Hooded Upper Eyelids – Causes, Treatment and Benefits

By Dr Naveen Somia

Hooded eyelid is a term that is used to describe the appearance seen when a large amount of skin forms a ‘hooded’ appearance over the upper eyelids due to age-related changes in the eyelid and eyebrow. The hooding of the upper eyelids makes the person look old and tired.

So, it is natural that the primary concern of patients undergoing upper eyelid surgery (upper blepharoplasty) is that they appear tired and old and, to the casual observer, they do not appear to be attractive or in good health.

Individuals who had eyelid surgery to address age-related features such as excess eyelid skin, hooded eyelids, droopy eyelids, fat herniation, dark circles and wrinkles around the eyes are rated as appearing more youthful, attractive, energetic and healthy.

What causes hooded eyelids?

Hooded eyelids are usually caused by a combination of many age-related changes in the eyelid skin, eyebrow, underlying fat, muscle and bone. The hooded appearance can mask underlying droopy eyelids (eyelid ptosis) and a droopy eyebrow that further exaggerates the hooded appearance. At your consultation, it is important that your Plastic Surgeon performs a thorough clinical assessment to determine if you have a droopy eyelid, a droopy eyebrow or both in addition to the hooded eyelid.

Why is the eyebrow position an important consideration in surgery for hooded eyelids?

Since the eyebrow and the upper eyelid are interconnected, age-related changes of the eyebrow such as eyebrow descent or eyebrow ptosis weighs down the upper lid restricts eyelid opening and restricts the visual field. Eyebrow droop is more noticeable in the outer half of the eyebrow segment as this has less support and gravity selectively depresses the outer eyebrow.

Why do people choose to have surgery to correct hooded eyelids?

People who seek surgery for hooded eyelids do so because they want their eyes to look more open, refreshed and less tired.

You would benefit from having hooded eyelid surgery if

  • You have over hanging excess upper eyelid skin or eyelid hooding
  • The ‘hooding’ or excess skin restricts your visual field, causes heaviness in the eyelids and tension headaches
  • The hooded eyelids along with droopy eyelids that make you look tired and sleepy

Is hooded eyelid surgery classified as functional or cosmetic?

Hooded eyelid surgery is mainly functional because it improves the visual field and addresses symptoms such as headaches and heaviness of the eyes. The cosmetic benefits are obvious but secondary, because a ‘normal and youthful’ appearance is restored to the eyelid.

Is surgery for hooded eyelid covered by Medicare or private health fund

If visual field restriction can be demonstrated by a formal visual field test performed by an optometrist, you will be eligible for Medicare and health fund cover.  At your consultation, your Plastic Surgeon will assess your eyelid and will refer you for the visual field testing. Lower eyelid surgery and eye bag surgery are deemed cosmetic and hence not covered by Medicare or Private Health funds.

Benefits of hooded eyelid surgery

Upper eyelid surgery has functional, medical, psychological and cosmetic benefits as it improves vision, quality of life activities, productivity and appearance.

The vast majority who consider eyelid surgery are unaware of the functional benefits of eyelid surgery and assume it is cosmetic.

Benefits following eyelid surgery for hooded eyelids

  1. Improvement in vision and peripheral vision, facial fatigue caused by forehead muscle compensation that often results from ptosis and hooded eyelids
  2. Improved quality of life activities such as improved reading and other close-work activities
  3. Reduction of symptoms of discomfort or eye strain due to heavy and droopy lids or eyebrows
  4. Significant relief for tension type headache and improved headache-related quality of life.
  5. Increased productivity in people under the age of 65
  6. Reduction in the risk of falls in people over the age of 65
  7. Studies demonstrate that individuals are rated as appearing more youthful, attractive, energetic and healthy following blepharoplasty

What results can I expect after surgery for hooded eyelids?

Eyelid surgery improves the visible signs of ageing and give you a fresh, rested and youthful look. Although most changes are noticeable straight away, we recommend waiting for 12 weeks for all the temporary changes including swelling to resolve to experience the final result.

Downtime following hooded eyelid surgery

  • For the first week, you will be asked to apply ointment to the suture line, eyedrops, ice packs and, in some cases, oral antibiotics.
  • During the first week, you should stay at home. If you go out, you must wear a pair of good quality sunglasses. It is not uncommon for patients to complain of the sun’s glare when they go outdoors.
  • Bruising and swelling may last up to 2 weeks.
  • Sutures are removed 5 – 7 days following the operation
  • You may start scar treatment 2 weeks following surgery as instructed by your Plastic Surgeon. Remember, eyelid scars heal very well.
  • Silicone gel is often recommended, and you should take care to ensure that the excess silicone gel does not get into the eye.
  • You can start wearing contact lenses about 4-6 weeks post-surgery.
  • Light activities are allowed for the first 4 weeks and you can start your normal activities including going to the gym after 4 weeks.

Dr Naveen Somia is a Fellow of the Royal Australasian College of Surgeons (FRACS) and the President of ASAPS, representing the highest standards of cosmetic excellence by registered specialist plastic surgeons. You can view his profile here.



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