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What is causing fullness in my upper eyelids? The presence of fullness in the
upper eyelids can have an impact on your appearance as well as your vision full
upper eyelids can have several causes solutions to address these causes often
required specialized procedures not usually performed by general plastic or
cosmetic surgeons I’m Dr. Amiya Prasad I’m a
Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years as an oculoplastic surgeon I’ve specialized in frequently
requested cosmetic eyelid surgeries such as for hooded eyes and under-eye bags as
well as specialized procedures not typically performed by general plastic
or cosmetic surgeons such as eyelid ptosis surgery surgery for lacrimal
gland prolapse and surgery to correct the effects of Bell’s palsy and thyroid
eye disease the most common cause of fullness of the upper eyelids is the
presence of extra skin and fat eyelid skin can stretch with aging resulting in
upper eyelid fullness which is referred to as dermatochalasis fact that is
normally situated in compartments around the eyes can push forward and create
local areas of puffiness as well as fullness which extends across the full
length of the upper eyelid fullness in the upper eyelids can also be associated
with drooping of the eyebrows in order to address fullness on the upper eyelids
caused by excess skin as well as fat I routinely perform a procedure called
upper eyelid blepharoplasty upper eyelid blepharoplasty
is a highly sought after procedure with great potential to improve the
appearance of your eyes unfortunately many doctors who perform upper eyelid
blepharoplasty have limited knowledge and experience within Anatomy around the
eyes this can lead to a higher risk for complications such as having too much
skin removed resulting in eye exposure as well as undesirable scars and
unsatisfactory aesthetic results I can attest to the value of having a high
level of expertise in eyelid surgery as a specialist who performs corrective
surgery for both upper and lower eyelid complications
my approach to upper eyelid surgery is to reveal the true shape of the eyes to
help you look refreshed while at the same time maintain the true character of
your eyes and face another possible cause for fullness above the upper
eyelids is lacrimal gland prolapse the lacrimal gland is the gland that
produces tears for the purpose of eye lubrication awareness of the location of
this gland is important during eyelid surgery fullness of the upper eyelids
can be partially caused by the lacrimal gland prolapsing this means that the
lacrimal gland which is normally located behind the bone descends downward
thereby prolapsing lacrimal gland prolapse can appear like a mass if there
are no other bulges caused by fat or by fullness from the eyebrow drooping an
important part is that during surgery this gland should be repositioned and
preserved using a technique called lacrimal gland resuspension as the
specialty of oculofacial plastic surgery includes training specifically in the
lacrimal system lacrimal gland resuspension is an integral part of
specialty focus on eyelid surgery it’s well established that non specialists
such as general plastic surgeon have removed the prolapsed gland the
same way fat is being removed the consequence of this action is a
reduction in total tear production with high health implications such as dry eye
syndrome another cause of heaviness in the upper eyelids come from the various
causes of mechanical ptosis mechanical ptosis occurs when a physical weight on
the upper eyelid causes the eyelid to droop this mask could be a benign growth
as well as excess skin caused by dramatic alesis or eyebrow ptosis there
are times when injectable fillers placed into the upper eyelids to treat
hollowing can also cause mechanical ptosis mechanical ptosis caused by a
benign growth or excess skin can be addressed with surgery in a situation
where mechanical ptosis is caused by the presence of a hyaluronic acid filler the
hyaluronic acid filler can be dissolved non-surgically using the enzyme
hyaluronidase a possible indirect cause of fullness in the upper eyelids is from
the eyebrow position drooping of the eyebrow is referred to as eyebrow ptosis
in many instances of eyebrow ptosis a non-surgical treatment using botulinum
toxin can be considered a procedure called the Botox brow lift involves
relaxing the depressor muscle group that pulls the eyebrows downward such as the
corrugator procerus and orbicularis oculi muscles by relaxing these muscles
the muscle which lifts the eyebrows called the frontalis muscle is working
unopposed thereby raising the eyebrows typically age-related changes caused the
eyebrows to descend which requires the physical repositioning and reshaping of
the eyebrows depending on the individual situation different types of brow
lifting and shaping surgery can be very effective
the procedures I perform such as eyelid surgery and of the lacrimal system as
well as the brow lifting procedures are routinely done with local anesthesia and
LITE IV sedation our patients are comfortable during surgery and recover
without the risks and side effects of general anesthesia typically my patients
return to work in one week when dealing with fullness above the upper eyelids
the importance of proper examination and diagnosis cannot be overstated as a
specialist in cosmetic and reconstructive oculofacial plastic
surgery I recommend that you have a thorough understanding of the different
anatomical aspects which are responsible for the areas of your concern further
you should have a clear understanding of the procedures recommended and the
outcomes you can expect I hope you found this information helpful thank you for
your question

