Many patients who come in for double eyelid surgery require simultaneous eyelid ptosis surgery as well. Patients often think they do not have ptosis when they look at themselves in the mirror and compare that to ptosis images they find on the internet. What they may not realize is that when they look at themselves in the mirror, they strengthen their eyelid elevating muscle, making their eyes look more alert than they actually are. Similarly, when they look at photos of themselves where they are posing for the camera including selfie photos, their eyes often do not show ptosis because they tend to strengthen their eyelids. The best way to determine whether one has eyelid ptosis is to look at candid photos that others have taken of them as these pictures will capture the normal resting state of their eyes.
Double eyelid surgery for patients with ptosis or borderline ptosis will induce eyelid ptosis due to the weight of the skin and soft tissue being attached to the eye elevating muscle. Therefore, the eye elevating muscle (levator muscle) has to carry that extra weight. This is why many patients that undergo double eyelid surgery do not look refreshed and their eyes do not appear bigger post-surgery.
A way to test whether one has eyelid ptosis is to try putting tape or glue on one’s eyelid to create a double eyelid fold and see how their eyes look with a temporary fold. Patients with moderate to severe ptosis will not be able to form a double eyelid fold with tape or glue or if they are able to, they tend to have a sleepy or harsh appearance. Patients with mild or borderline ptosis will often get a fold with the temporary tape or glue because the eyelid elevating muscle is strong enough not to show signs of weakness. However, please keep in mind that neither tape nor glue is actually connecting to the eye elevating muscle. Instead, it is attaching to the skin superficially or externally so the weight burden to the underlying eyelid elevating muscle does not actually occur. Therefore, in order to have beautiful double eyelid surgery results which include brighter looking eyes and naturally moving double eyelid folds, many patients require eyelid ptosis surgery simultaneously during double eyelid surgery.