Droopy eyelids can look sexy, but they can also look quite sleepy. There is a fine line between just a slightly droopy, ‘come to bed’ look of early ptosis to someone who has a slightly more droopy ‘I am tired’ look, even though I have had enough sleep.
Although a slight droopy eyelid can sometimes look very attractive more often droopy eyelids can make you look sleepy and tired. Therefore it is a good idea to think about how you can look more awake and refreshed.
Makeup is a very good way to look more awake and more refreshed. By putting on eyeliner in a darker colour, this can effectively raise the eyelids so that they look higher, more awake, more refreshed and more alert. However, after a while makeup no longer can do that and more definitive measures are required such as having eyelid surgery.
Droopy eyelids are often familial; it is the look of your family, your uncle, your mother or your aunt or even a brother if you have any siblings. Not everybody in the same family will get droopy eyelids, but there can be a tendency for you to inherit a predisposition for your eyelids to droop very slightly as you age.
Droopy eyelids can occur with extended contact lens wear, particularly for those patients who have been wearing gas permeable hard contact lenses which very slightly irritate the under the surface of the eyelid.
These cause, we believe, very low-grade inflammation and stretching of the front part of the levator muscle called the aponeurosis and so patients who are wearing contact lenses can often portray a more tired appearance with more upper eyelid skin show and a raised upper eyelid skin crease and associated raised eyebrows.
When I assess a patient with droopy eyelids one of the tests that I do is called the phenylephrine test. This test is an eye drop test, and it is just put into one eye if there is bilateral ptosis.
The phenylephrine drop is a sympathomimetic and it stimulates a little additional muscle in the upper eyelid which can raise the eyelid called the Müller’s muscle. The Müller’s muscle, when stimulated, gives a positive phenylephrine test. This test allows the patient to see the eyelid as if surgery had corrected it against the eyelid which has not had the drop which has still got the ptosis or droopy eyelid.
Very often when I use the phenylephrine test I can see and the patient can also see a vast improvement in terms of the eyelid height, the eyelid contour shape, the direction of a lashes, the level of the skin crease and the amount of lid showing and the eyebrow drops and the whole area looks more awake and more sparkly and more energetic. The patient says to me “Doctor, can you have this drop?” and unfortunately I have to tell them that it only lasts about 20 minutes and no they cannot take that drop home at putting it in themselves, but instead they could consider droopy eyelid surgery under a local anaesthetic here at Clinica London.
That is because they have already got a good idea of what type of result to expect, based on the phenylephrine test. We take photos before doing a phenylephrine test and afterwards and go over those with the patient so that they can see the difference. The phenylephrine test takes about 5 to 7 minutes to work. While it is working, we chatter away to the patient, I put the mirror in front of them and then after a few minutes I say well just have a look in the mirror, tell me what you can see, and they often will say “my goodness, that looks so much better. I have no longer got a droopy eyelid”, and then we know we have got a way forward to help them to look more awake and refreshed by having eyelid surgery.