Dermatochalasis results from a combination of natural aging, tissue laxity, and anatomical changes.
A. Age-Related Changes
- Gradual loss of elasticity in upper-eyelid skin
- Weakening of the orbital septum, allowing fat to protrude forward mainly in the inner compartment
- Reduced tone of the levator aponeurosis
- Natural descent of surrounding soft tissues
B. Genetic & Ethnic Factors
Some individuals naturally have:
- Thicker upper-eyelid tissues
- A low-lying or indistinct supratarsal crease
- Earlier onset of eyelid skin redundancy
C. Environmental & Lifestyle Factors
- Chronic sunlight exposure → collagen breakdown
- Smoking → impaired microcirculation
- Habitual eye rubbing (allergies, eczema) → mechanical stretching
D. Contribution of Brow Descent
As the forehead ages, the brow position lowers, pushing skin onto the upper eyelid.
This can exaggerate eyelid hooding even when the eyelid itself is normal.
2. How Do We Differentiate:
Excess Skin vs. Eyelid Ptosis vs. Brow Ptosis?
Correct diagnosis is essential for choosing the right procedure.
A. Dermatochalasis (Excess Skin)
- Redundant skin folding over natural eyelid crease
- Eyelid margin height remains normal
- Heaviness mainly from skin and soft tissue
- Visual obstruction may occur if folds drape over lashes
B. True Eyelid Ptosis
- Eyelid margin is low, covering part of the pupil
- Typically caused by levator aponeurosis dehiscence
- Requires levator repair, not just skin excision
C. Brow Ptosis
- Eyebrow sits below its natural anatomical position
- Creates appearance of upper-eyelid hooding
- Elevating the brow reduces the excess skin fold
- May require brow lift rather than blepharoplasty
3. Clinical Assessment at MACS Clinic
Our assessment is detailed, structured, and evidence-based.
A. Full Clinical History
- Symptoms of heaviness, tired eyes, or visual obstruction
- Dry eye history
- Contact lens use
- Allergies or habitual rubbing
- Previous eyelid or facial surgery
B. Precision Examination
- Eyelid margin height (MRD1)
- Levator muscle function
- Brow position and forehead compensation
- Skin quality, crease height, fat prolapse
- Identification and documentation of pre-existing asymmetry
- This is crucial, as some degree may persist post-operatively.
- This is crucial, as some degree may persist post-operatively.
C. Ophthalmic Safety Checks
MACS Clinic advises all patients to undergo:
- Visual acuity testing
- Intraocular pressure measurement
- Optional: visual field analysis if visual compromise is suspected
These are typically conducted by your optician before planning surgery.
D. Clinical Photography
Standardised photographs support:
- Accurate diagnosis
- Treatment planning
- Pre- and post-operative comparison
- Medical-legal documentation
4. Surgical Options for Upper Eyelid Rejuvenation
Every procedure is tailored to your eyelid anatomy.
A. Skin-Only Excision (Conventional Upper Blepharoplasty)
A thin strip of skin is removed along the natural lid crease.
Advantages
✔ Short surgery time
✔ Quick recovery
✔ Restores clean eyelid contour
✔ Excellent for mild–moderate dermatochalasis
Limitations
- Does not address muscle redundancy
- Does not treat true ptosis
- Brow descent may still create heaviness
B. Skin + Orbicularis Oculi Muscle Resection
Used when the muscle contributes significantly to heaviness.
Advantages
✔ More sculpted upper-eyelid frame
✔ Enhances crease definition
✔ Beneficial in thicker, heavier eyelid tissues
Disadvantages
- Excessive resection risks hollowing
- Slightly longer recovery
- Temporary swelling may be more pronounced
C. Supratarsal Fold Repositioning / Levator Aponeurosis Manipulation
Indicated for weak or asymmetric eyelid creases.
Benefits
✔ eye opening may improve
✔ Improves symmetry
✔ May mildly improve eyelid height if levator is lax
This technique is also helpful in Asian eyelid crease creation or enhancement.
D. Fat Preservation or Conservative Fat Debulking
The modern aesthetic principle is:
- Preserve volume whenever possible
- Remove only truly redundant fat
This prevents a hollow or aged appearance.
5. Post-Operative Care Instructions
Immediately After Surgery
- Apply cold compresses for 48 hours
- Keep the head elevated
- Use lubricating eye drops and ointment to prevent dry-eye symptoms
- Avoid excessive blinking, rubbing, or stretching
Wound Care
- Dissolving sutures are used at MACS Clinic
- Keep eyelids clean with sterile saline or Clinisept
- Makeup should be avoided for 10–14 days
Activity Restrictions
- No strenuous exercise for 2 weeks
- Avoid contact lenses for several days
- Avoid saunas, steam rooms, and dusty environments
6. Possible Risks and Complications
Most are minor and temporary, but patients must be informed.
- Bruising and swelling
- Mild blurred vision
Watery eyes or dry-eye symptoms
- Small areas of asymmetry
- Infection (rare)
- Scarring (usually well hidden in the crease)
- Under- or over-correction, asymmetry
- Temporary difficulty closing the eye (lagophthalmos)
- Need for revisional surgery
- Long-term recurrence due to continued aging
- Dry eyes
- Blindness (rare)
At MACS Clinic, careful planning and meticulous technique significantly reduce these risks.
7. Long-Term Results & Recurrence
Upper eyelid surgery offers long-lasting improvement.
However, because aging is continuous, some mild recurrence of skin laxity is possible over time.
8. Summary
Excess upper-eyelid skin is both a functional and aesthetic concern. Through a combination of:
- thorough assessment,
- differentiation between dermatochalasis, ptosis, and brow descent,
- safe surgical planning, and
- meticulous postoperative care,
MACS Clinic provides natural, refreshed, and long-lasting results for patients seeking upper-eyelid rejuvenation.
