What's causing my drooping eyelid? (Photos)

ive read a lot about ptosis, but I'm wondering if there's any way this may be allergy related. It is worse (as in photo) when my allergies are bad. Also bad in the morning. Is there any non-surgical way to at least improve it? I'm only 30 and would rather put off any procedures until they are both looking a little saggy. My father's side of the family gets a hooded eye (kind of different than my current problem) as they age, and I suspect I will want to get them both done eventually.

Doctor Answers 2

You don't have ptosis, but there is a little hooding in one eyelid - there are surgical and non-surgical options to treat it

Thank you for your question. You’re asking what’s causing your drooping eyelid, and you state you’ve learned a lot about ptosis. You also ask if this is possibly allergy-related. You submitted a photo to help me guide you.
Just a little about my background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. As I’ve been in practice over 20 years in Manhattan and Long Island, I have focused on cosmetic and reconstructive issues of the area of the eyelids and face, as well as complex revision surgeries, and the many different artistic approaches in enhancing eyes. This is a type of issue I deal with in my practice every day. I think it’s very good you have pursued knowledge in this area and you’re familiar with the term ptosis. To help guide you and others like you who come to my office, I’ll get into the definitions, how they would be relevant to your situation.
One of the things I help people understand is that a drooping eyelid can be caused by something called dermatochalasis, which means excess or redundant skin. This is more consistent with what appears in your right upper eyelid, where the skin is hooded over and approaches the eyelash. This is distinguished from ptosis which describes the relative position, with ptosis meaning low, of the eyelid margin relative to the pupil. It looks like the eyelid margin relative to the pupil is pretty symmetric. What you are dealing with is an asymmetry in the relative hooding of your eyes. There are a variety of reasons for this situation. When the skin is asymmetric from relative stretching of the skin, or the shape of the orbit (the bones around your eyes) is a little different, or the relative amount of fat around the eyes, it is very common to have this situation.
As far as doing something surgical is concerned, I can tell you that being in practice for over 20 years, I have operated on many people your age who had this exact issue. If your goal is to achieve a certain amount of symmetry, well you have a couple of different options. One approach would be to add volume on the left upper eyelid in the sub brow area to try to make it look more full to match the right eye to do a subtractive procedure where you take fat on the right eye as well as some on the left eye to create better symmetry. So I don’t think you have to necessarily adhere to a rule of delaying surgery if surgery is the best solution. There was a time when it was justifiable to delay surgery because people would not want to go under general anesthesia and put themselves under additional physical stress and go through hospitalization.
In my practice, we do everything under local anesthesia with LITE™ sedation. This includes eyelids and facelifts, cheek implants and even body procedures like liposuction, breast augmentation, we do under local anesthesia with LITE™ sedation. That means that you don’t have to go under general anesthesia. We put it into a small intravenous and just give you a little liquid equivalent to liquid valium.
So I think that the terminology is important to understand but practically speaking, you need to meet with a doctor who has a lot of experience with eyelid surgery to help you understand what your options are. Sometimes eyelid surgery is oversimplified and people will do something and regret having done it. As a specialist, I do a lot of revision surgery and I’ve seen that scenario. So I spend a lot of time with patients and try to help them understand what their options are and then help them make an informed decision. So as I said, surgery may be an option for you, fillers may be an option for you. Maybe it’s some type of balance is also possible between those options but ultimately, a proper examination and consultation is necessary to get a real 3-dimensional sense of what is appropriate.
So 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
4.3 out of 5 stars 59 reviews

Hooding of eyelids

Your description sounds typical for morning puffiness which can look substantially better at the end of the day. Eyelid features are largely hereditary but may fluctuate with allergies, puffiness, and other factors such as thyroid dysfunction. The eyeball position may also play a role in the appearance of the upper and lower lids. The photo shows more hooding on the right, and a double crease on the left. There is no easy solution without surgery, but sleeping on your back and elevation of the head and torso at night - couple pillows or wedge - might minimize the puffiness - also - limiting salt intake. The left eye seems a little deeper in the socket - you may want to make an appointment to see an Oculoplastic surgeon for a baseline examination.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

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