What do I call this in my eyelids? Best surgery to fix this? (photos)

Question

My eyelids always looks so weird to me. Triple eyelid? How can surgery fix my eyelids?

Kenneth D. Steinsapir, MD · Answer

You have central leavtor disinsertion causing upper eyelid ptosis and a mild compensatory eyebrow elevation. The disinserted tendon tends to retract into the orbit and take with it anterior orbital fat that would otherwise contribute volume you your upper eyelid fold. The other source of volume for the upper eyelid fold is a small skirt of fat that comes from below the eyebrow. Then the brain is lifting the forehead to compensate for the heavy upper eyelid, less volume is available to the fold. As a consequence of these changes, it looks like your upper eyelid fold is empty. Cutting away this skin and muscle will permanently leave you with an innie eyelid and not repair your actual underlying eyelid problem. You will immediately look older and post-surgical. By repairing the upper eyelid ptosis and reposting the retracted anterior orbital fat, it is possible to reconstruct the upper eyelid fold to restore a much more youthful upper eyelid. You need an anterior levator resection ptosis surgery, anchor blepharoplasty and crease lowering. It is also possible that you may need a lateral canthoplasty. A detail in person assessment is needed to develop an individualized plan for you. Don't get the wrong surgery. Your eyes can be your best feature.

Sam Speron, MD, FACS · Answer

Thank you for your questions and pictures!  Upper eyelid hooding can be corrected with an upper blepharoplasty.  It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you. That said, even after surgery I always warn patients that there will still be asymmetry and things will not look 100% perfectly even because some asymmetries cannot be corrected unless you reposition bone, remove muscle etc. and somethings are just not worth doing.Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid surgery but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all,you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope my answer helps and if it does, please take a moment to upvote this answer on the “response”button on the top right. Have a great day.

Marc Polacco, MD · Answer

Thank you for your question. What you're probably noticing is skin excess of the upper eyelid. Both genetics and age play a role in this. The treatment of choice would be an upper eyelid blepharoplasty, which involves removing excess skin, and hiding the incision in a natural crease. I hope that helps, and all the best to you.
-Dr. P

Ashley B. Robey, MD · Answer

Hi, thanks for sharing your photos. They suggest that you may have some mild upper eyelid skin excess. It's mild, so your options are: do nothing, remove some excess skin (blepharoplasty), add some botulinum toxin under the brow to lift it up a millimeter or so, consider RF micro needling to face (including eyelids) for tightening purposes.

Take care!

Take care!

Carmina Cardenas, MD · Answer

If I understood correctly you are referring to the little roll of skin right at your upper lid fold. That is a bit of saggy skin which causes the appearance of two folds one at your original fold and then one more above. 
It is important the physical evaluation to be sure aside of the extra skin, you don’t have blepharoptosis because the treatment of both conditions is completely different. 
You must be seen by an Oculoplastic specialist. 
Dr. Cárdenas

Mehryar (Ray) Taban, MD, FACS · Answer

You may benefit from upper blepharoplasty and/or upper eyelid filler injection. Need more detailed evaluation to determine.

Michelle Copeland, MD, DMD · Answer

Thank you for sharing your photos! Eyelid surgery has become one of my most popular procedures. If excess upper eyelid skin is hooding the eye and needs to be eliminated, an incision is made in the crease at the top of the lid and excess fat and skin are removed. The incisions are closed and sutured on the underside of the skin. If undereye puffiness and dark circles need to be eliminated, an incision is made along the lower lashes that will be almost invisible when it heals. Next, the fat below is either removed or redistributed and the saggy and crepey excess skin is then pulled up and cut off. The incisions are closed with tiny sutures, which are removed in four to six days. The incisions are along your eyelash line, making it a virtually scarless procedure.

An effective non-surgical option that might benefit you is Thermage, which can tighten the skin around the eyes. The new and improved Thermage is a virtually painless, non-invasive (no incision!) treatment that can tighten skin and stimulate your body to make healthier collagen—the building block that provides structure to your skin. Fast and easy, Thermage requires no downtime from normal activities. The use of certain topical creams can also be helpful to reduce the appearance of dark circles and puffiness around the eyes. I suggest making an appointment with a board certified plastic surgeon to discuss your options.

William Portuese, MD · Answer

The extra fold of skin on your upper eyelids called dermatochalasis. A conservative skin only upper blepharoplasty can accomplish improvement in this area, and it can be done under local anesthesia as an outpatient procedure.

Darryl J. Blinski, MD · Answer

The surgery needed is upper eyelid blepharoplasty or lift of upper eyelids. This can be preformed under local anesthesia w or w/o IV sedation. Fees from $2,500-$8,000.

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