Why the cause comes first
People use the words droopy eyelid for three different problems. In true ptosis, the muscle that lifts the lid is weak, so the lid edge sits low over the iris. In dermatochalasis, extra upper-lid skin folds over a lid edge that sits in the normal place. With brow descent, the brow has settled and weighs the lid down.
Each one needs a different answer. Dr Sin Yong examines the lid and brow before proposing anything. One lid sitting lower than the other is treated as a possible sign of ptosis and gets extra scrutiny. The consultation may end with no treatment being advised.
Droopy eyelids treatment Singapore: cause and route
| Cause | How it shows | Route |
|---|---|---|
| True ptosis | The lid edge sits low even when the brow is lifted away | Oculoplastic or medical assessment. No energy or injection aimed at the lid |
| Dermatochalasis, early | Extra skin over a lid edge in the normal position | Carefully delivered energy to lid skin, with limits stated at the start |
| Dermatochalasis, significant | Skin excess folds heavily over the lid | Referral for a surgical discussion |
| Brow descent | Lifting the brow by hand opens the whole eye | Energy along the brow and temple, and BTX brow technique |
| Asymmetric lids | One lid sits lower | Extra scrutiny as possible ptosis |
A simple way to think about it
Lift your brow gently with a finger while looking in a mirror. If the whole eye opens, the brow may be part of the problem. If the lid edge still sits low over the coloured part of the eye, the lid muscle may be the issue. Heaviness that worsens through the day is read as a brow and fatigue pattern. This is only a guide, because examination decides which of the three applies, and some people have more than one. Treat this as a starting point, and see a doctor about any new or one-sided droop.
The non-surgical options
HIFU or Thermage tighten this area. The lift is only a matter of millimetres.
Botulinum toxin rebalances the muscles pulling the brow down.
For the texture and early laxity of lid skin.
For the brow and upper face, along vertical vectors. Some patients need this and FSX in sequence.
The brow is rebalanced and tightened, and the lid itself is left alone. The lift stays modest, so it suits people who want a subtle change.
What to expect with energy near the eyes
Energy around the eyes is planned with care and staged conservatively. With the Thermage eye tip, contact lenses are removed and shields are used, and lids can stay puffy for longer afterwards. FSX Laser starts with numbing cream. It can leave redness, warmth, mild swelling and fine scabbing, which should be left to shed. It does not lift a descended brow, so the VF Lift may be added for that. HIFU cannot remove heavy skin or replace lost volume, and it is not planned for lean faces.
Who this suits
It suits lid heaviness driven by brow descent and early upper-lid skin laxity with a normal lid edge. It also suits heaviness that worsens as the day goes on. You need to expect a modest, subtle lift. Treatment is staged conservatively. If you expect a result equal to eyelid surgery, please wait and discuss this first. A problem at brow level is not given a lid procedure.
When you will be referred
Referred for oculoplastic or medical assessment.
Referred for a surgical discussion. No laser package is offered for skin that needs removing.
Visual field obstruction is referred on.
This is referred on and is not treated as a cosmetic concern.
Who should wait or avoid it
Please wait.
Inflammation, infection or skin disease at the site comes first.
Avoid BTX with a known allergy or a disorder such as myasthenia gravis.
New, asymmetric or fluctuating ptosis needs medical assessment first.
These may rule out some devices, depending on the area.
This is a reason to wait and discuss other options.
What it cannot do
Neither energy nor injection corrects a weak lid muscle.
Skin that needs removing cannot be lasered away.
Non-surgical care is not an equal to eyelid surgery.
No duration is promised.
No lid procedure is offered for a brow-level problem.
FSX Laser does not lift a descended brow.
A new, one-sided or fluctuating droop needs medical assessment first.
Risks and side effects
Mild redness, warmth or swelling after energy treatment usually settles, as do small bruises or tenderness after injections. Uncommon risks are temporary lid or brow heaviness, brow asymmetry, headache, dry or irritated eyes, and surface burns with energy devices. Contact the clinic the same day for a lid that droops further, new double vision, eye pain, vision changes, blistering, spreading redness, one brow or lid becoming much lower, or swelling that increases. Doses and placement are planned with care, because botulinum toxin can leave a lid or brow heavier for a time.