Heavy, hooded upper eyelids are often blamed on excess skin. Frequently the real culprit is the muscle that lifts the lid - and the two need entirely different treatment

A woman in her late forties came to my clinic with a complaint I hear often. Her eyes looked smaller than they used to. She wasn't sure if she looked tired, older, or simply different. She showed me photographs from a few years earlier, and the change was unmistakable: her upper eyelids now sat heavily over her eyes, and the open, awake look she remembered had quietly closed in.