When an individual presents with “droopy (upper) eyelids”, there is frequently more to take into consideration than the eyelids themselves. Is it excess eyelid skin alone? Have the eyebrows dropped? Is there an actual mechanical inability of the eyelids to fully open the eyes? Multiple factors can contribute to the appearance of the eyelid. The peri-orbital region (everything around the eyes, not including the eyeball itself) works in an incredibly dynamic and inter-dependent fashion. As we age, loose skin accumulates over the upper eyelids which, when severe, can droop to the extent of intruding on and occluding vision. This effect is often compounded (especially on the outer region of the eyelid) by age-related descent or drop of the eyebrows.

A common phenomenon, known as “compensated brow ptosis”, occurs when vision begins to be obscured by droopy eyelid skin, and the body actively tries to lift up this curtain of skin to improve vision by over contracting the muscles which lift up the eyebrows and eyelids. This can explain the deep forehead frown lines often seen concurrently in patients with droopy eyelids! It is crucial in such cases to elucidate which factor forms the major contribution to the appearance – the eyelids or the eyebrows? Both may be held accountable. Treatment is naturally geared toward correcting the major causal factor. The patient however may be warned that removing excess upper eyelid skin or undergoing a brow lift alone may not fully correct the problem, and that an adjunctive procedure to correct the minor causal factor may be required later down the tract.