Q: I am in my late 40’s, and recently have had co-workers, friends, and family ask me if I am tired or upset when I am in a fine mood. When I look in the mirror, I see that I do have almost a scowl that is primarily around my eyelids and brows with lines between my brows. What would be the best way to bring back a more rested and happy look?

A: One of the most frequent complaints I hear from patients is having a tired, sad, or angry appearance due to heavy upper eyelids. They are not sure of the cause but recognize that their expression does not reflect how they feel.

We all start to age in our 30’s, and often the first visible sign of aging is in the upper third of our face. To address these signs of facial aging, it is critical to determine the underlying cause of the appearance of heavy eyelids or drooping brows. During a comprehensive consultation with each patient, I discuss the patient’s concerns and evaluate the source of the angry, tired look. This evaluation allows me to recommend the procedure that is the best option to restore the patient’s natural, relaxed look. The best way to demonstrate to the patient whether the issue is related to their eyelids or brows or both is to have them look in a mirror while I review their facial anatomy with them. This is a very important part of the diagnosis because photographs or computer images do not accurately show the effect of facial muscle activity in the eye area.

One of the most frequent causes of heavy upper eyelids is a condition called dermatochalasis or excess skin and soft tissue on the upper eyelids. A surgical procedure called blepharoplasty (eyelid lift) can correct this by removing the excess skin and soft tissue to regain a more youthful, rested appearance around the eyes. To perform a blepharoplasty, I hide the incision in the upper eyelid crease. After removing the excess soft tissue and skin, I meticulously close the incision with sutures that remain in place for 6 days. This method minimizes the chance of visible scarring.

In addition to dermatochalasis, a low or ptotic and droopy eyebrow can also cause the appearance of excess skin weighing down the upper eyelid. During a consultation, I will be able to determine if a low or ptotic brow is a contributing factor and if so, then an endoscopic brow lift is needed to reposition the brow to its correct anatomical position. I perform a brow or forehead lift using the newer endoscopic approach. With the endoscopic technique, I hide all incisions behind the hairline using only 3-4 incisions. The sutures are moved 10 days after surgery.

I perform both of these procedures in our fully accredited in-office procedural suite. After both of these same-day procedures, patients can experience mild swelling and bruising around the eyes. During the preoperative visit, we provide information that will help to minimize the amount of swelling and bruising you may experience. Camouflage makeup can be applied one week after surgery.

My goal is to accurately identify the cause of the heavy, tired look, and to recommend the appropriate procedure to help patients regain a natural, rested, and more youthful appearance. Please call our office to schedule a consultation with me if you would like to discuss your concerns about facial aging.

Dr. Cynthia M. Gregg

Dr. Cynthia M. Gregg discusses the Blepharoplasty (Eyelid Lift) procedure: