Puffy thick eyelids, brow lift, and double eyelid surgery
When we look at eyes, we are not only looking at double eyelid folds, we are also looking at the overall “feel” of the eye and the eyelid. More specifically, if the eyelid looks heavy, no amount of natural double eyelid folding will make the eye look refreshed and natural. This heavy look is often mistaken for fat in the upper eyelids. However, the main cause of heaviness of the upper eyelid is thick eyelid skin, brow drooping, and eye positioning deep in the eye socket.
Thick eyelid skin induces puffiness of the eyelids. In these patients, removing fat will not significantly thin out the heavy feel of the eyelid. If one decides to remove the eyelid skin too much, then the distance between the eye and the brow is decreased. For females, this creates a more masculine look as the distance from eyebrows to eyes in men is shorter than than in women. By doing a brow lift, we can thin the heavy upper eyelid skin. If one lifts the brow up with one’s fingers, one would realize that the eyelid has thinned and they actually do not have much fat in the upper eyelid skin. Another important point to make is that the fat in the upper eyelid is there to create a lubricating and crushing effect in eyelid motion. The fat in eyelids is not the same fat as body fat. We will talk about eyelid fat in future blogs.
The other reason for heavy-looking eyelids is brow drooping from excess brow motion. Many people tend to open their eyes with brow elevation. They do this to get their forehead muscles to help them open their eyes. By continually raising one’s brow, the connection of the brow to the underlying deeper structure weakens and the brow drops. The optimal condition is to open one’s eyes without having to raise one’s brow by performing a ptosis surgery at the time of the double eyelid surgery. However, if the brow has drooped, then the solution is to re-raise the brow and stabilize it so that it does not easily droop again with age.
In future blogs, we will discuss deep-set eyes and how this induces eyelids to sag and cause puffy eyelids. We will also discuss various options for brow lifts.