Eyelid Ptosis and Pseudoptosis in the 70s: Forehead Thread Lift Case Study

a. A woman in her late 70s was experiencing heavy eyelids and restricted upper visual fields due to drooping eyelids and lateral brow sagging.

b. She had a history of previous upper blepharoplasty, and considering the burden of revision surgery, a forehead thread lift was performed.

c. Post-treatment evaluations monitored the progression of eyebrow position, lateral eyelid hooding, left-right asymmetry, and areas of skin irritation.

Hello. I am Dr. So-hyun Park, the Chief Director specialized in wrinkle reduction.

Today, we will examine the case of a woman in her late 70s who experienced heavy eyelids and obstructed vision when looking upward. This patient had a history of undergoing upper blepharoplasty in the past to trim sagging upper eyelid skin. However, over time, continued aging and tissue changes led to recurring ptosis around the eyelids and eyebrows.

In particular, her upper visual field felt restricted, opening her eyes felt heavy, and the outer eyelid skin repeatedly touched the lash line, causing ongoing discomfort and irritation. This type of eyelid ptosis is rarely just a localized issue of the eyelid skin; it requires a comprehensive evaluation of brow position, forehead muscle usage, temporal changes, and several other contributing factors.

1. Pre-Treatment Condition of Brows and Eyelids

Looking at her pre-treatment state, the position of the eyebrows sat somewhat below the supraorbital rim, and the lateral tail of the brow drooped lower than the medial head.

This is a common aging characteristic seen in individuals in their 70s, where brow ptosis itself makes the upper eyelids appear even heavier.

There was also a noticeable difference between the left and right eyelids. One side was hooded more than the other, with redundant skin sagging predominantly over the lateral eye area.

Furthermore, because the excess skin obscured the eyelid margins, findings consistent with pseudoptosis—where it appears as though the eyelid-elevating muscles are failing—were confirmed. Because the cause of pseudoptosis differs from a true decline in levator muscle function, distinguishing between the two is a critical diagnostic step.

Around the outer corners of the eyes, the drooping skin touched the eyelashes. When this contact is chronic, surrounding skin can suffer recurrent irritation and chafing, so clinical symptoms reported by the patient were also thoroughly assessed.

2. Evidence of Forehead Muscle Compensation to Open the Eyes

Examining the forehead revealed multiple deep transverse wrinkles extending from the lower to the upper regions. These wrinkles remained clearly visible even without active facial expression, which necessitated examining her habitual manner of opening her eyes.

When eyelids feel heavy due to drooping skin, patients often subconsciously raise their eyebrows to see better. In doing so, the frontalis muscle is continually recruited, and over long periods, this repetitive motion leads to prominent horizontal forehead creases.

This patient also had relatively deep transverse wrinkles across the bridge of her nose. When a patient recruits not only the forehead and brows but also the procerus and surrounding nasal musculature to open their eyes, bridge wrinkles can become markedly pronounced.

Therefore, when assessing eyelid sagging in patients in their 70s, one must not merely measure the excess skin, but also evaluate how they habitually open their eyes and how excessively they engage the forehead and nasal muscles.

3. Temporal Hollowing and Lateral Brow Ptosis

Changes in the temporal region were also examined.

This patient exhibited considerable temporal hollowing, likely driven by age-related fat and muscle atrophy.

When volume and structural support in the temples diminish, the lateral brow and outer eye corners naturally drift downward. In particular, when the lateral brow descends, the upper eyelid skin below it folds downward as well, exaggerating the appearance of eyelid hooding.

This patient presented with both temporal hollowing and lateral brow sagging. Consequently, rather than evaluating the eyelid skin in isolation, brow height and curvature, bilateral asymmetry, temporal volume loss, and frontalis muscle dynamics were assessed comprehensively.

4. Selecting Treatment While Weighing the Risks of Re-operation

This patient had a history of prior upper blepharoplasty.

Over the years, renewed sagging developed around the brows and eyelids, leading to complaints of heavy eyelids and obstructed superior vision.

Because she had already undergone surgery once, undergoing a secondary surgical revision posed significant burdens. During consultation, the current brow position, degree of lateral sagging, skin quality, and previous surgical history were thoroughly reviewed. Taking these factors into account, a forehead thread lift was selected.

