Sagginess of the upper eyelids is in many cases the earliest sign of aging, anticipating many years to other stigmata such as wrinkling, sagging face and neck or eyebrows droopiness.
The anatomy of eyelid rejuvenation (excludes skin aging and wrinkles) is divided into upper eyelids (excludes the eyebrows) and lower eyelids, which do not overlap to each other. Aesthetic aging upper eyelids may show as only sagginess, only bagginess or both at the same time, not necessarily with the same grade of severity.
Upper eyelids sagginess is a simplified way of naming the chalasia or aging overgrowth and flaccidity of the skin at the upper eyelid and the orbicularis oculi muscle portion corresponding to the upper eyelid, which develop excessive tissue overtime and fold over the upper eyelid and even the eyelashes; in a extreme grade may partially blind the visual field of the eye.
Although there are cases of severe upper eyelids sagginess in young or very young people due to familiar hereditary factors, medications, smoking habit, unhealthy lifestyles or certain illnesses which may require corrective treatment, the most common scenario is patients showing a marked degree of upper eyelid sagginess from the 40s, often as the only remarkable sign of facial aging or associated with eyebrows aging.
In many occasions the patient is unable to detect the eyebrows droopiness, attributing their dissatisfaction to the aging of drooping upper eyelids. In the border region between the brow (frontal territory) and the upper eyelid (orbital territory) there is a very clear frontier between a thin, dark and elastic skin that belongs to the upper eyelid and a lighter, thicker and firmer skin that corresponds to the eyebrow and therefore does not belongs to the upper eyelid.
Some patients call droopy upper eyelids what is really eyebrow droopiness, or both problems coexist so we would be before a case of skin excess on the upper eyelid aggravated by the descent of the tail of the eyebrow. It must be borne in mind that when the eyebrows descend they cause a severe aggravation of the upper eyelid skin excess, which may confuse patients and surgeons who are not experienced in facial plastic surgery. In other words, the greater the descent of the eyebrows, the more it seems that upper palpebral skin is left over, but it is not the real amount of excess skin on the upper eyelid; the actual amount of excess skin on the upper eyelids is diagnosed with the eyebrows in their correct position.
It is very important that the patient receives an exact diagnosis, because under no circumstances should eyebrow skin be removed for misinterpreting that much upper eyelid is in excess, which would cause even greater lowering of the eyebrow, just as you cannot pretend to remove the excess of upper palpebral skin by an aggressive treatment of the eyebrow, as it would entail a grotesque and artificial appearance or even a functional limitation of upper eyelid closure.
In most cases, the patients suffer at the same time from skin and muscle excess on the upper eyelid along with a greater or lesser degree of eyebrow droopiness, so it is usual to simultaneously perform the treatment of both problems.
As a rule of thumb it can be said that the eyebrow should be at the same level as the upper edge of the orbital rim (bony frame that surrounds the eye) or slightly above; in some cases and especially in women the tail of the eyebrow should be noticeably above of the mentioned edge of the orbital bone.
Best state of the art treatment for the saggy upper eyelids is the upper tarsal (palpebral) crease concealed incisions upper eyelid myocutaneous (skin and muscle) blepharoplasty.