Drooping Eyelids - Find a Specialist and Get Information

Drooping eyelids have various causes. For example, they occur naturally as we age. As part of the aging process, the skin’s elasticity gradually decreases, including in the eyelids. The eyelids then succumb to the effects of gravity and begin to droop more and more. However, drooping eyelids only become medically significant when, for example, eyelashes cause irritation in the eye or the person’s field of vision is restricted by the drooping eyelid.

In addition, drooping eyelids can result from inflammatory conditions, as well as from lack of sleep, high nicotine and/or alcohol consumption, and fluid retention in the skin (edema).

Drooping eyelids are caused by excess skin on the upper eyelid @ FotoHelin / AdobeStock

Warning: If a drooping eyelid develops very suddenly, it could even be a sign of a stroke. Those affected often also experience difficulty speaking, signs of paralysis, or a drooping corner of the mouth. Since a stroke is a medical emergency, you should call emergency services immediately in such a situation.

From a medical perspective, drooping eyelids are a purely cosmetic issue in the majority of cases. However, drooping eyelids are often associated with fatigue and exhaustion and can thus become a real psychological burden for those affected. Anyone bothered by drooping eyelids can have them treated or lifted by a cosmetic surgeon at their own expense.

The situation is different if drooping eyelids cause medically significant complications. These include, for example, eye infections caused by eyelashes rubbing against the eye. They also include eyelid malpositions and a restricted field of vision caused by the drooping eyelid.

Tip: In any case, it is advisable to submit a request for coverage to your health insurance provider before undergoing drooping eyelid surgery. The provider will then assess whether there is a medical indication and whether the procedure is therefore necessary and should be covered. There are, in fact, other treatment options besides surgery that may also be worth considering. These alternatives to droopy eyelid surgery include, among others:

• Botox injections,
• laser treatment,
• ultrasound therapy, or 
• Plasma Pen therapy.

Blepharoplasty, also known as eyelid lift surgery, can generally be performed on both the upper and lower eyelids. However, the upper eyelid is most commonly affected. Since the procedure is purely cosmetic in many cases, eyelid lift surgery for drooping eyelids is generally not covered by health insurance. There is one exception: if the drooping eyelids are so severe that they restrict the field of vision. In such cases, the surgery is medically necessary, and the procedure is generally covered.

The procedure takes about 20 minutes per side @ thomsond /AdobeStock

The surgery is performed by a drooping eyelid specialist as an outpatient procedure under local anesthesia. The surgeon marks the incision lines in advance. The incision lines follow the natural creases of the eye as closely as possible so that any scars are less noticeable later on.

During a droopy eyelid lift (blepharoplasty), excess eyelid skin is removed; portions of the fatty tissue may be removed or repositioned; and finally, the surgeon closes the eyelid. Eyelid surgery is performed either with a scalpel or a laser, depending on the surgeon’s expertise.

Although laser surgery may seem more advanced and patients would likely prefer this procedure, wound healing appears to take longer compared to traditional surgery with a scalpel. Laser surgery for droopy eyelid correction generates heat, which causes blood vessels to clot more quickly—a factor that is very likely a major reason for the slightly slower wound healing following laser surgery. At the same time, however, this also results in significantly less bleeding from the surgical wound. 

The risks of surgery to correct drooping eyelids are the same regardless of whether the procedure is cosmetic or medically necessary. As with all surgical procedures, the main risks are bleeding and infection. Some examples of common risks and complications of eyelid lift surgery:

• Bleeding,
• soft tissue damage,
• sensory disturbances,
• double vision,
• visual disturbances, such as a blurred field of vision,
• infections and abscesses,
• conjunctivitis, 
• Scarring, keloids, or 
• disorders of tear flow.

Wound healing after an eyelid lift typically takes up to 14 days. During this time, care should be taken not to touch the wound area too much. In the first three days after the procedure, patients should also apply cold compresses to the wound. Exercise and heavy physical labor are also off-limits during the first few days after the procedure.

Drooping eyelids and their correction should be entrusted to experienced specialists in the fields of ophthalmology, ophthalmic surgery, and aesthetic or cosmetic surgery—depending on whether there is a medical indication for eyelid lift surgery or whether it is purely a cosmetic procedure. Here are some recommendations for drooping eyelid specialists and suitable surgical centers.