No one wants to look like Sleepy from the Seven Dwarves, but eyelid drooping and sagging is a common concern for many individuals regardless of age, gender, or race.
Overview
The average person blinks over 28,000 times a day. That’s a lot of work for the upper and lower eyelids. It’s no wonder then that the eye is one of the first areas of the body to show signs of aging. This kind of daily wear and tear can lead to undesirable eye appearance and even certain medical conditions.
As eyelids droop and sag, they create an aged aesthetic and can also cause dry eyes and excessive tearing due to the altered function of the eyelid. Eye drops and artificial tears can alleviate some of these side effects but do not address the age-related changes or underlying cause.
Fortunately, numerous cosmetic procedures exist to address these eye concerns. The American Academy of Plastic Surgeons reports that blepharoplasty (eyelid surgery) was one of the top five cosmetic procedures in 2018. Understanding eye anatomy and the classification of eyelid abnormalities can help you make an informed decision on the risks and benefits of pursuing an eyelid procedure.
The Specifics
What Is the Anatomy of the Periorbital Area and Eyelids?
The eye socket is composed of four bones: the frontal bone of the skull (forehead), the zygomatic bone, the maxilla (upper jaw), and two small lacrimal bones near the nose.
The eyeball sits within the eye socket, suspended by small ocular muscles, ligaments, and the optic nerve. It consists of the clear cornea, white sclera, and pigmented iris. The skin, fat, and muscle tissue surrounding the eye are comparatively very thin. Facial muscles provide a range of motion for expression. The lacrimal gland produces tears, and the lacrimal caruncle produces secretions for eyeball lubrication.
The upper and lower eyelids are lined with conjunctival tissue, contain hair follicles for eyelashes, and meet at the medial (nose side) and lateral (ear side) canthi. They are controlled by small eyelid muscles.
What Causes Sagging and Hooded Eyelids?
Sagging and hooded eyelids can be caused by genetics, certain medical conditions, and natural aging. As we age, the already thin skin around the eye continues to degrade due to decreasing collagen and elastin production, leading to muscle weakness and loss of skin structure. These factors cause eyelids and the skin around the eye to droop or sag.
Genetics also plays a major role in eyelid appearance. People of all ethnic groups may experience naturally hooded or sagging eyelids, but individuals of Asian descent are especially predisposed to hooded eyelids or a monolid due to their bone structure and environmental adaptations.
What Are the Main Concerns Related to Sagging and Hooded Eyelids?
There are numerous concerns related to the appearance of both the upper and lower eyelids. The term “eyelid malpositioning” captures abnormalities of the normal six to seven-millimeter space from the eyelid crease to the eyelid margin. Medical terms like entropion (inward turning of the eyelid) and ectropion (outward turning of the eyelid) may contribute to overall malpositioning. Here are the subcategories of hooded and sagging eyelids:
- Eyelid Ptosis: Refers to upper eyelid drooping or sagging caused by improper function of the levator muscle or loss of skin structure due to aging. Eyelid ptosis can affect men, women, and children and may result from trauma.
- Sagging Lower and Upper Eyelids: Refers to drooping or inappropriately oriented eyelids due to aging, medical conditions, genetics, or trauma.
- Upper Eyelid Fold: Also known as a hooded eyelid, it refers to upper eyelids that lack a definitive crease, commonly seen in Asian cultures.
Who May Wish to Correct Their Sagging and Hooded Eyelids?
Individuals with sagging or hooded eyelids that interfere with appearance or vision may consider an eyelid procedure. Those of Asian descent can benefit from specialized procedures for addressing hooded eyelids. Anyone with eyelid malpositioning or abnormalities who has ruled out underlying medical issues can consult a plastic surgeon to determine their best treatment option.
How Can Someone Change the Effects of Sagging and Hooded Eyelids?
Blepharoplasty is the term for surgeries performed on the upper or lower eyelid. Depending on your unique concern, numerous procedures with varying levels of invasiveness exist to alter eyelid anatomy, restoring both appearance and function.
For Eyelid Ptosis:
These procedures aim to correct the position and function of the upper eyelid by altering its connection to the surrounding muscles:
- Eyelid Ptosis Surgery External Approach
- Eyelid Ptosis Surgery Internal Approach
- Eyelid Ptosis Frontalis Sling Fixation
For Eyelid Malposition:
Various procedures correct different types of eyelid malpositioning:
- Eyelid Malposition: Scar Excision and Spacer
- Lateral Canthal Suspension Canthopexy for Lower Eyelid Malposition
- Lateral Tarsal Strip Canthoplasty for Lower Eyelid Malposition
- Lower Eyelid Malposition: Massage and Steroid Injection
- Corner Sutures for Entropion (inward turning of the eyelid)
- Lower Eyelid Blepharoplasty Transconjunctival Approach
- Lower Eyelid Blepharoplasty Transcutaneous Approach
- Upper Eyelid Blepharoplasty
For Upper Eyelid Fold:
These procedures address the lack of a definitive upper eyelid crease, especially in individuals of Asian ancestry:
- Asian Blepharoplasty
- Asian Blepharoplasty Open Incisional Approach
- Asian Blepharoplasty Partial Incisional Suture Technique
The Takeaway
Abnormalities of the eyelids can lead to dissatisfaction with appearance and frustrating symptoms like excessive dryness and tearing. Specific procedures exist to correct genetically correlated concerns like hooded lids, or acquired conditions like sagging/drooping eyelids, entropion, and ectropion. Don’t let upper and lower eyelid abnormalities interfere with your best self. Remember, your eyelids work hard for you—over 28,000 times a day!
