Sleepy eyes or a chronically sagging eyelid can give the impression that you are sleepy, aloof or disinterested. Drooping, sagging and bagginess of the eyelids, is a symptom of aging that can have a subtle, but significant impact on your overall appearance. But there is something you can do about eyelid droop. Eyelid droop is reversible and with Dr. Korman’s help, you can achieve a refreshed, awake and vibrant appearance that accurately reflects how you feel on the inside. Contact any one of our offices in Mountain View, Carmel or San Jose to schedule a consultation and learn how sleepy-looking eyelids and a tired appearance can become a thing of the past. Eyelid Ptosis Ptosis describes drooping or sagging of the upper eyelid. It is vital to distinguish between having extra skin that hangs over the eyelid margin, and true eyelid ptosis where there is decreased visibility of the iris (colored portion) over the pupil. Both conditions can become more exaggerated or worse when the patient is tired or awake for long periods, causing the forehead and eyelid muscles to tire. In some instances of ptosis, the condition may be “lazy eye” where at least one of the eyelids are almost completely shut at all times. The causes of eyelid ptosis range from muscular damage, genetics, or aging. Those who are experiencing eyelid ptosis may also go on to develop other eye impairments such as astigmatism. The condition can present many issues for quality of life, including but not limited to impaired vision and loss of self-confidence. Activities such as driving or reading can become challenging or completely out of reach. Eyelid ptosis is the result of the weakening of the levator muscle in the eyelid. Weakening and stretching of the levator muscle can be caused by aging or wearing rigid contact lenses for long periods of time. The clearest indication of ptosis is when one or both of the upper eyelids appear to sit directly on the pupil with no color of the iris showing. Less obvious signs are when one of the eyelid creases is not even with the other. Those with ptosis may unconsciously tip their posture, raise the eyebrows or lift their heads to compensate for the loss of vision. Over time, this can cause other secondary health problems, especially for children with ptosis. In adults, the development of ptosis can occur when muscles of the eyelid become separated or stretched away from the eyelid, which may be a result of injury or aging. When aging is the main cause of eyelid ptosis, both the skin laxity and muscle excursion are involved. Skin laxity develops over time and is a major culprit in aging symptoms such as deep creases, wrinkles, and sagging. Skin laxity is when skin loses its natural, youthful elastic quality. Loss of elasticity means your skin’s ability to resist the effects of gravity and bounce back from stretching is diminished. Overexposure to the sun, stress, and your genetics are known contributors to skin laxity. If skin laxity is the cause of the eyelid droop, this can be corrected with a blepharoplasty ( eye tuck). If the eyelid droop is caused by eyelid ptosis, shortening of the leavtor muscle is used to treat the ptosis. Blepharoplasty A blepharoplasty, or eyelid surgery, addresses the functional and cosmetic issues caused by eyelid droop by restoring the normal function of the eyelids. A blepharoplasty may also be performed to address aging symptoms of the lower eyelids. The treatment is a surgical procedure that can excise drooping eyelid skin to achieve a refreshed, awakened appearance and improve vision. Eyelid droop is often a matter of skin elasticity, but it also may be the result of stretching out of the levator muscle which elevates the eyelid. As many patients may already be aware, skin elasticity, or the ability of skin to resist the effects of gravity, is one of the key issues of aging. The eyelids are one of the first areas to show signs of aging and this is because the eyelids are made of especially thin skin. Since the upper eyelids are constantly at odds with the force of gravity, drooping develops as elasticity diminishes. Blepharoplasty is a highly effective treatment for skin laxity. The procedure is performed under local anesthesia and an incision is made along the length of the natural skin crease. Next a strip of muscle (orbicularis oculi) is removed and excess fat is removed as well. The incision is closed with a running weave suture which is removed in 3-4 days. Once your skin begins to lose elasticity, it is very difficult to reverse on your own or with any kind of over-the-counter treatments. Sun protection and moisturizers are important for preventing further effects of aging on the skin, but can only do so much. Drooping eyelids