Blepharoptosis versus blepharoplasty?
Distinguishing if you need blepharoptosis repair or blepharoplasty is based on the position
of the eyelid relative to the pupil.
In fact, it is common for ptosis to be missed because the plastic surgeon assumes that the
eyelid appearance will be improved with blepharoplasty alone.
This results in eyelids being droopy and the person looking tired inspite of having eyelid
surgery.
Let’s just get some terminology clear, excess skin over the eyes causing hooding and a tired
appearance is called dermatochalasis.
When the eyelid margin is lower than it should be, this condition is called blepharoptosis.
Very often, a person can have both dermatochalasis and ptosis at the same time.
This can be a challenge to make the proper diagnosis and surgical plan.
During my evaluation, I routinely lift up the excess skin to determine if the eyelid
margin position improves.
If the eyelid position is still low, then the patient has ptosis which can be addressed
appropriately.

Do Radio Frequency Devices Work for Hooded Eyes?
Over the past 15 years, different companies have promoted heating devices as non surgical
solutions for sagging skin.
Unfortunately the harsh reality is that more heat does not result in more tightening.
In fact in my experience many people have come to our practice after undergoing these
treatments feeling that their skin looked more aged and thinner.
This makes sense when you think about the physiology of skin.
A young face has layers of fat which creates not only volume but contributes to the health
and glow of youthful skin.
In fact in our practice, we routinely use prp or platelet rich plasma derived from your
own blood to enhance the fat cells under the skin to contribute to better skin quality.
It is my perception that the high energy heat levels which are being delivered by these
newer heating technologies which boast about how high their temperatures reach is actually
literally cooking the fat under the skin an accelerating the aged appearance.
Temporary benefit is typically perceived due to swelling which creates the illusion of
volume.
With this understanding, it’s clear in my opinion that hooded eyes are best managed
by cosmetic upper eyelid blepharoplasty.

What’s Better for Hooded Eyes: Lasers or Surgery?
Since the mid 90’s when the original CO2 lasers were introduced, lasers and radiofrequency
technology has tried to displace blepharoplasty for the treatment of hooded eyes.
In my experience, when someone has hooded eyes to the level where they seek the attention
of a physician, they have more skin than can be contracted by heat whether its from a laser
or radiofrequency.
The typical intended strategy of heating devices is to heat the skin of the forehead to contract
and elevate the brows by slow contraction of the skin over several months.
In addition, especially with radiofrequency, there’s a need for multiple sessions.
I have yet to be impressed by results using this method.
Hooded eyes also often have areas of fat which need to be sculpted which can only be accomplished
without surgery.
In conclusion for people who want a solution for hooded eyes, in my opinion, surgery allows
for more precise control and customization with different levels of tissue which contribute
to a cosmetically pleasing result.

