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Bulging/Sagging Upper Eyelid

What is a bulging/ sagging upper eyelid? A bulging/ sagging upper eyelid – also known as puffy/ hooded eyelid, is a condition that makes the eyelid look swollen, giving an aged and tired appearance.

A bulging upper eyelid can be caused by excessive orbital fat or water retention on the upper eyelid. Having excessive orbital fat may be a hereditary feature.

Water retention however, often happens when a person wakes up in the morning and diminishes throughout the day; hence a bulging upper eyelid caused by water retention does not require medical treatment. A sagging upper eyelid on the other hand is caused by skin laxity due to the process of ageing.

The correction of bulging/ sagging upper eyelid involves a minor surgical procedure to remove the excess fat or skin and to lift up the skin of the eyelid. The procedure is performed under local anaesthesia and generally takes less than an hour.

Patient is given oral painkiller and antibiotic for 3 days, while stitches are removed after 5 days.

For bulging upper eyelid caused by excessive orbital fat, surgery is the only option. For sagging upper eyelid, there are non-surgical options such as skin resurfacing fractional CO2 laser or Plexr® plasma treatment. However, these non-surgical options require 6 to 10 sessions in order to make a difference and the results are not as promising nor long lasting compared to straightforward eyelid surgery. In addition, there is downtime of around one week.

If too much orbital fat or skin is removed during surgery, it may lead to the condition of sunken upper eyelid in the future. Therefore, it is important to preserve a certain amount of orbital fat and to go to a skillful surgeon.

There is nothing much that can be done to prevent bulging eyelid caused by excessive orbital fat. For puffy eyelid caused by water retention; you can try using a cold press on the eyes, raise your head higher while you sleep and get enough sleep to help with reducing water retention. Prevention of sagging upper eyelid may not be possible but it can be delayed with general eye care.

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