Home Treatments Understanding Dermatochalasis: Causes, Symptoms & Treatments

Understanding Dermatochalasis: Causes, Symptoms & Treatments

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Dermatochalasis is an eye condition characterised by excess skin hanging or drooping from the upper eyelids. It is more commonly known by names like baggy eyelids, drooping eyelids, heavy eyelids or eyelid hooding. This happens when the connective tissue that gives the eyelids their structure and shape starts to weaken, becoming less elastic as key fibres break down.

Ageing is the most common cause of dermatochalasis of the eyelid, but it is not the only one. It can also be linked to genetics, with some people naturally more likely to develop dermatochalasis than others. Other risk factors include repeated or chronic sun exposure and UV damage to the skin, habits like smoking or excess alcohol consumption, or a poor skincare routine. It may also be caused by repeated episodes of eyelid inflammation due to conditions such as thyroid eye disease.

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Dermatochalasis is often an uncomfortable condition. The drooping skin can cause discomfort, as well as visual issues and cosmetic dissatisfaction. The skin can obscure a person’s peripheral vision, making it harder to enjoy simple activities, such as reading or driving. Some also dislike the tired-looking appearance that dermatochalasis brings. Fortunately, effective dermatochalasis treatment options exist.

What Is Dermatochalasis?

Dermatochalasis is simply the medical term for the condition of loose, redundant, and drooping skin of the eyelid, most commonly the upper eyelid, though it can also affect the lower lid. It is similar to another eyelid condition, ptosis, but the two are distinct, with ptosis affecting the eyelid’s muscles and dermatochalasis affecting its skin.

It is a common sign of ageing, most prevalent in middle-aged and elderly individuals and may produce the following symptoms:

Excessive, drooping skin hanging from the upper eyelids
Feelings of heaviness and puffiness
Visual obstruction in the upper part of the peripheral visual field
An aged or tired-looking face
Skin irritation or conditions like dermatitis
Headaches, along with possible pain in and around the eye area

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Dermatochalasis vs. Ptosis: What’s the Difference?

As touched on above, dermatochalasis has some similarities to ptosis, which sometimes causes the two conditions to be confused. However, there are clear distinctions.

Most notably, dermatochalasis is caused by changes in the skin of the eyelid – it becomes less elastic and weaker, leading to a drooping appearance.

Ptosis, meanwhile, is caused by weaknesses or damage to the muscles that lift and hold the upper eyelid in place. Both can cause eyelids to look droopy, but for different reasons.

Because of their similarities, it can be hard to tell, at first, which condition a patient has. A specialist will have to conduct a thorough eye examination, including visual inspection, slit-lamp examination, and other tests to diagnose the condition. It is also worth noting that some patients may experience both conditions simultaneously.

Common Causes and Risk Factors

In many cases, it is not possible to prevent dermatochalasis since it occurs naturally as part of ageing or is part of a person’s DNA. Those who have parents or older family members with this condition are more likely to get it themselves later in life. Other causes of dermatochalasis are tied to lifestyle choices and environment, like sun exposure, drinking, smoking, and poor eye skin care.

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When to Seek Medical Advice

You can seek medical advice, support, and treatment at our dermatochalasis London clinic or with your own doctor as and when you feel the need. Many patients seek treatment when their dermatochalasis starts causing them excessive bother, distress, or discomfort, either for aesthetic reasons (e.g., a “tired-looking” face) or functional reasons (e.g., difficulty seeing when reading, driving, etc.).

During your initial consultation, your doctor will discuss your symptoms and any previous eyelid or eye treatments or surgery.
They’ll then conduct a detailed assessment of your eyelids, taking precise measurements and evaluating how your eyes complement your overall facial features. The oculofacial or oculoplastic surgeon will touch your eyelids and digitally identify the excess skin and soft tissue that has to be removed, showing you this in a mirror so that you can better understand your condition of dermatochalasis and how it may be improved surgically.

Photos of the eyelids and peri-orbital area will be taken, with you looking straight ahead and other eye positions, for your medical records.

Visual field analysis may be required for your private medical insurance company if the lateral hooding is interfering with your field of vision.

They will also evaluate your vision and eye health. Based on their findings, they will provide an individualised treatment plan to achieve your desired look. This is usually surgical.

Treatment Options for Dermatochalasis

While you may not be able to prevent the onset of dermatochalasis, there are steps you can take to minimise your risk of developing it or reduce the impact of its symptoms. These include:

Looking after the skin of the face with the aid of moisturising products
Protecting your skin before extended sun exposure by using sun cream every day and wearing sunglasses and a wide-brimmed hat during the summer
Limiting the amount of time you spend in the sun
Avoiding smoking and excessive alcohol consumption

If you are affected by dermatochalasis, then surgical blepharoplasty is the treatment of choice for most patients. There are two forms of blepharoplasty:

Upper blepharoplasty: This procedure removes excess skin, minimal or no muscle, and fat from the upper eyelid to reduce hooding and puffiness. Sometimes this can be combined with adjunctive techniques to address simultaneous problems such as ptosis or brow droop. The incisions are hidden in the natural folds of the eyelid and are closed with sutures or adhesive. No scar is visible long-term because the incision is made in the natural skin crease and smile lines.
Lower blepharoplasty: This surgery focuses on the lower lid, helping to ease issues like bags under the eyes and fine lines. The anatomy of the lower eyelids is complex and unique in each patient. The surgeon may perform a combination of fat sculpting, softening of the ligaments and tightening of the eyelid, depending on the patient’s individual requirements. Often, the incision can be hidden behind the eyelid so as to avoid visible scars. If skin has to be removed surgically, the incision is usually made just below the lash line.

