing of different contact lenses, that tendon can get thin, so it becomes attenuated or it separates or decreases.
The typical solution for acquired ptosis is levator muscle surgery or ptosis surgery. This is determined based on a very specific type of examination performed typically by an oculoplastic or oculofacial plastic surgeon. The goal is to not just address the extra skin, but to address the muscle. In our practice, it is routine to perform this procedure in our office operating facilities under local anesthesia with LITE™ sedation. We actually want your cooperation during the surgery - there is no pain, but we have you open your eyes and even sit you up during the surgery to see the eyelid level, and make adjustments appropriately. It is a deceptively complex type of work, and the procedure deals with very delicate muscles and minimal numbers of millimeters which can go one way or the other. It is very important to meet with a doctor who is highly experienced in this area and can guide you in the appropriate plan to help you open your eyes up and look better, so your eyes are not continually drooping again. You have to start with a proper diagnosis, then typically a surgical plan such as ptosis surgery. I hope that was helpful, I wish you the best of luck and thank you for your question.
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New York Oculoplastic Surgeon
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Thank you for asking your question and posting your photo. You have a ptotic (droopy) eyelid. There are several methods for elevating the eyelid. See an experienced board-certified Oculoplastic Surgeon for full evaluation and guidance.
Good luck,

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