Want to Thin Thick Eyelids? Eyelid Position is Key

Today, a 22-year-old male patient visited, expressing a desire to make his thick eyelids thinner. He mentioned he had heard he had ptosis and felt he was opening his eyes with his forehead, so he wanted correction.

Many people seem to misunderstand that thick upper eyelids are due to a lot of fat in the eyelids. However, it seems that many patients understand the removal of orbital fat within the eyelid during many past double eyelid surgeries as a procedure to make the eyelids slimmer.

However, orbital fat in the eyelid is not a primary cause of eyelid thickness.

There are largely two main reasons why eyelids appear thick: 1) when the skin or the orbicularis oculi muscle (the muscle that closes the eye, located directly under the skin) and its associated fat (post-orbicularis oculi fat) are thick, and 2) when the eyebrows, which are at the boundary between the eyelid and forehead, are low. The orbital fat that patients refer to is tissue located deeper between the levator palpebrae superioris muscle and the orbicularis oculi-related fat layer. It plays a role in protecting the eyeball and allowing the levator palpebrae superioris muscle to move freely, separated from surrounding tissues. To create a double eyelid crease, an adhesion must be formed between the muscle fascia, which is the distal part of this levator palpebrae superioris muscle, and the skin. Therefore, orbital fat is only removed conceptually to clear this area when it is difficult to create an adhesion due to it being caught in the distal part of the orbital fat. Thus, its correlation with eyelid thickness control is less than expected. Since skin or muscle thickness cannot be adjusted, muscle-related fat can be removed, but the actual amount is often not large, and removal is difficult due to severe adhesion with surrounding tissues.

Then, there is the next problem: low eyebrows. This is prominent in the aging process. As people age, the position of the eyebrows changes medially and inferiorly. In other words, aging generally occurs in the direction of frowning. This is presumed to be related to the increasing changes in vision with age. Therefore, if you lift your eyebrows with your fingers and raise them in the opposite direction, the eyelids become much thinner. That is, the eyelid simply appears to be pushed down as the position of the upper eyebrow comes down. In young people, sometimes the eyebrows are low regardless of aging, which ultimately causes the eyelids to appear 'puffy'. This is either due to prominent periorbital bone or the eyeball itself appearing sunken, making the periorbital bone relatively higher. In this case, rather than planning to cut a part of the frontal bone (brow bone), lifting and raising the eyebrows in the same way helps improve the appearance of swollen and sagging eyelids.

The fact that eyebrow position has a greater impact on eyelid appearance is a point that many plastic surgeons have only relatively recently agreed upon. The most active method to raise the eyebrows is 1) endoscopic forehead and brow lift, and the most conservative but relatively popular method is 2) injecting botulinum toxin (aka Botox) into the muscles between the eyebrows and at the corners of the eyes. The commonality of these two methods is that the former surgically weakens the muscles that lower the eyebrows, and the latter temporarily reduces muscle strength with medication. If surgery is still daunting, it might be good to consider Botox injections between the eyebrows and at the corners of the eyes about once every six months.

Frequently Asked Questions

What are the main causes of thick eyelids?

There are two main causes of thick eyelids. First, when the skin or the orbicularis oculi muscle and its associated fat are thick, and second, when the eyebrows, located at the boundary between the eyelid and forehead, are low. Orbital fat, which many people misunderstand, is not the primary cause.

Is eyelid fat removal effective in thinning eyelid thickness?

No, the correlation between eyelid orbital fat removal and eyelid thickness control is less than expected. Orbital fat plays a role in protecting the eyeball and assisting the movement of the levator palpebrae superioris muscle, and is only partially removed when necessary for double eyelid crease formation.

Does eyebrow position affect eyelid thickness?

Yes, eyebrow position significantly affects eyelid appearance. As the eyebrows lower, the eyelid tissue is pushed down, making it appear thicker. As people age, eyebrows may shift medially and inferiorly, or even in young people, eyebrow bone structure can make eyebrows appear low.

How can thick eyelids caused by low eyebrows be improved?

Thick eyelids caused by low eyebrows can be improved by lifting and raising the eyebrows. The most active method is an endoscopic forehead and brow lift, while a relatively conservative method is injecting botulinum toxin (Botox) between the eyebrows and at the corners of the eyes.

Can Botox treatment also lift eyebrows?

Yes, Botox treatment can also lift eyebrows. The principle is to temporarily weaken the muscles that lower the eyebrows by injecting botulinum toxin between the eyebrows and at the corners of the eyes. If surgery is a concern, you might consider Botox treatment about once every six months.