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When patients come to see us for heaviness or sagging of their upper eyelids there are two possible reasons.
First, many people simply have too much extra upper eyelid skin. Age, genetics, sun exposure, and years of
blinking cause the skin of the upper eyelid to relax. The result ranges from a very subtle extra fold of upper
lid skin that may be your only indication of aging, to so much extra skin that it actually sits on your eyelashes,
causing heaviness, fatigue, and some obstruction of your vision.
The treatment for excess upper eyelid skin is relatively straightforward. An incision is made in the crease where
you open and close your eyes. The extra skin is removed and the incision is sutured closed. Because the incision
lies in the crease created by the eye as it opens and closes, the scar, once it has healed, is virtually invisible.
The second reason for upper eyelid heaviness is that one of the earliest signs of aging is that the eyebrows
start to come down. As they do, they push the skin just underneath the brows onto the upper eyelids, causing
heaviness and fullness. The treatment for this is a Browlift (now performed quickly using small incisions and
even smaller endoscopes).
Often the most difficult question when seeing a patient with heavy upper eyelids is deciding whether their appearance
is caused by too much extra upper eyelid skin, brow skin that has fallen and is crowding the upper eyelids, or a
combination of both. Most of the patients that I see for a second opinion who have had upper eyelid surgery and are
unhappy with their results, actually obtained a good result from the upper lid surgery, but because they still have
heavy brow skin crowding their upper eyelids do not look nearly as youthful as they thought they would following
the surgery. A quick endoscopic, or small incision Browlift often solves this problem.
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