If your upper eyelids look heavy, tired or uneven, you may assume the cause is simply excess skin. Sometimes it is. But droopy eyelids can also be caused by ptosis, where the eyelid itself sits too low, and many people have both. In Singapore, where long hours at a screen are common, tired-looking eyes are easily blamed on lifestyle, and the real cause can go unexamined. Knowing which condition you have matters, because they are treated differently.
What is Dermatochalasis?
Dermatochalasis is the medical term for loose, excess eyelid skin. Ageing, year-round UV exposure in our tropical climate and the gradual loss of collagen and elasticity cause the skin to stretch and fold over the lash line. It is usually addressed with upper blepharoplasty, which removes surplus skin (and fat, where needed).
What is ptosis?
Ptosis means the upper eyelid margin sits lower than it should. In adults, it commonly develops when the eyelid’s lifting muscle or its tendon-like attachment (the levator aponeurosis) stretches, weakens or detaches. Long-term contact lens wear, which is common where myopia is so widespread, habitual eye rubbing (including from allergies) and previous eye surgery can contribute. Treatment, known as ptosis repair, tightens or repositions the lifting mechanism to restore eyelid height.
Why the two are so easily confused
Heavy skin can weigh the eyelid down and make the eye look smaller, creating an appearance of ptosis known as pseudoptosis. The reverse also happens: genuine ptosis can be hidden behind folds of skin. Researchers have highlighted undiagnosed ptosis as one cause of unsatisfactory results after upper eyelid surgery, and in many older adults the two conditions occur together.
Signs to raise with your doctor
- More suggestive of ptosis: the eyelid edge covers part of your pupil, one eye looks smaller than the other, you lift your eyebrows or tilt your head back to see, or your eyes feel heavier as the day goes on.
- More suggestive of excess skin: a fold of skin rests on or over your lashes, your eyelid crease looks crowded or hidden, or the top of your vision feels blocked.
How the difference is confirmed
The only reliable way is an in-person assessment by an oculoplastic surgeon. This typically includes measuring eyelid height in relation to the pupil, assessing the strength of the lifting muscle, and evaluating your skin quality and brow position. Brow position matters because many people lift their brows without realising, to compensate for a low eyelid, and the brow may settle once the eyelid is corrected (Lee et al., 2014).
Treatment depends on the cause
- Excess skin only: upper blepharoplasty.
- Ptosis only: ptosis repair, with the technique chosen according to severity.
- Both: the two are often planned together, sometimes with a brow procedure (Lee et al., 2020).
Double eyelid surgery is a common request in Singapore, and in East Asia it is often combined with ptosis correction. A sleepy look or a crease that will not form can therefore have more than one cause.
