Sagging eyelids not only make the eyes look smaller and more tired, it can cause vision concerns as well. What are the causes and can sagging eyelids be treated? What are the treatments available?

One of the common problems plaguing middle aged to older people is drooping of the eyelids. Eyelid drooping is excess sagging of the upper eyelid. The issue can be further dissected into 2 distinct problems:

1. The edge of the upper eyelid is lower than it should be (ptosis)
2. Presence of excess baggy skin in the upper eyelid (dermatochalasis)

Eyelid drooping is often a combination of both conditions.

While the normal ageing process is the most common cause, there are situations in which ptosis can be present from birth, or can occur as a result of an injury or disease such as neuromuscular disease, stroke, swelling in the eyelid, diabetes or even as a complication of botox treatment.

This can cause disturbance to one’s lifestyle. In mild cases, it may not be aesthetically pleasing as a droopy lid is often associated with feeling tired, sleepy or not paying attention. In severe cases however, it can disturb with function if vision is affected and increased tearing despite feeling of dry eyes may be noticed.

In assessing a droopy eyelid, doctors will often first rule out any medical condition as a cause. If a disease is found, it will be treated. However as most cases of drooping eyelids are due to ageing process, treatment is often focused on reversing or addressing how the ageing process causes a droopy eyelid. Coupled with age-related changes around the eyes, such as excess skin causing wrinkling and bags under the eye, fatty tissue deposits that make the eye look puffy, periorbital hollows worsening dark circles and tear troughs, it can make us look older and more tired than we are.

The choice of treatment of course depends on the severity of the condition and the predominating factor that is causing the ptosis. For mild cases, there are a number of treatment options available; conversely, severe cases typically require surgical intervention.

Treatment options for mild cases include:

1. Eyedrops

Certain eyedrops can stimulate a muscle that elevates the eyelid and cause the muscle to contract, allowing an extra 1-2mm eye opening. It required daily use to maintain the effect. However, it will not work for people who have droopy eyelid due to excess skin, saggy eyebrows or underlying nerve or eye injury.

2. Botox

Injectable products that contain botulinum toxin (such as Botox or Dysport) can be used to help smooth out wrinkles and when applied to the right muscles, can accentuate muscle activity in the opposite direction to help brighten and open up the eyes. For the brow, Botox can also be used to elevate the brows.

3. Fillers

Fillers, when correctly placed, whether in the temples, forehead or brows can help to restore volume in surrounding areas of the eye to lift and open up the brows and lids.

4. Skin tightening devices

Skin tightening devices such as Thermage and Ultherapy again can be used to tighten and lift skin above the eyelids to stimulate collagen production and give a lift to heavy looking lids. These treatments are suitable only for mild cases of ptosis or in cases where there is not too much excess skin.

5. Threadlift

Often, one of the areas that start to droop are the corner of the eyes and the edge of the brows. By performing threadlifts to lift the skin, we can help anchor the skin to reverse the downward sag of the skin on the outer side of the eyes

6. Stitch blepharoplasty

In this procedure, certified doctors/ surgeons perform a procedure in which a surgical stitch is used to elevate the eyelids. This procedure is suitable only for patients who have a mild ptosis not associated with significant laxity of skin in the upper eyelids.

7. Surgical blepharoplasty

This surgery is performed by a facial plastic surgeon, plastic surgeon or ophthalmologist on an outpatient basis, usually under local anaesthetic. The main goal of the surgery is either to elevate the upper eyelid, and/or to remove the excess skin in the upper eyelid. This procedure however is typically associated with downtime and recovery period.

To decide which treatment is best for you, speak to your doctor.