Upper eyelid blepharoplasty surgery can take anywhere from 45 minutes to an hour and a half. The procedure is typically performed under local anaesthetic, sometimes with sedation for longer cases, especially if the lower eyelid blepharoplasty is also being performed. Most patients will be able to go home on the same day. Recovery typically takes 2 weeks, during which rest and relaxation are recommended.

As with any surgery, there are potential risks and side effects, including:

Puffiness
Asymmetry
Irritation or sensitive, watery eyes
Dry eyes
Bruising
Small scars, which tend to fade over time
Risk of visual problems, like blurry or double vision
Injury to eye muscles
Bleeding
Infection
Allergic reactions

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Also, as this is often considered a cosmetic procedure, it is not covered by the NHS, except in cases where the patient’s vision is seriously impacted. Private costs vary from £2,000 to £10,000, on average, depending on the number of eyelids being operated on and the extent of the surgery. The cost includes the surgeon for the procedure, and the clinic charges a theatre fee. Two or three post-operative visits will be required, and lots of drops and ointments will be needed for a few weeks after surgery to keep the eyes comfortable.

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What to Expect During Recovery

Immediately after surgery, it is common to experience some irritation, and your eyes may feel puffy, sensitive, and watery. They may feel dry, so lots of drops and ointment are prescribed for the first few weeks.

Your surgeon will advise you on how best to support your body as it recovers, including cleaning your eyelids with ointment or drops, propping your head up while sleeping, wearing sunglasses, and using cold packs and painkillers to manage discomfort.

You will also be advised on cleaning the eyelids and when to return to the clinic for the removal of stitches (also known as sutures) and other follow-up appointments to monitor your post-operative progress and advise. Most patients will need to take between 8 days and two weeks off work, or longer in some cases, depending on your job. You should also avoid any strenuous physical activity for at least the first few days, do not go swimming, and avoid smoking and smoke in general. You should also try not to rub or touch your eyes and avoid wearing contact lenses and eye makeup for the first few days.

Additionally, if you experience any abnormal or persistent side effects, it is important to call the clinic right away.

Case Study: A Patient at Clinica London

Clinica London’s oculoplastic surgeons have helped many hundreds of patients overcome the symptoms of dermatochalasis through successful dermatochalasis surgery, particularly upper eyelid blepharoplasty. Patients like Ann, who began struggling more and more with dermatochalasis symptoms in their early 60s. Ann had difficulty enjoying the activities she had enjoyed throughout her life, like reading, stitching, and driving.

She sought the help of specialists at Clinica London. In an initial consultation, she shared her concerns and underwent an assessment. One of our doctors diagnosed dermatochalasis and recommended upper surgery to ease Ann’s symptoms. Her surgery was a complete success, restoring much of her peripheral vision.

Ann was thrilled with the level of care and attention she received during her treatment journey with Clinica London, especially with her personalised treatment results. She also appreciated the ongoing support from our team during the recovery phase, with helpful lifestyle recommendations and tips to help her enjoy clearer vision and healthier skin for years to come.

FAQs About Dermatochalasis

What is the difference between dermatochalasis and ptosis?

Dermatochalasis refers to excess eyelid skin, while ptosis refers to weakened or paralysed eyelid muscles. Dermatochalasis is common on the upper eyelids.

Ptosis usually refers to the dropping of the upper eyelids. Ptosis means “to fall down” in Greek.

Can dermatochalasis go away on its own?

Not typically. It is a progressive condition, often related to age, and will get worse with time unless treated surgically.

Is eyelid surgery for dermatochalasis covered by the NHS?

Upper eyelid blepharoplasty can rarely be covered in the NHS, where the condition significantly impairs the person’s upper field of vision. In most other cases, it has more cosmetic effects and is not covered. Hence, many patients go privately to see their Oculofacial / Oculoplastic Surgeon for more rapid and effective surgery.

How long does blepharoplasty recovery take?

Recovery can take about 10 to 14 days on average. Initial sensitivity and other side effects such as bruising and swelling should subside within the first few days, stitches are removed after the first week, and most patients are back to regular routines before two weeks.

Will surgery leave visible scars?

For upper eyelid blepharoplasty, very small incisions are made in the natural folds of the eyelid, the skin crease, and the smile lines. The incisions will leave scars, but they are usually not very noticeable and should fade with time.

Conclusion: Start Your Treatment Journey Today

While dermatochalasis is a natural and painless condition, it is not something you must endure. Treatment options exist, with dermatochalasis surgery effectively remedying large parts of the symptoms and dramatically improving quality of life. To start your treatment journey, contact the Clinica London team today to schedule a dermatochalasis appointment with the oculofacial and oculoplastic surgeons, Ms Ting and Ms Olver.

Our clinic operates as a private surgery and is not affiliated with the NHS (National Health Service)

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Getting the right treatment for dermatochalasis now could prevent serious eye problems later in your life. To find out more about the available treatments for dermatochalasis, book a consultation.

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