Are my large eyelids, deep crease, and drooping normal?
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!
Thank you for your question!
You’re 35-years-old and you submitted a photo and you asked if the large eyelid and
the drooping if that is normal.
And so that photo is very helpful and I can share with you my approach to dealing someone
like yourself when you come to a practice like mine.
I’m a cosmetic oculofacial plastic surgeon.
I specialize in cosmetic surgery of the eyes, face and body and I’m fellowship certified
by the American Society of Oculofacial Plastic Surgery.
I’ve been in practice for over 20 years and basically to begin with, we can define
your condition and your condition is referred to as ptosis.
Ptosis means drooping and your situation its eyelid ptosis.
Now the question that comes to mind first is this new onset or is this a more recent
onset or is this something you’ve always had and recently has gotten worse.
Now the reason why we want to know this is if your eyes are perfectly wide open and they
were fine for your whole life and then you recently had this sudden onset, well, that
requires neurologic workup to look for possible neurologic causes.
If your eyes were always relatively low and you can look back at your old photos and that
the eyelids have drooped more recently, well that can be congenital ptosis which has gotten
a little bit worse.
That means that you’re born with the ptosis and it got a little bit worse.
Now there is also acquired ptosis and somebody who can look like this where the eyelid crease
is very high and there’s a large lid but typically that is referred to as involutional
ptosis and it usually more age-related and age-related meaning someone over or in their
late 50s and older.
And very often, it’s related to thinning of a tendon called levator aponeurosis that
gets thinner overtime and the eyelid droops but in a 35-year-old, what is more common
if it’s acquired is sometimes in associated with contact lens wear.
A lot of times people wear contact lenses especially those who wear hard lenses can
have thinning of that aponeurosis or tendon.
So with the assumption after you’ve had this workup for the neurologic workup is clear
and is basically a muscle-related ptosis, we do something called levator advancement
surgery.
That means taking the muscle that lifts the eyelid.
The word levator is like the world elevator to lift and we move it forward and correct
the position that it should be in.
A lot of times it’s thin or slipped back or combination of both.
Now during this surgery, we actually have you awake for this very important part because
the muscle is very sensitive.
And we have you open your eyes and look at you from the front and sit you up and want
to make sure that the eyelid height, shape and contour is desirable and is symmetric.
It’s remarkably complex and is elegant in the same way that it’s just a lot of small
factors that have to be balanced in order to get a nice shape.
This is most of the domain of oculofacial or oculoplastic surgeons.
Just to make sure that you have to rule out neurologic causes just to get that out of
the way.
I recommend that you meet with a neurologist, an ophthalmologist or a neuro ophthalmologist
to have at least the neurologic issues worked out.
Look back at your photos, bring the photos with you when you meet your doctors so that
they can look at what you looked like a year ago, 5 years ago, 10 years ago just to see
how much of a change there is.
You need a more detailed examination to really determine what kind of ptosis you have.
Certainly, this isn’t normal.
Your eyelids are much too low and you should meet with a doctor to evaluate what your diagnosis
is and to determine what your diagnosis is and then move forward with the appropriate
medical or surgical as is appropriate for the diagnosis.
So I hope that was helpful, I wish you the best of luck and thank you for your question!