Signs you might need eyelid surgery
The findings that indicate blepharoplasty, including the functional ones patients often do not realise are related to their eyelids.
Some of the reasons for eyelid surgery are cosmetic and some are functional, and patients frequently arrive having noticed the functional ones without connecting them to their eyelids at all.
1. Excess skin on the upper lids
Skin loses elasticity and begins to fold over the lid, obscuring the natural crease. It becomes progressively harder to apply make-up to a lid that is no longer visible.
2. Difficulty seeing past the lid
This is a functional problem, not a cosmetic one. A drooping fold encroaches on the upper and peripheral field of vision and interferes with reading and driving.
The clearest sign is not the vision itself but the compensation: if you find yourself raising your eyebrows to see properly, and doing so without thinking about it, that is worth having assessed.
3. Persistent bags below the eyes
Where these are caused by protruding fat pads rather than fluid, they do not respond to rest, to skincare or to temporary measures, because there is nothing temporary about them. The operation removes or repositions the fat.
4. Ptosis of the lid
Ptosis is drooping caused by weakness of the muscle that lifts the lid, and it is a different problem from excess skin — although the two look similar and often coexist. The distinction matters, because removing skin does not correct a weakened levator muscle, and correcting the muscle does not remove redundant skin. Examination distinguishes them.
5. A permanently tired appearance
Where sagging skin and shadowing produce an expression that does not match how you feel, and it has not improved with anything non-surgical.
6. Difficulty holding the eyes open comfortably
Excess skin and muscle laxity make the lids feel heavy. The result is eye strain, and sometimes headache from the constant frontalis activity used to compensate.
7. Irritation where skin meets skin
Where a fold of loose skin rests on the lid margin, it can cause redness, irritation and occasionally infection. Where topical measures have not resolved it, the underlying redundancy is the problem.
8. Non-surgical treatment has stopped working
Botulinum toxin and fillers do useful work on dynamic lines and on volume. They do not remove excess skin. Where the complaint has become one of skin rather than of lines, continuing with injectables is postponing rather than treating.
Who is a suitable candidate
Excess skin of the upper or lower lids, or vision affected by drooping; general health adequate for an elective operation and no significant untreated eye condition; realistic expectations; and a wish for a durable change rather than a temporary one.
What the consultation covers
Examination of the lids, an assessment of which of the above findings are present, whether the problem is skin, fat, muscle or a combination, and what each can be expected to achieve — together with the recovery and the risks.
The procedure this relates to
Surgery to the upper eyelid, the lower eyelid or both, removing or repositioning skin, fat and muscle. It is done to soften the changes that come with age, and where drooping upper lids obstruct the field of vision.
Before you act on this
Everything here is general. What applies to you depends on your anatomy, your history and what you are trying to achieve, and none of that can be assessed from a page. If a question here is yours, bring it to a consultation.