I was born with naturally hooded lids and now that I'm in my mid 40's my lid has drooped dramatically. I know that the best solution for me would be to get a blepharoplasty but would like to find an alternative as I'm scared to death that the upper eyelid surgery will change my eye shape. I know botox will not get rid of extra skin but will it lift the upper eyelid to give me a more open eye look?
Upper Eyelid. Born With Hooded Lids? (photo)
Doctor Answers 7
Blepharoplasty for hooded upper lids
A conservative upper eyelid blepharoplasty with skin and very minimal amount of fat will give a very desired result and make your eyes looked more well rested, without changing the shape of them. Best to seek out someone who is lots of experience with upper eyelid surgery. For examples, please see our eyelid photo gallery link below
Upper blepharoplsty to enhance the eyes
Conservative upper blepharoplasty will not change the appearance of your eyes; it will enhance them in more youthful way. There is also some fullness in the lateral corners of the upper eyelids, which are likely prolapsed lacrimal glands, which can be tucked in during upper blepharoplasty. Botox will not achieve the results desired. See an oculoplastic surgeon for evaluation.
Upper Eyelid. Born With Hooded Lids?
Skin only upper blepharoplasty may be helpful, and it should not change the shape of your eyes. Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA
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Your concerns are valid.
It is one thing to say you are going to be conservative. It is a whole other thing to be conservative. Take a very good look at your photo from your twenties. You have a very full sub-eyebrow area. That is an essential feature of your face. It is not enough for a surgeon to tell you that they will be conservative with removal of skin in your upper eyelid. You need to understand that a surgeon who tells you that does not get what is going on. While conservative removal of skin is appropriate, it is not sufficient to preserve fullness in your sub-brow area. If you carefully study your younger picture, you are actually now lifting your eyebrows more to compensate for the fullness of the sub-brow area resting on the eyelid. There is also a very slight cosmetic ptosis present in the actual eyelid.
Normally eyelid surgeons would make your crease incision at 10 mm and then determine how much skin to removed using a variety of formulas that describe how much skin needs to be left between the eyebrow and the eyelashes. This is a guarantee that your eyelid will look hollowed even though this would not be the intention of your would be eyelid surgeon. The 10 mm incision will heal 1-1.5 mm higher, a fact that is not widely understood by most eyelid surgeons. Why do they persist in making the incision at 10 mm? The answer is that is what the text books say.
By making the incision lower, typically 6.5 to 7.5 mm, the upper eyelid is less likely to be left with the appearance of being skeletonized. Now the incision is just part of what needs to be done. Many eyelid surgeons feel that it is also their job to remove fat. No fat should be removed from your eyelids. However you do need an anchor blepharoplasty and a subtle ptosis procedure. To accomplish this, the levator aponeurosis needs to be expose. I will estimate that only 10 to 20% of practicing eyelid surgeon know how to accomplish this. The skin and muscle of the eyelid platform, the skin between the crease incision and the eyelashes need to be carefully attached to the expose levator aponeurosis. This can also be used to carry out the ptosis procedure. This maneuver places the platform skin on slight stretch and supports the eyelashes so they are perky. The needed skin removal is planned preoperative to expose a certain amount of platform skin. This is a big guess because it is impossible to know precisely how much your eyebrows will relax after surgery. Less is more. One can always remove more skin if needed often as an office procedure but putting skin back into the eyelid is very challenging.
I personally think that botox, even my microdroplet botox treatment will not be enough to make the difference for you.
Hope this information is helpful.
Upper Eyelid / Blepharoplasty
This is a very common request from patients. The goals would be to rejuvenate the eyelids and refresh the eyes while still maintaining a very natural and balanced appearance with the rest of your face. If you are looking to enhance the excess skin in the upper eyelids, blepharoplasty will not change the eye shape but create a more youthful appearance. Please consult with a board certified specialist who can assist you with achieving the results you seek.
Upper eyelid hooding
Botox can be used to help lift the eyebrows a bit, and this sometimes can influence the appearance of the upper eyelid. In your case, I do not believe that Botox would have a significant effect on your upper eyelids. Unfortunately, surgery is the best option for you. The procedure is fairly simple and should not change the shape of your eyelid. It would just remove some of the skin on your upper eyelid so that it would improve the hooding.
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.