Dear Dr. Winder:
Q. People are constantly asking me if I'm tired, upset or angry when, in fact, I'm just fine. I'm 46 years old and when I look in the mirror, I've noticed a heavy look to my eyelids . . . could this be the heart of the problem?

A. This may be a result of redundant skin of the upper eyelid, or a common first presentation of brow ptosis. Unfortunately, as we age everything "goes south" so to speak, including the skin of the forehead and brow area. It's secondary effect causes the skin of the upper eyelids to "bunch up", or to hide the eyelid altogether. Dramatic effects can be accomplished with some form of "brow" or "forehead" lift. In some cases, when the excess skin is extreme, an upper eyelid blepharoplasty may need to be done at the same time. Brow lifts can be done with one of two surgical approaches - either a "supra" brow lift, or a "coronal" forehead lift. A supra-brow lift is accomplished with an incision in the forehead, just above the eyebrow. This procedure can be done with as little as local anesthetic. A coronal forehead lift is approached through an incision that goes across the top of the head, behind your hairline where it is nicely hidden. This procedure requires that the patient have either an I.V. Mac or General Anesthesia. In some cases, when your vision is impaired and documented by failure of "visual field studies", your health insurance may pay for the procedure.

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