Eyelid surgery, or blepharoplasty for hooded eyes, is a highly customized procedure because the underlying cause of the problem is different from patient to patient. Other factors that are taken into account include a person’s cosmetic goals and anatomies, as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smaili.
One of the most common causes of the hooded appearance is the excess skin in the upper eyelid, which happens with advancing age, although sometimes genetics could also play a role.
Skin resection via incision within the natural eyelid fold (to hide the scars), with or without fat removal, is usually enough to correct the aforementioned problem. However, it is crucial not to over-do the procedure to avoid skin retraction, unnatural appearance, and unfavorable scarring.
It is equally important to preserve some fats in the upper lid area to simulate the “youthful plumpness” of the face. Over-aggressive fat removal, meanwhile, can lead to a skeletonized appearance of the eye socket, Dr. Smaili warns.
Another possible cause is the descent of the lateral eyebrows that is better addressed by a brow lift, which is way different from the primary goal of eyelid surgery.
Most brow lift surgeries just address the lateral aspect of the eyebrow because the medial part rarely sags to a significant degree to the point that it requires some lifting. The idea is to raise just the “outer half” of the brow to show more of the eyelid platform.
The third cause of a hooded eyes appearance is eyelid ptosis in which the levator muscle becomes weak to the point that it can no longer support the skin and other structures of the lid. This underlying problem requires a more complex approach than a skin-only resection.
Patients with ptosis need their levator muscle to be tightened, which could be done with the use of strands to raise the lids (they are positioned between the eyelid and eyebrow). While this technique can correct the underlying problem, it is not uncommon for patients to experience temporary incomplete blink and dryness of the eye.
With time, patients should be able to close their eyes fully, although in the initial healing stage they will have to frequently lubricate their eyes with drops and/or ointment to prevent them from drying out.
Sometimes, plastic surgery insurance is possible if the excess upper eyelid skin or muscular ptosis is affecting a patient’s vision. But proper documentations, e.g., photos, clinical exams results, visual field tests, and specialist’s recommendations are needed for pre-approval.