cannot be prevented once symptoms begin to develop. If eyelid ptosis is present, caused by the stretching of the levator muscle, the procedure involves tightening the levator muscle. Eyelid ptosis can occur when the levator muscle becomes stretched or detached from the eyelid margin. Benefits of Blepharoplasty and treating Eyelid Ptosis Treating a droopy eyelid with a blepharoplasty is safe, effective and produces natural-looking rejuvenation. There are a number of benefits to a blepharoplasty including: Long-Term Results – Since the excess skin causing vision blockage is surgically removed, the results of a blepharoplasty are extremely long-term. Local Anesthesia – Dr. Korman practices only the most modern blepharoplasty techniques. The treatment is performed under local anesthesia, which is a safer alternative to general anesthesia. Outpatient Procedure – A blepharoplasty is an outpatient procedure, meaning the patient is back on their feet and able to return to light, daily activity on the same day as the treatment without the need for a hospital stay. Restored Vision – The blepharoplasty removes sagging skin that blocks vision or may involve tightening of the levator muscle in the eyelid to restore normal eyelid function. The double eyelid lift creates a crease in the upper eyelid for those who do not naturally possess one. Two sections are created by dividing the skin of the upper eyelid. This treatment is a popular option for patients of East Asian descent. Candidates for the Eyelid Lift Ideal candidates for an eyelid lift are in good overall health but are experiencing eyelid droop due to aging, weakened levator muscles, or a congenital defect. Men and women can benefit from the blepharoplasty. It is best if patients are non-smokers and have realistic expectations of treatment. Eyelid ptosis of one or both eyes may be treated to achieve a balanced and even eyelid appearance. Consultation Candidates you have any questions about eyelid ptosis and the blepharoplasty can schedule a consultation with Dr. Korman. Dr. Korman and the experienced staff at Korman Plastic Surgery can help you determine which treatment options will be fit your goals. Your consultation is a personalized meeting where your eyelid ptosis can be assessed and an appropriate treatment customized to your specific presenting issues. Together with Dr. Korman, you will be able to discuss the details of the blepharoplasty or any alternative treatments that may better fit your case. Preparation To ensure the best possible experience for those undergoing a blepharoplasty, we recommend the following pretreatment steps: Arrange transportation to and from the treatment center as you will be unable to drive home. Dr. Korman’s office can arrange a ride for you if you prefer. Avoid wearing clothing that must be pulled over the head because you will want to avoid the risk of touching your eyes. Anti-inflammatory medication and herbal supplements must be discussed with Dr. Korman and typically will have to be stopped at least two weeks before the procedure date to avoid complications. Blepharoplasty Procedure The blepharoplasty procedure is performed according to the specifics of how eyelid ptosis is presenting in the patient. Generally, the treatment takes approximately one hour and is performed on an outpatient basis. The main phases of the procedure are anesthesia, incision, closure, and recovery. Once the eyelids are prepared and cleaned, local anesthesia not only ensures the patient is comfortable but also, this type of anesthesia reduces risk. Sutures are used to tighten the weakened levator muscle. Additionally, excess fat and skin tissue may be removed at this time. The incision is closed with extremely fine sutures and topical, lubricating ointments are applied. Results and Recovery At the end of treatment, you will be taken to a recovery area to receive cold compresses and your aftercare instructions. Gauze and surgical tape may be applied and pain medication may be prescribed for your recovery. Sutures are typically removed three to four days after treatment during a follow-up appointment. Bruising and swelling around the eyes are common for the first week of recovery but will subside. Taking herbal supplements such as arnica montana, bromelain ( pineapple enzyme), and bioflavanoids can reduce the postoperative bruising. We recommend additional sun production around the eyes such as sunglasses. Cost Treating eyelid ptosis is a highly tailored and detailed treatment where each procedure is customized to the anatomy of the individual. The cost of a blepharoplasty will reflect the different techniques used. At the end of the consultation, you will receive a detailed breakdown of the cost of treatment.