Upper Eyelid Sagging: Brow Lift or Blepharoplasty? | James H. Rosing, M.D.

Patient Question:  What is upper eyelid ptosis?  Do I need a brow procedure or upper eyelid procedure to correct sagging upper eyelid skin?    

Dr. Rosing:

Eyelid ptosis is defined as attenuation of the levator aponeurosis which is connected to the muscle that suspends your upper eyelids in the natural position above the pupil arcing along the upper iris (colored part of the eye).  There are other causes, though thinning of the levator is the most common.  The most common cause of upper eyelid ptosis is senile ptosis which is a normal part of aging.  The appearance of someone with eyelid ptosis shows as one eyelid lower than the other.  Treatment is usually performed by an ophthalmologist.

Dermatochalasis refers to skin excess that accumulates above the upper eyelid crease or below the lower lid margin.  This is treated by plastic surgeons and is called blepharoplasty.  Because dermatochalasis can occur in the upper and lower eyelids, patients may be candidates for an upper blepharoplasty, lower blepharoplasty or both.

Brow ptosis is when there is descent of the eyebrows towards the upper orbital rim and sometimes falling below the lateral part of the orbital rim.  Of note, brow ptosis can contribute to dermatochalasis.

Board certified plastic surgeons with oculoplastic training as well as oculoplastic ophthalmologists can easily differentiate between these three conditions and therefore provide the appropriate treatment.