What is the difference between ptosis and excess eyelid skin?

Ptosis is a low position of the eyelid margin itself, caused by weakness or stretching of the muscle that lifts the lid. Excess skin (dermatochalasis) is loose skin folding over an otherwise normally-positioned lid. They look similar but are corrected by different operations — ptosis repair versus blepharoplasty — and are often present together.

Will my eyes look natural and symmetric, not startled?

Yes. Lid height is set by careful measurement to match your other eye and your natural degree of openness, not over-raised. The aim is a rested, symmetric, awake eye that still looks like you.

How long is recovery from droopy eyelid surgery?

Bruising and swelling settle over 1 to 2 weeks, similar to eyelid surgery generally. The lid height continues to settle into its final position over several weeks, which is why the result is judged at a few weeks rather than on day one.

Eyelid surgery

Ptosis repair — droopy eyelid surgery in Beverly Hills.

Q: Will my eyes be symmetric afterward?

Symmetry is the goal and lid height is set by careful measurement during surgery. Because eyelid tissues heal individually, a small percentage of patients need a minor adjustment afterward to fine-tune height or symmetry — this is discussed in advance.

Reopening an eye that a low lid has been quietly closing — and restoring symmetry between the two.

Direct answer

Ptosis repair is surgery to lift a drooping upper eyelid by tightening the muscle and tendon that raise it. Unlike blepharoplasty, which removes skin, ptosis repair corrects the position of the lid margin itself. It suits adults whose lid sits low enough to look heavy, sleepy, or asymmetric to its partner — making one eye appear smaller or more tired than the other.

By Justin Karlin, MD, MS ASOPRS-certified oculofacial surgeon · UCLA faculty — about the surgeon

What it is

Each upper eyelid is lifted by a muscle called the levator, which attaches to the lid through a thin tendon. When that tendon stretches or detaches — from age, contact-lens wear, prior eye surgery, or, less often, a congenital or neurological cause — the lid sits too low. This is ptosis (blepharoptosis). Repair re-establishes the connection so the lid opens to a normal, symmetric height.

Ptosis vs. excess skin

Ptosis is frequently mistaken for “hooded” eyes. The two are different: ptosis is a low lid margin, while hooding is loose skin folding over a normally-positioned lid. They often coexist, and correcting one without the other leaves the eye looking only half-treated. A key part of the exam is measuring the lid margin and levator function to tell them apart — and, when both are present, combining ptosis repair with upper blepharoplasty.

Who is a candidate?

An upper lid that sits low, covers part of the colored iris, or looks asymmetric to its partner.
A sense of needing to raise the brow or tilt the head to see.
One eye that looks smaller, sleepier, or less open than the other.
Adequate levator function on measurement, and good eye-surface health.

The technique

There are two well-established routes. An external (anterior) approach advances or tightens the levator tendon through an incision hidden in the lid crease — versatile, and easily combined with skin removal. An internal (posterior) approach tightens the lid from the conjunctival side with no external incision, well suited to milder ptosis with good levator function. Height and contour are set by careful intra-operative measurement and, where appropriate, adjusted with the patient responsive.

Recovery timeline

Days 1–3Swelling & bruising. The lid may look high or uneven early on — this is expected as tissues swell.

Days 5–7Any external sutures removed. Swelling begins to settle.

Weeks 2–4Height settles. The lid finds its true position as swelling fully resolves.

6+ weeksResult judged. Symmetry is assessed; a minor adjustment is occasionally made.

Often combined for a refreshed eye

In an aesthetic plan, raising the lid is rarely done in isolation. Dr. Karlin frequently pairs a measured ptosis correction with upper blepharoplasty and micro fat grafting, so the eye is not only more open but better supported and rested. The goal is symmetry and an awake, natural eye — never a startled one.

On this page

Procedure facts

Time in surgery: 45–90 min
Anesthesia: Local ± sedation
Pairs with: Bleph + fat transfer
Back to work: 1–2 weeks
Height settles: 2–6 weeks

Questions

Ptosis repair, answered.

How is ptosis different from excess eyelid skin?

Ptosis is a low position of the lid margin itself, from a weak or stretched lifting muscle. Excess skin is loose skin folding over a normally-positioned lid. They look similar, are fixed by different operations, and are often present together.

Will my eyes look natural, not startled?

Yes — height is set by careful measurement to match your other eye and your natural openness, never over-raised. The aim is a rested, symmetric, awake eye that still looks like you.

Will my eyes be symmetric afterward?

Symmetry is the goal, and height is set by careful measurement. Because lids heal individually, a small number of patients need a minor adjustment to fine-tune height — discussed in advance.

How long until I see the final result?

Bruising and swelling settle over 1 to 2 weeks, but the lid height continues to settle over several weeks. The result is judged at a few weeks, not on day one.