By: Richard O. Gregory, MD
The question of “hooded eyes” was recently posed to an Internet site that I contribute. Several points are pertinent to the plastic surgery discussion of this eyelid/brow deformity. Indeed, brow ptosis and eyelid ptosis are two completely distinct disorders addressed by different procedures. Sometimes the patient will have both. Many times, however, the concern is over the droopy eyebrow which crowds the upper lid thereby reducing the upper eyelid area. This is particularly noticed in women who wear makeup.
Brow ptosis or drooping brow can be due to a variety of factors including the anatomy of the forehead and orbit, aging which stretches the skin and supporting ligaments, as well as gravity and other factors. There are patients who inherit a tendency to droopy brows. Brow lift addresses this in a variety of ways. Botox can also be used to improve or correct this disorder on a temporary basis.
Eyelid ptosis, however, is due to a loss of lifting power of the upper eyelid muscle (levator muscle) which originates from the roof of the eye socket and attaches to the eyelid near the crease. This can be due to a variety of conditions including congenital, medical disorders, trauma, and even aging to a certain extent. Although usually bilateral eyelid ptosis if unilateral can be cause for concern.
The correction for the brow ptosis is completely different from the eyelid ptosis. A blepharoplasty combined with a levator shortening can improve or correct the eyelid ptosis. There are several different methods for achieving this, but most involve an incision with a shortening of the levator muscle. Brow ptosis, however, is corrected with a brow lift, again for which there are several procedures. Your condition should be discussed with your plastic surgeon who might recommend blepharoplasty or brow lift or possibly even both. Many times this is combined with a facelift or other cosmetic procedure on the face. Droopy brows and eyelid sagging are a specialty at the Institute of Aesthetic Surgery.