Looking for Eyelid Surgery?

Dr. Kahana offers a customized approach to various eyelid surgeries. Please continue reading below to learn more about the eyelid surgery options available to you.

Droopy Upper Eyelids

Droopy eyelids can make it difficult to keep your eyes open, giving you a sleepy appearance and potentially interfering with vision. For good vision, the margin of the upper eyelid – the location of the lashes – should easily clear the pupil (dark circle in the middle of the iris). Peripheral vision is most affected by droopy eyelids, making it harder, even dangerous, to drive. When working on a computer, droopy heavy eyelids can make staring at the screen very challenging. And when reading, droopy eyelids may drop further to cover part of the pupil, making reading difficult.

There are three causes of droopy eyelids: (1) weakness of the muscle that opens the eyelid (levator palpebrae superioris), (2) excess eyelid skin, and (3) mechanical brow drooping. When the drooping is caused by weakness of the levator muscle, it is referred to as “true ptosis” (the first ‘p’ of ‘ptosis’ is silent). When the brows are very droopy causing mechanical brow ptosis, they press on the upper eyelid skin and cause it to bunch up, giving the appearance of even more excess eyelid skin (dermatochalasis).

A customized approach to droopy upper eyelids requires a complete eye exam, including assessment of eyelid muscle function as well as skin height and brow position. The goals of treatment depend on whether your primary concern is functional (i.e. vision is affected) or cosmetic. Of course, ALL eyelid surgery must be performed aesthetically, and Dr. Kahana is an expert in optimizing the appearance as well as the function of upper eyelids, with a focus on brow-eyelid crowding, eyelid crease, eyelid platform, and lash position.

In older patients and patients with laxity of the eyelids, address the laxity is important to do first. The upper eyelids are like windshield wipers: if they don’t fit nicely over the surface of the eye, every blink leaves “streaks” that can lead to irritation, tearing and blurry vision. Furthermore, the eyelid opening muscle – the levator – pulls against the ligaments of the eyelid, and if these are lax, the muscle is less effective. Repair involves tightening the ligaments and tendons of the eyelids through tiny incisions in the corners of the eyes.

Certain medical conditions, particularly thyroid eye disease, can cause the upper eyelids to retract, giving the eyes a “buggy” and “bulgy” appearance, while causing exposure, irritation, tearing and redness. Repair involves releasing the tight tissues that cause the eyelids to retract. This is usually done from the underside of the eyelid, without any skin incision.

The lower eyelids are not nearly as mobile as the upper eyelid, but they are more susceptible to the effects of gravity. There are many conditions that affect the lower eyelids:

  1. Ectropion: the eyelid is turned outward. This is usually caused by laxity of the ligaments and tendons that keep the lid in good position.
  2. Entropion: the eyelid is turned inward, causing the lashes to rub against the cornea and conjunctiva, causing pain, irritation, redness and discharge.
  3. Baggy lower eyelids: with age and certain genetic predispositions, orbital fat can herniate, giving the lower eyelids a “baggy” appearance. This often also involves descent of the cheeks, hollowing of the junction between the cheek and lower eyelid, and lateral laxity of the eyelid.
  4. Lower eyelid retraction: Retraction of the lower lids can be cause by many factors, including laxity, mechanical/gravitational pull, loss of tissue (from prior surgery or trauma), and medical conditions such as thyroid eye disease.

Repair of lower eyelid malposition is among the more complex of oculoplastic procedures. The goals are (1) to restore eyelid position in order to protect the eye, and (2) improve the appearance of the eyelid. Cosmetic lower eyelid surgery frequently involves removing or repositioning herniated orbital fat and tightening the muscles and ligaments of the lower eyelid. In addition, elevation of the cheeks can improve appearance by smoothing the transition between the eyelid and cheek. Excision of excess skin is usually not needed, and any excision must be performed carefully and conservatively in order to avoid complications such as lower eyelid retraction. As the ‘go-to’ surgeon for correcting eyelid surgery complications in patients from throughout the Midwest, Dr. Kahana is particularly experienced with avoiding complications.

This patient presented with bilateral upper eyelid ptosis. She underwent small incision external levator muscle repair. Post op is 2 months.

This patient presented with left upper eyelid ptosis and a history of trauma. She underwent left upper eyelid external levator muscle repair. Post op is at 3 weeks.

This patient presented with left lower eyelid entropion, causing the lashes to rub the cornea. He underwent entropion repair surgery. Post op is 2 weeks.

This patient presented with thyroid eye disease and left upper eyelid retraction. She underwent left upper eyelid retraction repair via a posterior approach (no skin incision). Post op is at 6 months.