Do I Have Ptosis? If So What Came First, Hollow Eyes or Ptosis? (photo)

I have always been bothered by the way my eyes look: tired and very hollowed. I also notice that my eyes droop considerably unless i try to raise my eyebrows. I have amblyopia, astigmatism & very mild strabismus. And, looking back at pictures when i was younger I had a lower crease. But during my early teens I have very high crease & they're very hollow too. I feel like I don't resemble my age (mid 20's) because of it. Did the hollow eyes cause the ptosis or vice versa?

Doctor Answers 11

Eye ptosis and hollow eyes

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Ptosis is certainly present in both eyes and should be addressed by an oculoplastic surgeon. Once the eyes are in the appropriate position, the hollowness on the upper lids will not be as apparent.  The hollowness did not cause the ptosis.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Remedies for drooping eyelids

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As the prior posters have mentioned, you do have blepharoptosis and in order to resolve this, you will need to see a plastic or oculoplastic surgeon for an evaluation and to determine what is causing this as the treatment plan is determined by the cause.  You can re-establish a crease and improve on your hollowness with surgery.  Good luck!

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Ptosis causes hollowness of the upper eyelids

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You have what is known as acquired ptosis of the upper eyelids.  As you observed, you had normal eyelids when you were younger.  It is not uncommon to develop ptosis as one gets older.  I see that you wear contact lenses.  In your situation this may be the cause rather than age related since you are young.  Hard contact lenses have been known to cause ptosis.  

As ptosis develops, the eyelid crease gradually rises up and the eyelid skin fold becomes indistinct.  Along with it the upper portion becomes gradually hollow.  Ptosis is the result of thinning and stretching of the paper thin tendon of the eyelid opening muscle (levator).  This tendon is normally attached to the firm plate (this is what you use to flip your eyelid) and lifts it like a garage door.  It is also attached loosely to the overlying skin at and above the usual eyelid crease.  When the tendon gets thin and stretched it cannot open the eyelid all the way and vision gets blocked.  This in turn causes the brain to drive the muscle harder.  Since the loose attachment to the overlying skin is still intact, the skin fold and crease in general becomes higher by the excessive pull of the muscle.  This causes the crease to become high and the orbit to become hollow.  In addition, the brows are pull up to help lifting the eyelid.  This makes the hollow worse.  As you can see, it is a chain reaction that started from thinning of the tendon from the close rubbing of the contact lens edge from the inside and ended with hollowness of the orbit.

As far as treatment is concerned, shortening/reattaching the tendon to the plate will restore the eyes to the former shape.   Acquired ptosis responds well to this surgical treatment.  You will be able to see better also since ptosis restricts the upper field of vision.  It is done under local anesthesia as an outpatient.  It is usually covered by insurance.

Seung K. Kim, MD
San Francisco Plastic Surgeon

Upper eyelid ptosis

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Your observation is right on the money:  you do have upper eyelid ptosis. This droopy eyelid can lead to a more hollow upper eyelid, and ptosis repair will improve the hollowoness somewhat, but it may also lead to a bit of more redundant skin.

This may be something that is may be ideally addressed in two stages: first repair the ptosis to see what effect it will have on improvement on the upper eyelid hollowness. If you are not happy with the improvement, the second stage can address with fat grafting and possible skin excision.

If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

You likely have involutional ptosis

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The high lid crease and minimal distance of the eyelid above the pupil (MRD) indicates ptosis. This is best repaired by an Oculoplastic surgeon. In Orlando area, I recommend Dr. David Auerbach or Dr. Tom Kropp. I have referred patients to them with good results. If you have subsequent cosmetic concerns of hollowness, we can help with Restylane injections, which give volume in those areas. Best, Dr. G.

Edward J. Gross, MD
Orlando Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Do I Have Ptosis? If So What Came First, Hollow Eyes or Ptosis?

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Based upon the posted photos you have bilateral ptosis. As to cause a detailed medical history and ONLY in person ocular examination can lead to an answer. 

Ptosis and eyelid hollowness

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You definitely have eyelid ptosis and hollowness.  The two are essentially unrelated.  However, ptosis can make the hollowness more pronounced and ptosis surgery can help fill the hollowness to some extent.  Consult an oculoplastic surgeon for nonsurgical (filler injections, etc) and surgical options (ptosis surgery, fat injections).

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews


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Based on the pictures it appears that you have bilateral uplid Ptosis and hollowed upper lid.  You may benefit from Ptosis repair and fat grafting to the upper lid.  You should see an experienced plastic or oculoplastics surgeon in these techniques.

Gary A. Tuma, MD, FACS
Princeton Plastic Surgeon

Hollow Eyes

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Yes, several conditions exist which require a Facial Cosmetic Surgeon and an Occuloplastic Surgeon to help you improve your valid concerns.

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Do I Have Ptosis? If So What Came First, Hollow Eyes or Ptosis?

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You do appear to have a bilateral upper eyelid ptosis. That is a very astute observation! Your deep upper eyelid sulcus is likely related to your ptosis. I recommend that you consult with an oculoplastic surgeon or plastic surgeon with alot of ptosis repair experience. This surgery is not the same as an upper blepharoplasty and you do need a specialist familiar with ptosis repair. I hope this information is helpful.

Stephen Weber MD, FACS

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.