Sleepy Eyes or Ptosis? Signs You May Need Ptosis Correction | Sleepy Eyes Surgery in Korea

“You look sleepy” is one comment, but the look behind it can have several causes. It may be ptosis, where the strength to open the eye falls short, or it may come from sagging skin, thick eyelids or sunken upper lids. Not every pair of sleepy-looking eyes needs ptosis correction. Below, we go through how the causes are told apart, which signs point to ptosis correction, and what is decided after that.

Where does a sleepy look come from?

A common thought

People always tell me I look sleepy. Does that mean I have ptosis?

‘Sleepy eyes’ describes a look, while ‘ptosis’ describes a condition of the eyelid. In ptosis, the muscle that lifts the upper eyelid (the levator muscle) is weak, so when the eye opens, the lid sits low and covers part of the iris. This can make the eyes look sleepy and smaller.

However, not every sleepy look comes from ptosis. The causes of sleepy-looking eyes can be broadly sorted into four groups.

1. Eye-opening strength (muscle) — The levator muscle is weak, so the lid margin itself sits low. This is what people usually mean by ptosis.
2. Sagging eyelid skin — Here the bigger cause is not eye-opening strength but skin that has lost elasticity hanging down over the lashes.
3. Thick eyelids and fat — The eyelid skin is thick and holds more fat, so the eyes look heavy.
4. Sunken upper lids — The area above the eye is hollow, so the eyes look tired or the double eyelid looks loosened into several folds.

In some cases a drooping brow also makes the eyes look heavy, and some people have two or more of these at once. That is why surgery is not chosen from the sleepy look alone; the first step is to work out which group the cause belongs to.

What does weak eye-opening strength look like in daily life?

Of the four groups, the one directly linked to ptosis correction is the first: eye-opening strength. When this strength falls short, it can show up in daily life like this.

1. You open your eyes with your forehead and brows — Your forehead tenses or you raise your eyebrows when you open your eyes.
2. Horizontal lines form on your forehead — Repeatedly lifting the eyes with the brows and forehead can contribute to forehead lines.
3. Your eyes do not open easily and feel uncomfortable — Your eyes may feel hard to open and uncomfortable.
4. You still look sleepy after double eyelid surgery — The crease was made but your look has not changed much, or the double eyelid seems to have loosened.

In a consultation, along with these signs, we look at how much of the iris shows when you open your eyes comfortably with your brows and forehead relaxed. The 1mm Plastic Surgery ptosis correction guide explains that about 80% of the iris showing is regarded as the normal range, and less than that can give a sleepy look. This number is only one reference point, however, and the actual judgment is made through a consultation.

The steps for a self-check in front of a mirror are covered in our earlier Korean-language post, 「눈매교정, 내 눈에는 해야 할까? 하면 안 될까?」 (Ptosis correction: should I have it or not?). A self-check is for reference only and cannot decide on its own whether you need ptosis correction.

Does a different cause change the direction discussed in a consultation?

Yes. Even for the same ‘sleepy eyes’, the surgical direction discussed in a consultation can differ depending on which group the cause belongs to. The table below sums up, for each group, what is looked at and which directions are considered.

Cause	Mainly looked at	Directions considered
Eye-opening strength	How much of the iris shows when the eyes are opened comfortably; whether the forehead and brows are used	Ptosis correction (non-incisional · incisional)
Sagging eyelid skin	Whether skin covers the lashes, whether it blocks vision, the distance between eye and brow	Upper blepharoplasty · Sub-brow lift
Thick eyelids and fat	Skin thickness, amount of fat	Incisional ptosis correction · Fat removal
Sunken upper lids	Extent and shape of the hollow, whether the double eyelid looks like several folds	Upper eyelid fat grafting

The directions in the table are ‘what is considered’, not a fixed formula. In some cases two or more procedures are combined, and the exact method is decided after a consultation and examination.

• Upper blepharoplasty — An incision on the upper eyelid removes sagging skin, and the length and position of the muscle are adjusted so eye-opening strength is addressed as well.
• Sub-brow lift — An incision just below the eyebrow lifts the sagging skin, leaving the existing double eyelid crease untouched. The incision site differs from upper blepharoplasty.
• Upper eyelid fat grafting — Fat is placed into the hollow above the eye. Depending on how well the fat settles, a second graft is sometimes done.

If ptosis correction is right for you, how are incisional and non-incisional methods chosen?