Do I Have Eyelid Ptosis, Extra Skin, or Both?
Determining if you have eyelid ptosis, extra skin or a combination of both is critical
to having a successful cosmetic procedure.
Eyelid ptosis is a condition where the eyelid margin is lower than it should be resulting
in a sleepy or tired appearance.
Eyelid ptosis can be caused by stretching or thinning of the muscle which lifts the
eyelid called the “levator” muscle.
Eyelid ptosis can also be caused by the weight of the skin and soft tissue over the eyelids.
Dermatochalasis is a term used to describe excess skin over the eyes often referred to
as “hooded eyes”.
Ptosis correction generally involves surgery on the sensitive levator muscle and can be
performed with upper eyelid blepharoplasty which addresses excess skin and fatty tissue
over the eyes.
If you’re concerned about having tired looking eyes, meet with an experienced eyelid specialist

How Much Swelling Occurs after Upper Eyelid Surgery?
Swelling after eyelid surgery is affected by factors such as :
– Surgical technique – Anesthesia method
– Immediate care after completion of surgery – At home aftercare
– The existence of other conditions such as sinus problems and allergies
In our practice, we’ve developed a system to minimize swelling after surgery by using
minimally traumatic surgical technique, local anesthesia with LITE™ intravenous sedation
and by specific processes to care for our patients immediately after surgery and for
after they go home. For most of our patients, swelling is minimal and they can return to
work within one week.

Blepharoplasty Complications?
Blepharoplasty complications include problems such as excess bleeding, infection, undesirable
scarring, vision loss and double vision just to name a few.
Eyelid surgery complications can not only affect your appearance but can also affect
the health of your eyes.
It is also important to define what is a complication.
If for example after having upper or lower eyelid surgery, the surgeon needs to address
extra skin or more fat pockets, these are considered enhancements and not complications.
In my practice people come for revision surgery for what can be defined as complications.
For example, one of the most common reasons people come to us is for lower eyelid retraction
after lower eyelid blepharoplasty.
For many of these patients, their eyes become irritated from exposure of areas on the eye
previously protected by the normal position of the lower eyelids.
Review with your surgeon the potential complications of blepharoplasty and discuss how these complications
are managed.

How is a blepharoplasty performed?
Blepharoplasty is a general term for upper and lower eyelid surgery to improve appearance
and function.
Typically, blepharoplasty is performed to address excess skin and bulging fat around
the eyes.
As an Oculofacial Plastic Surgeon, I can’t emphasize enough the importance of having
blepharoplasty performed with an understanding of the health of the eyes and having the skills
to perform the procedures necessary to accomplish this.
A significant part of my practice is performing advanced revision surgery for patients who
come from all over the world.
I routinely perform blepharoplasty in my Joint Commission certified operating facilities.
The procedures we do are done with local anesthesia with intravenous or I.V.
sedation.
Most of our patients return to work in less than 1 week and have little or no discomfort.

What is Transconjunctival Blepharoplasty?
Transconjunctival blepharoplasty is a term which applies to a technique to address puffy
under eye bags from the inside of the eyelid.
This is in contrast to a procedure called a transcutaneous blepharoplasty.
I routinely perform this procedure in my practice and can comment on several of the advantages
of this approach.
One of the most important benefits is that there is no external incision so there will
be no evidence of having had a cosmetic procedure.
A common concern during consultation is the desire to preserve the natural shape of the
eyes.
By performing the surgery from the inside of the eyelid, several of the key anatomic
factors responsible for maintaining the eye shape are preserved by performing this technique

What is the difference between an eyelid lift, blepharoplasty and ptosis surgery?
Eyelid lift is a term that generally refers to a surgical procedure to address excess
skin and fat around the eyelids.
Blepharoplasty typically refers to a surgery to the upper and lower eyelid to address excess
skin, fat and any other anatomical issue.
For example, you can undergo an upper eyelid blepharoplasty or lower eyelid blepharoplasty
or both.
Ptosis surgery refers to any surgical procedure specifically to improve the vision of the
eyelid margin relative to the pupil such as levator muscle advancement, levator resection
or frontalis sling surgery.