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Posted: 2:36 p.m. Sunday, September 01, 2019

By Anita Mandal, M.D.

Question: I had an upper eyelid lift 6 years ago, but still had loose skin afterwards. After revision surgery to correct this, there was still extra skin. A different surgeon advised a brow lift, stating that my sagging brows made my eyelids look heavy. A 3rd plastic surgeon said that the lid heaviness was due to extra skin left on the outer part of my upper lid that was not properly removed. I think he nailed it! I’ve had my lids done twice. Is there an upper limit to how many times one can have eyelid surgery?

Answer:The key lies in your surgeon’s ability to identify the correct cause of upper eyelid heaviness. These causes include excess loose skin of the upper eyelids, poor elasticity of the upper eyelid skin and/or a sagging brow that gives the illusion of upper eyelid heaviness. Identifying the correct cause impacts choice of treatment.

A most common cause of persistent heaviness after upper eyelid surgery is failure to make the proper incision. A careful examination may reveal that most of the upper eyelid skin has been properly removed except for the area near the outer eyelid. It is important that the outer aspect of the eyelid incision extend upwards and outward to avoid a droopy appearance to the eyelid after surgery.

Another cause is too little removal of of the entire upper eyelid skin. Your surgeon should know the balance between removing too much skin, resulting in an overly tight and pulled upper eyelid vs. not removing enough. In patients with dry eye syndrome or a thyroid condition, it is prudent to have a conservative upper eyelid skin removal to avoid worsening of the original condition. In such cases, your surgeon should discuss realistic expectations before surgery.

Your surgeon should also recognize when a heavy upper lid is due to a sagging brow rather than to excess upper lid skin. The treatment for the former is typically a brow lift. In milder cases, this can sometimes be achieved with Botox and injectable fillers. In others, a surgical brow lift may be needed. If upper eyelid skin is removed when a brow lift is, in fact, needed, one may not be happy with the results. Seeking a skilled specialist who can make the proper diagnosis is key.

Finally, a cause overlooked by some surgeons relates to poor eyelid skin elasticity. As facial aging progresses, not only does the upper eyelid skin become loose but it also becomes inelastic. When it is very inelastic, performing a standard upper eyelid lift could result in a variety of cosmetic as well as functional complications.

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Dr. Anita Mandal is a double Board Certified Facial Plastic Surgeon practicing since 1998. She exclusively specializes in facial rejuvenation and non-invasive body contouring. In addition to being on the medical staff at Jupiter Medical Center, her offices house both surgical and laser suites. Dr. Mandal is committed to giving her patients the most natural looking results.

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