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Understanding and Managing Eyelid Hooding and Dermatochalasis

The delicate skin around the eyes is often one of the first areas to show signs of aging. This can lead to eyelid hooding and dermatochalasis, conditions characterized by drooping and bulging eyelids. These changes can make individuals look tired and aged, prompting many to seek corrective procedures.

Causes and Symptoms

Eyelid hooding results from a loss of skin elasticity, leading to excess skin that droops over the eyelids. It can also be caused by periodic swelling (blepharochalasis) or medical conditions like Ehlers-Danlos syndrome, thyroid eye disease, and others. Symptoms include a feeling of heaviness in the eyelids, impaired vision, and irritation from drooping skin.

Medical vs. Cosmetic Concerns

Patients may seek surgery for both aesthetic and functional reasons. Dermatochalasis can affect vision by obstructing the visual field, particularly with lateral hooding. It can also interfere with makeup application and cause watery eyes due to irritation from dead skin cells.

Peri-orbital Changes

Dermatochalasis can lead to ptosis (drooping of the upper eyelid) due to disinsertion of the levator aponeurosis, and pseudo-ptosis from the weight of the excess skin. Brow drooping may also occur, requiring compensatory brow elevation.

Indications for Surgery

Surgery, typically through blepharoplasty, can correct both cosmetic and functional issues. It is indicated for patients with superior visual field defects, visual strain, ptosis, and reduced upper margin reflex distance, significantly improving vision and quality of life.

Assessment for Surgery

Assessment involves evaluating the severity of dermatochalasis, ptosis, and fat herniation. Measurements of the vertical palpebral aperture and upper margin reflex distance help identify ptosis. A visual field test (e.g., binocular Esterman) determines the extent of visual impairment. Pre- and post-operative photography is essential for documentation.

Goals and Procedure of Blepharoplasty

The aim is to sculpt the upper eyelid for a natural, youthful appearance. The procedure involves marking the skin crease, administering local anesthesia, making an incision, excising excess skin and muscle, managing fat pads, and closing the incision. Post-operative care includes using lubricating eye drops, ice packs, and keeping the head elevated during sleep.

Complications and Management

Potential complications include bruising, swelling, watery eyes, corneal abrasion, and rare issues like hematoma or infection. Patients should be informed about these risks and the possibility of needing further surgery for optimal results.


Most patients are satisfied with their blepharoplasty outcomes. For the best results, the procedure should be performed by an oculoplastic surgeon familiar with the anatomy of the eye. Discussing the use of cosmetic fillers like Sculptra before and after surgery can enhance results.


Eyelid hooding and dermatochalasis can significantly impact appearance and vision. Understanding the causes, symptoms, and surgical options allows medical professionals to provide effective treatments, improving patients’ quality of life and aesthetic satisfaction.

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