Blepharoplasty

Dermatochalasis: the heavy lid

A tired look, or a feeling that the eyelids are heavy, is often caused by dermatochalasis: drooping of the skin and fatty tissue within the eyelid fold. Ageing contributes to it, and hereditary features such as naturally hooded folds can produce the same appearance decades earlier.

As the fold drapes down over the edge of the lid, it can reach the lashes and in some cases turn them inward. At that point the complaint stops being purely cosmetic and starts interfering with the upper field of vision.

What the procedure does

The surgical procedure that addresses fullness of the lid fold is blepharoplasty. The excess fold of skin is removed along with some of the subcutaneous tissue.

The lid crease is an important feature of the eyelid and can be moved or accentuated during surgery. A crease may be high or low, distinct or indistinct, single or multiple. Contouring of the fat pads, positioning of the lid crease and orientation of the lashes matter as much as how much skin comes off. Refining contour and crease is what produces a rested appearance rather than merely a tighter one.

Preferences differ and should be discussed before surgery rather than after. Some patients want a more sculpted lid, others prefer to retain a fuller look that suits their face. A natural result, in either direction, is the goal worth asking for.

What to expect

It is wise to allow at least a week of healing before returning to an active routine. Swelling and bruising are normal, and sutures can feel irritating for the first few days. Antibiotic ointment on the incisions helps sutures dissolve, prevents infection and soothes inflammation, though it can blur vision temporarily when it reaches the tear film.

Most patients report a tight feeling in the lids for a few weeks, which is expected and usually resolves by around eight weeks. Healing varies between individuals, but many people are presentable by the start of the second week.

Follow-up matters twice: early, to remove sutures, and later, to assess the result once swelling has settled and the crease incision has faded. Judging an eyelid result at two weeks is judging swelling, not surgery.