What is the difference between excess skin and a drooping eyelid (ptosis)?

Excess skin or ptosis: two similar causes with two different treatments. Eye surgeon Dr Dulaimi explains the difference.


At a glance

  • Excess skin (dermatochalasis): too much skin on the upper eyelid hangs over the lash line; the eyelid margin itself is at its normal height. Treatment: upper eyelid correction.
  • Ptosis (drooping eyelid): the eyelid margin itself sits too low because of a weakened or stretched eyelid muscle; the eye looks smaller and vision at the top can be limited. Treatment: ptosis correction, for mild ptosis through the inside of the eyelid.
  • Both can occur together; the eye surgeon determines this during a consultation at the clinic, with a measurement and the eye-drop test; this cannot be done online.

Watch the video: two causes, two treatments, explained by Dr Dulaimi

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What you hear in the video

What is the difference between excess eyelid skin and a drooping eyelid, ptosis? Both look like a drooping eyelid. Yet they are two different things, with two different treatments. And that is exactly why everything starts with the right diagnosis.

With excess skin, the medical name is dermatochalasis, there is too much skin on the upper eyelid. The skin of the upper eyelid is the thinnest skin of the body. Over the years it loses elasticity and stretches, until the excess skin hangs over the lash line. The eyelid margin itself remains at its normal height. It is the skin above it that falls over it.

With ptosis the problem is not the skin, but the muscle that lifts the eyelid. It does not work sufficiently. As a result the eyelid margin itself drops. The eye looks smaller, and in pronounced cases the eyelid covers part of the pupil.

For excess skin, the upper eyelid correction is the appropriate treatment: the doctor removes the excess skin through an incision in the natural eyelid crease. Ptosis requires a muscle correction, a fundamentally different procedure. For mild ptosis we perform it through the inside of the eyelid, without an incision in the skin. If ptosis is mistaken for excess skin and only skin is removed, the complaint remains. Sometimes both occur together.

Which of the two applies to you is determined by the eye surgeon during the consultation, with a measurement of the eyelids and, in case of ptosis, an eye-drop test. For that you come to the clinic, because the measurement cannot be done online. The introductory consultation is free of charge and without obligation.

Every recovery is personal. All risks are discussed with you during the consultation.

Excess skin (dermatochalasis)

With excess skin there is too much skin on the upper eyelid. The skin of the upper eyelid is the thinnest skin of the body; over the years it loses elasticity and stretches, until the excess skin hangs over the lash line. The eyelid margin itself remains at its normal height. The treatment is the upper eyelid correction: the doctor removes the excess skin through an incision in the natural eyelid crease.

Ptosis (a drooping eyelid caused by a weakened eyelid muscle)

With ptosis the problem is not the skin, but the eyelid muscle that lifts the eyelid. It is weakened or stretched, so the eyelid margin itself sits too low. The eye looks smaller, and in pronounced cases the eyelid covers part of the pupil and limits vision at the top. Ptosis requires a muscle correction, a fundamentally different procedure from removing skin. For mild ptosis (1 to 2 mm) we perform it through the inside of the eyelid, without an incision in the skin: the Fasanella-Servat ptosis correction. Ptosis correction (Fasanella-Servat): €1,750 per eye, including consultation, aftercare and check-ups.

Two treatments, and why the diagnosis comes first

If ptosis is mistaken for excess skin and only skin is removed, the complaint remains. Sometimes both occur together; the eye surgeon then discusses with you which combination of treatments is appropriate.

The third cause: the brow

Sometimes the eyelid is innocent and the brow has dropped. It pushes the eyelid skin down. Removing eyelid skin alone can then pull the brow down even further and make the picture worse. In that case the treatment starts with the brow position: the direct brow lift, combined with an upper eyelid correction where needed. These three causes can look alike and also occur in combination.

How we determine it

Which cause applies to you is determined by the eye surgeon during a consultation at the clinic in Zwolle or Amsterdam: with a measurement of the eyelid position and the strength of the eyelid muscle and, if ptosis is suspected, the eye-drop test (phenylephrine test). This measurement cannot be done online; for ptosis we therefore do not offer an online introduction. Our eye surgeons are BIG-registered (Dutch healthcare register) and work according to the guidelines of the Dutch Ophthalmological Society and the Dutch Orbital Society. The introductory consultation is free of charge and without obligation; consultations are available in English.

Frequently asked questions

What is the difference between excess eyelid skin and a drooping eyelid (ptosis)?

Excess skin (dermatochalasis): too much skin on the upper eyelid hangs over the lash line; the eyelid margin itself is at its normal height; treatment: upper eyelid correction. Ptosis (drooping eyelid): the eyelid margin itself sits too low because of a weakened or stretched eyelid muscle; the eye looks smaller and vision at the top can be limited; treatment: ptosis correction, for mild ptosis through the inside of the eyelid. Both can occur together; the eye surgeon determines this during a consultation at the clinic, with a measurement and the eye-drop test; this cannot be done online.

What is the difference between ptosis and excess skin?

In ptosis, the eyelid margin itself is positioned too low due to a weakened eyelid muscle. With excess skin, the skin of the upper eyelid hangs over the eyelid margin, while the margin is at the normal height. Sometimes both occur together. During the consultation, the eye surgeon will determine your specific condition and the appropriate treatment.

What is the drop test?

During the consultation, you will receive an eye drop containing phenylephrine. This stimulates Müller's muscle, causing the eyelid to rise temporarily. If the eyelid reaches the desired height, the eye surgeon knows that the Fasanella-Servat technique is suitable for you.

Can the consultation take place online?

No. An in-person consultation at the clinic is required for a ptosis correction. The eye surgeon measures the position of your eyelids and the strength of the eyelid muscle and performs the drop test; this can only be done at the clinic.

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