What Causes Eyelids to Sag?

When you’re tired, your eyes give you away. Your eyelids droop over your pupils and present that half-mast look that tells the world you were up all night. But when they sag even if you’re well-rested, you need more than a good night’s sleep. You may need blepharoplasty — an eyelid lift.

Dr. Michael Macdonald, our board-certified facial plastic surgeon here at Aesthetic Surgery Center in San Francisco, California, performs this delicate procedure on patients when their sagging eyes cause cosmetic and vision problems.

But not all eyes sag for the same reason. Whether your eyes are drooping because you’re getting older or you were born with hooded lids, Dr. Macdonald can correct the problem and give you a more rested, youthful look.

Why are my eyelids sagging?

The most common cause of droopy lids, also called ptosis,  is age. With each passing year, your muscles get weaker all over your body — including your levator muscles, which are responsible for keeping your eyes open. Beyond advancing years, you may be able to blame any number of conditions for your saggy eyes, including:

  • Injury
  • Complications of a previous eye surgery
  • Genetics
  • Nerve damage
  • Myasthenia gravis
  • Migraine headaches
  • Eyelid tumors
  • Stroke
  • Diabetes
  • Botox® gone wrong

Depending on the culprit behind your droopy eyes, the problem may correct itself once the underlying condition is resolved. But in many cases, eyelid surgery is the best bet for shoring up droopy lids.

How to improve your look and your vision

If you and Dr. Macdonald decide that surgery is right for you, you have several decisions to make about the procedure(s). After thoroughly examining your facial structure and discussing your medical symptoms and/or aesthetic goals, Dr. Macdonald recommends the best course of treatment, which may include any combination of the following procedures.


Dr. Macdonald can perform blepharoplasty on either your upper lids, your lower lids, or both. So if you have droopy lids above and puffy bags below, a couple of tiny incisions and the removal of excess fat and skin can have you looking more refreshed and alert.

Arcus marginalis release

If your eyes appear hollowed out and sunken in, Dr. Macdonald may reposition some of the excess fat in your lower lids and cheeks to plump up the area around your eyes.

Laser skin resurfacing

Age does a number on your eyes. Not only do the muscles weaken and cause your lids to sag, but the delicate skin around your eyes also becomes thin and wrinkled. Laser skin resurfacing added on to your blepharoplasty procedure can tighten up crepey skin for a smoother complexion.

Brow lift

Is it your eyelids or your eyebrows that are hanging down? It may be difficult to tell the difference, but Dr. Macdonald can let you know which facial feature is to blame. If gravity has caused your brows to sag, a brow lift can make a dramatic difference

Is surgery right for you?

Choosing to undergo surgery is a very personal and individual decision that involves many variables, including your overall health and your expectations. Dr. Macdonald helps you navigate your options with compassion and experience. Feel free to ask him any question and express all your concerns and wishes — it’s the only way to arrive at the best decision for your unique needs.

To schedule a consultation with Dr. Macdonald, book a visit through our online request tool or call our friendly staff today.

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