Are my large eyelids, deep crease, and drooping normal? (Photo)

Question

I am 35 years old and very self conscious about my eyes. I am pretty sure this is not a normal eye shape. Is there anything I can do to help open my eye more? I am constantly asked if I am tired, even when I am not. Eye dr.'s comment on how droopy my one eyelid is. I do believe it's droopy but what about the large amount of eyelid? thanks!

John J. Martin, Jr., MD · Answer

You have a significant ptosis of both upper eyelids.  You also have a very deep upper eyelid sulcus, which makes the eyelid appear very long.  Most people have some fat up there, which creates the crease and gives volume to the upper lid.  It would be helpful to see a picture from maybe 15 years ago to get an idea as to whether you have always had this appearance, or if it is new.  Make an appt with an oculoplastic surgeon to evaluate the upper eyelids.  Bring in some old photos so they can see how you looked before.

Amiya Prasad, MD · Answer

I’m a cosmetic oculofacial plastic surgeon and I specialize in cosmetic
surgery of the eyes, face and body. I’m a fellow certified by the American
Society of Oculofacial Plastic Surgery and have been in practice for over 20
years.

Your condition is referred to as ptosis or drooping of your eyelid. To
know the cause of this, we have to determine if this was a recent onset, or if
your eyes were already relatively low to begin with. If this was a sudden
onset, you would need a neurologic workup to look for possible neurologic
causes. You also have to look at old photos to see if you have a case of
congenital ptosis that has gotten worse.

There is also acquired ptosis where someone can have a very high eyelid
crease and a large lid. In a 35-year-old, acquired ptosis is mostly associated
with contact lens wear. People who wear contact lenses especially those who
wear hard lenses can have thinning of that aponeurosis or tendon.

Involutional ptosis is usually
more age-related for people in their late 50s and older. It’s related to a
tendon called levator aponeurosis that gets thinner overtime.

After you’ve had the neurologic workup and it is clear, we do levator
advancement surgery. This procedure moves the levator muscle or the muscle that
lifts the eyelid forward and corrects its position because it's sometimes thin,
slipped back, or a combination of both. During this surgery, the patient is
awake for this very important part because the muscle is very sensitive. We let
the patient open their eyes and let them sit up to make sure that the eyelid
height, shape, and contour are symmetric. It’s remarkably complex and there are
a lot of small factors that have to be balanced in order to get a nice shape. Ptosis correction surgery is primarily done by oculofacial/oculoplastic
surgeons.

I recommend that you meet with a neurologist, an ophthalmologist, or a
neuro ophthalmologist to have the neurologic issues worked out. Also, look back
at your photos and bring the photos with you when you meet your doctors so that
they can look at what you looked like. You need a more detailed examination to
really determine what kind of ptosis you have because this isn’t normal. Your
eyelids are much too low, so you should meet with a doctor for a diagnosis and
then move forward with the appropriate medical or surgical procedure. I hope
that was helpful, I wish you the best of luck, and thank you for your question.

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Chase Lay, MD · Answer

You definitely a have ptosis and you have a deep or retracted superior eyelid sulcus.  That retracted sulcus is the byproduct of loss of attachment of the levator aponeurosis tendon.  You have 2 options for ptosis repair.  External approach and internal approach.  The internal approach would probably be inadequate in your case.  In any case, get an evaluation from a medical ophthalmologist first and then consult experienced eyelid surgeons who performed ptosis surgery regularly.  Your healing time will be about 10-14 days with external suture removal taking 7-9 days.Chase Lay, MD

Are my large eyelids, deep crease, and drooping normal? (Photo)

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Are my large eyelids, deep crease, and drooping normal? (Photo)

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