Treatment modalities, including forehead thread lifting, are not universally applied to all cases of eyelid ptosis. The treatment plan varies based on age, skin elasticity, degree of brow ptosis, amount of remaining eyelid skin, surgical history, patient discomfort, and desired outcomes.

In particular, cases like pseudoptosis driven by redundant skin or brow descent require a completely different approach compared to true ptosis caused by weakened levator muscles, making precise clinical differential diagnosis essential.

5. Observed Post-Treatment Changes

Following the forehead thread lift, the eyebrow position and periorbital regions were re-evaluated and compared to the baseline state.

The eyebrows were elevated closer to the supraorbital rim, and the distance between the brow and eyelid margin widened compared to before the procedure.

The palpebral aperture also appeared wider, and noticeable improvement was observed where redundant skin had previously hooded the lateral eyelid and caused continuous friction.

Bilateral eyelid asymmetry was also checked and showed visible alleviation compared to pre-procedure status.

Additionally, subtle improvements were observed in the nasal bridge creases that had formed from chronic recruitment of forehead and nasal muscles to open the eyes. The evaluation did not focus solely on cosmetic improvements; progress was also tracked regarding functional relief from obstructed upper vision and alleviation of lateral eyelid irritation.

Because the degree and longevity of post-treatment results vary across individuals, periodic follow-ups are necessary to monitor long-term outcomes.

6. Eyelid Ptosis Requires an Evaluation of Underlying Anatomy

When someone in their 70s experiences heavy eyelids and limited superior vision, the root cause is not always confined to the eyelid skin alone.

Multiple anatomical structures around the eyelids and eyebrows—including the frontalis muscle, orbicularis oculi, brow-supporting retaining ligaments, and temporal fat and musculature—interact continuously.

When eyelid skin sags, patients often involuntarily compensate by recruiting forehead muscles to clear their visual field. If this cycle persists, transverse forehead furrows and nasal bridge wrinkles become pronounced, and discrepancies in brow height or shape can emerge.

Therefore, when diagnosing eyelid ptosis or pseudoptosis, it is vital to assess not only the redundancy of eyelid skin, but also brow position, facial asymmetry, forehead muscle movement, and temporal hollowing.

Crucially, if a patient has already had an upper blepharoplasty, existing eyelid skin redundancy, scar tissue, brow alignment, and levator muscle function must be examined with greater precision. Even if cases appear to share similar eyelid sagging, the underlying mechanisms differ. Determining whether revision surgery is necessary or if alternative approaches such as forehead lifting or thread lifts are viable must be decided through personalized, professional consultation.

This case review details the progress of a specific patient and does not represent guaranteed outcomes. Results and longevity vary depending on individual anatomy, skin condition, degree of aging, lifestyle habits, and chosen modalities; comprehensive consultation with a medical professional is necessary prior to treatment.

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You can view the detailed treatment plan and clinical course of this forehead thread lift for eyelid ptosis and pseudoptosis in the 70s in the accompanying video.

Frequently Asked Questions

If my eyelids droop again after upper blepharoplasty, is revision surgery my only option?

No, alternatives such as a forehead thread lift can be considered. When the burden of a secondary eyelid surgery is high, a comprehensive evaluation of brow position, forehead muscle compensation, and skin quality allows for non-surgical lifting options to alleviate hooding and visual obstruction.

How does pseudoptosis differ from true ptosis?

Their etiologies are different. True ptosis stems from functional weakness in the levator muscles that elevate the eyelids, whereas pseudoptosis occurs when excess skin or drooping eyebrows hood over the eyelid, making it appear weak. Treatments differ significantly, necessitating an accurate diagnosis.

Is eyelid ptosis in one's 70s caused strictly by eyelid aging?

No, it involves complex, multi-layered anatomical factors. Age-related descent of the lateral brow, temporal volume loss, and chronic frontalis muscle recruitment to widen the visual field all interact, making a holistic evaluation essential.

What changes can be expected following a forehead thread lift?

Patients can anticipate brow repositioning alongside improved upper visual fields. The distance between the brows and eyelid margins widens, lateral skin folding is cleared, and chronic tension in the forehead and nasal bridge muscles can be eased, softening bilateral asymmetry.