Ptosis? Orbital rim implants?

Question

Im looking to fix two areas of my eyes. First problem is my upper eyelids, they’re very heavy and lately have been getting in the way of my vision. Because my eyelids are droopy, I carry a lot of tension in my forehead and upper eyes. For the second area, my under eyes. I believe the hollowness of my under eyes plays a part in how droopy my face is. Especially since I have a lot of fat in my cheeks. So I was wondering, do I ptosis? And what do I need to fix my under eyes? Will filler work? Or should I go all the way and get an actual procedure? I’m wanting a more feminine look and I want my eyes to appear more open, with less tension. Please help me

Guray Yesiladali, MD, FEBOPRAS · Answer

Without an in-person examination, it's not possible to give a definitive answer, but based on the photos you've shared, your condition does not appear to be true ptosis (muscle weakness). Instead, the heaviness in your upper lids seems to be due to skin and soft tissue excess.
In this case, an upper blepharoplasty (eyelid surgery) would likely address the issue effectively by removing the excess tissue that's contributing to the visual obstruction and tension in your forehead.
If your goal is a more lifted, refreshed look around the eyes, this procedure can be combined with a brow lift. That decision depends on how much you want to elevate the overall eye area and how low your brow position is anatomically.
As for the under-eye area: there does not appear to be significant skin excess in your photos, so lower eyelid surgery may not be necessary.
The hollow appearance may be due to volume loss or shadowing, rather than loose skin.
In such cases, treatments that improve skin quality&mdash;such as mesotherapy, PRP, or laser&mdash;may help address pigmentation and support a more rested look.
About the procedures:
- Upper blepharoplasty removes excess skin and fat on the upper eyelid to improve both function and appearance.
- Brow lift elevates the eyebrows and opens up the upper eye area when there is descent of the brow.
- Lower blepharoplasty is performed when there is visible skin laxity or fat bulging under the eyes. In the absence of that, non-surgical options are preferred.
- Ptosis surgery is only necessary when the eyelid itself is drooping due to muscle weakness (levator dysfunction). It involves tightening or repositioning the levator muscle and is not indicated unless true ptosis is diagnosed during dynamic examination.
I hope this gives you a clear overview of your options. A personalized surgical plan depends on your facial anatomy and aesthetic goals.
&mdash; Güray Yeşiladalı, MD

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Hi there, and thank you for your thoughtful question and clear photos!

Let’s break this down:
Do you have ptosis?

From the images you shared, it does not appear that you have true ptosis. Ptosis means the upper eyelid margin (where the lashes are) droops and may partially cover the pupil. In your case, the eyelid margins are appropriately positioned, but you do seem to have heaviness from excess upper eyelid tissue or skin, particularly laterally (toward the outer corners). This can mimic ptosis and even cause forehead strain from subconsciously lifting the brows to see better.

A proper in-person eyelid exam would be needed to confirm, but this looks more like upper eyelid hooding or redundancy, not true ptosis.

What might help:
If you're 20 or older and emotionally/physically mature for aesthetic surgery, here are two options worth exploring:

1. Upper Eyelid Blepharoplasty (Eyelid Lift)

A well-performed upper blepharoplasty can remove excess skin and fat, reduce the feeling of heaviness, and relieve forehead tension.
It also creates a cleaner, more defined eyelid crease, contributing to a more feminine, refreshed look.
2. Tear Trough Correction (Under Eyes)

You’ve got well-developed cheeks (which is great for facial balance!), but that can accentuate the hollowing under the eyes.
Since you’re young, starting conservatively with a hyaluronic acid filler like Restylane-L or Belotero in the tear troughs may help restore volume and soften the transition between the lower lid and cheek.
If filler doesn’t hold well or the hollowing is too deep, then fat grafting or even orbital rim implants could be discussed in the future — but those are more advanced and typically reserved for structural deficiencies, which doesn’t seem obvious in your case from these photos.
 Summary: Your Personalized Plan
✅ No true ptosis — likely upper eyelid skin heaviness
✅ Consider upper eyelid blepharoplasty to reduce heaviness and forehead tension
✅ For the under-eyes, start with tear trough filler
❌ Orbital rim implants not necessary at this stage

Mustafa Aydinol, MD · Answer

Thank you for sharing your photos and detailed explanation. From what you’ve described and based on the images, it seems that your concerns stem from both upper eyelid heaviness (possibly mild ptosis or brow descent) and under-eye hollowness that disrupts facial balance.
To achieve the more feminine, refreshed, and open-eyed look you’re after, here’s what may help:
✅ Brow Lift: An endoscopic brow lift can subtly elevate your brows and relieve the tension you feel in your forehead from overcompensating for droopy upper lids.✅ Upper Eyelid Surgery (Blepharoplasty): This will remove excess skin and give your eyes a more open appearance &mdash; especially if it’s affecting your vision.✅ Endoscopic Midface Lift: This can help elevate your cheek tissues, improving the lid-cheek junction and overall contour.✅ Nano Fat Grafting (or carefully placed filler): This can soften under-eye hollows and help blend the transition between the lower lid and upper cheek for a more harmonious result.
A detailed, in-person assessment is essential to determine the presence and extent of ptosis and whether muscle tightening is also needed.
With the right combination of procedures, you can absolutely achieve a softer, more open, and feminine look. Wishing you all the best on your journey!
Warm regards,Dr. M. Mustafa AydınolPlastic, Reconstructive & Aesthetic SurgeryIstanbul, Türkiye

Daniel A. Barker, MD · Answer

I don't think you have ptosis based on the photos. Upper lid skin would be easy to remove but you are young and don't have a lot of extra skin on the upper lids. An endoscopic brow lift might get you the look you desire. As far as the under eye area, I am not a huge fan of cheek implants. I think you might do well with fat grafting. It looks really natural and does not migrate like filler does.

Ptosis? Orbital rim implants?

Answers (4)

Answer: Possible Fat Grafting

Answer: Possible Fat Grafting

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Ptosis? Orbital rim implants?

Answers (4)

Answer: Possible Fat Grafting

Answer: Possible Fat Grafting

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Everything you need to know about Eyelid Surgery

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