If the cause lies in eye-opening strength, ptosis correction is considered. Ptosis correction is surgery that adjusts the function that lifts the eyelid to set how much of the iris shows, and it is broadly divided into non-incisional and incisional methods. Which one suits you depends on the degree of ptosis and on the thickness and fat of the eyelid.

• Non-incisional ptosis correction — Tiny openings are made along the designed line, and knots reinforce eye-opening strength while setting the double eyelid crease. Because the skin is not cut along a long line, scarring tends to be less of a concern. However, fat removal is hardly possible, and it is a method suited to cases where ptosis is not severe and the eyelid is thin.
• Incisional ptosis correction — After an incision along the designed line, the eye-opening muscle is pulled and tied to adjust its length. It can be applied to most cases, including severe ptosis, and fat can be addressed at the same time. However, fine scarring may occur.

In short

For mild ptosis with a thin eyelid, the non-incisional method is often considered; for severe ptosis, or thick skin with more fat, the incisional method is often considered. Even if you have already had double eyelid surgery, ptosis correction can be considered without touching the existing crease if eye-opening strength falls short. You can find details of the methods in the 1mm Plastic Surgery ptosis correction guide.

What are recovery and side effects like after ptosis correction?

Ptosis correction is surgery that deals with the function of opening the eye. Whether non-incisional or incisional, it is surgery, so there is a recovery process and side effects may occur. The recovery period differs by method and eye condition, and we explain it for each person in the consultation.

Side effects and points to note

Common recovery reactions — Swelling, bruising and a difference between the two sides may occur. The course of recovery differs from person to person and is checked through a consultation.

Eye discomfort — You may feel a gritty or tight sensation, a foreign-body sensation or dryness.

Degree of correction — If the eye already has enough opening strength and is corrected more than needed, the eyes may feel as if they open too wide. That is why it is important to correct within the range your current condition needs. Depending on the individual, the degree of correction and differences between the sides may not match what you expect.

Scarring — The incisional method may leave fine scarring.

Correcting one side only — If only one side is corrected, the eyes may later become uneven again compared with the other side.

Symptoms to report to your surgeon right away — If you have severe pain or pressure in the eye that painkillers do not control, an eye that does not close fully, a scar that becomes red and hard, a small lump you can feel, or recurring inflammation, seek care right away.

Sleepy eyes and ptosis: frequently asked questions

Is ‘sleepy eyes surgery’ the same as ptosis correction?

Surgery that changes a sleepy look is often called that, but the term does not refer to a single operation. If the cause is eye-opening strength, ptosis correction is considered; if it is sagging skin, upper blepharoplasty or a sub-brow lift; if it is sunken upper lids, fat grafting — the direction changes with the cause.

I still look sleepy after double eyelid surgery. Can I have ptosis correction?

If eye-opening strength still falls short after double eyelid surgery, ptosis correction can be considered without touching the existing double eyelid crease. However, the sleepy look may come from another group, so the cause is checked first.

Only one eye looks sleepy. Can ptosis correction be done on one side only?

Correcting one side only is possible. However, the eyes may later become uneven again compared with the uncorrected side, so we recommend deciding after checking the condition of both eyes together.

Are forehead lines related to the eyes?

They can be. When the eyelids sag or eye-opening strength is weak, people lift their eyes with the brows and forehead, and when this is repeated it can contribute to forehead lines. Reducing forehead lines themselves needs a separate consultation.

Is there less concern about scarring with non-incisional ptosis correction?

Because the skin is not cut along a long line, scarring tends to be less of a concern. However, it is surgery that makes tiny openings, so there is a recovery process such as swelling and bruising, and it may not suit eyes with severe ptosis or thick eyelids with more fat.

What happens in a consultation

Before the sleepy look itself,
we check which group the cause belongs to

• Checking how much of the iris shows when your eyes are opened comfortably
• Checking eyelid skin sagging, thickness and fat
• Checking the upper lid area, brow position and differences between sides
• Explaining the surgical direction that fits the cause, and its side effects

We check the structure of your eyes together with the function of opening them, and discuss a suitable surgical direction. Results and the course of recovery may differ from person to person.

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This post was written by the founder of a medical institution to provide medical information. The eye images in this post are concept illustrations and diagrams made to aid understanding; they do not show real people and are not before-and-after images. The interior image is from the ‘Clinic tour’ on our website and may differ from the actual premises. For any surgery, its suitability for you, the result and the course of recovery may differ depending on your eye condition, and side effects may occur. Please confirm the details through a consultation.