Ptosis vs. Dermatochalasis: How to Tell the Difference

Ptosis, or blepharoptosis, occurs when the upper eyelid sits lower than usual due to a problem with the levator muscle, which is responsible for lifting the eyelid. Ptosis can be present from birth or develop later in life.

Ptosis, or blepharoptosis, occurs when the upper eyelid sits lower than usual due to a problem with the levator muscle, which is responsible for lifting the eyelid. Ptosis can be present from birth or develop later in life.

Common Causes of Ptosis

• Age-related weakening or stretching of the levator muscle
• Nerve issues, such as injury or neurological conditions that affect eyelid movement
• Trauma or previous eye surgery that affects the muscle attachment
• Long-term contact lens use, which can gradually loosen the levator

Typical Indicators

• One or both upper eyelids sit lower than normal, sometimes partially covering the pupil
• Eyes appear asymmetrical or constantly tired
• Vision may be partially blocked in more severe cases
• You may unconsciously raise your eyebrows to lift the drooping eyelid

Treatment

While mild cases may be temporarily managed with prescription eye drops, surgical correction is often necessary when ptosis interferes with vision or facial symmetry. Surgery typically involves tightening or reattaching the levator muscle to restore proper eyelid function and position.

Dermatochalasis involves excess upper eyelid skin, sometimes accompanied by fat protrusion, usually as a result of ageing. Unlike ptosis, the eyelid muscle itself is generally functioning well; the drooping appearance comes from redundant tissue rather than a weakened muscle.

Common Causes of Dermatochalasis

• Natural ageing and gradual loss of skin elasticity
• Genetic tendencies for looser eyelid skin
• Sun exposure and lifestyle factors affecting skin quality

Signs You May Notice

• Excess skin forming a visible fold over the upper eyelid crease
• Puffiness or bulging caused by fat protruding through weakened tissue
• Obstruction of the upper field of vision in more advanced cases
• Eyelid margin or lash line remaining in its normal position, unlike in ptosis

Treatment

Upper eyelid blepharoplasty is commonly used to remove excess skin and fat, helping to restore a more alert and rested look. If the eyelid margin is already well positioned, this procedure alone may suffice. However, when ptosis is also present, both conditions can be addressed during the same surgery.

Distinguishing between ptosis and dermatochalasis requires a detailed examination by a plastic or oculoplastic surgeon. During consultation, your surgeon will:

• Measure eyelid height and assess levator muscle function
• Examine skin redundancy and fat distribution
• Determine whether both conditions are present