Hooded Eyes
Excess upper eyelid skin — and why it is not the same thing as a droopy eyelid
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- Skin or muscle? The distinction decides the operation — and it is measured, not guessed
- Free consultation — £25 booking deposit, redeemable against treatment
- Consultant plastic surgeons, GMC specialist register
- Visual field testing where the hood affects your vision
- CQC registered hospital in central Manchester
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Hooded Eyes
Dermatochalasis — Assessment and Treatment in Manchester
A hooded eye is one where surplus upper eyelid skin folds down over the crease, and in more marked cases over the lash line. The medical term is dermatochalasis. It is the commonest reason people become unhappy with their upper eyelids, and it is almost entirely a consequence of the skin losing elasticity with age, helped along by sun exposure, smoking and genetics — some families hood in their thirties.
The practical complaints are consistent: eyeshadow no longer stays where it is put because the fold sits on top of it, the eyes look tired regardless of how much sleep you have had, and in more advanced cases the fold sits on the lashes and cuts into the upper field of vision, so you find yourself lifting your brows to see.
There is one thing worth establishing before anything else, and it is the whole point of this page: hooding and drooping are two different problems with two different operations. Getting them the wrong way round is the commonest reason someone comes out of eyelid surgery with an eye that is no more open than it was.
Skin or Muscle? Dermatochalasis vs Ptosis
The distinction that decides the operation
Understanding Your Assessment
Dermatochalasis is excess skin. The eyelid itself opens normally, but a fold of surplus skin hangs over it. Lift that fold with a finger and the eye underneath looks entirely normal. The operation is an upper blepharoplasty: remove the skin, and the eye is uncovered.
Ptosis is a drooping eyelid. The levator muscle that lifts the lid is weak or has detached from its insertion, so the lid margin itself sits low over the pupil. Lifting the skin fold does not help, because the problem is beneath it. The operation is a ptosis repair, which tightens or reattaches the muscle — a different procedure entirely.
The measurement that separates them is MRD1: the distance from the centre of the pupil to the upper lid margin when you look straight ahead. Normal is around 4 to 4.5mm. Below that indicates true ptosis, and the smaller the number the more marked it is.
The two frequently occur together, particularly in older patients, and where both are present both need addressing. Removing skin from an eye with unrecognised ptosis produces a tidier eyelid that is still half shut — which is precisely the complaint that brings people in for revision.
The brow test
Something worth checking in a mirror before your consultation. Look straight ahead, relaxed. Now place a finger firmly on your brow and hold it down at its natural resting position, so you cannot recruit your forehead to lift it.
If your eyelid still looks heavy with the brow held down, the hooding is coming from the eyelid skin and an upper blepharoplasty addresses it. If holding the brow down makes things dramatically worse — and you realise you have been unconsciously lifting your forehead all day — then a descended brow is contributing, and eyelid surgery alone will disappoint you. That needs a brow lift, or both.
This is a rough guide and not a substitute for examination, but it is the single most useful thing you can check yourself, and it explains why some people are dissatisfied after technically well-performed eyelid surgery.
When Hooding Affects Your Vision
Hooded Eyes Assessment in Manchester
Where the fold of skin reaches the lashes it starts to obstruct the upper part of your visual field. People adapt without noticing — tilting the chin up to read, lifting the brows constantly, and getting tension headaches from the forehead muscles doing a job the eyelid should be doing.
This is the circumstance in which upper blepharoplasty is sometimes funded on the NHS. It generally requires formal visual field testing demonstrating obstruction, and thresholds vary between commissioning areas. If your hooding is heavy enough that you lift your brows to see, it is worth asking your GP before going private — and we will say so at assessment rather than quietly taking the booking.
Deansgate Hospital is a CQC‑registered independent hospital in central Manchester. Assessment is with a consultant plastic surgeon on the GMC specialist register, with MRD1 measured, brow position assessed, and visual field testing arranged where the hood is heavy.
What Can Be Done
The options, and which finding each one addresses
Surplus eyelid skin is removed by excision. There is no cream, device or injectable that removes skin, and non-surgical “eyelid tightening” treatments produce nothing meaningful in established hooding. What matters is choosing the right operation for what is actually causing the heaviness — skin, muscle, brow, or more than one.
1. Upper Blepharoplasty — from £2,500
For dermatochalasis: excess skin with a normal lid position. A crescent of surplus skin, and sometimes a strip of muscle and a little fat, is removed and the wound closed in the natural eyelid crease where the scar becomes almost invisible. From £2,500 under local anaesthetic, or £5,000 under general. Thirty to forty-five minutes, day case, most people back at a desk within a week.
2. Ptosis Repair — quoted at consultation
For a genuinely drooping lid — a low MRD1. The levator muscle or its aponeurosis is tightened or reattached so the lid margin sits where it should. A different operation from a blepharoplasty, and frequently done at the same time as one where both findings are present. Quoted individually because the technique depends on how much levator function remains.
3. Brow Lift — from £8,000
Where a descended brow is pushing the eyelid tissue down. Removing eyelid skin in someone whose real problem is a heavy brow lowers the brow further and produces a crowded, unnatural result. From £8,000, and sometimes combined with a blepharoplasty.
4. Upper and Lower Together — from £6,500
Where the lower lids also carry bags or hollows, doing both in one sitting means one anaesthetic and one recovery. Upper and lower blepharoplasty from £6,500; lower lid surgery alone from £5,500.
To find out whether your heaviness is skin, muscle, brow or a combination, book an assessment in Manchester on 0161 470 9280 or enquire online. MRD1 is measured and brow position assessed as part of the appointment.
Am I suitable for upper eyelid surgery?
What is checked before you are booked
Most healthy adults with genuine dermatochalasis are suitable, and it is one of the better-tolerated operations in plastic surgery — often under local anaesthetic, with a short recovery and a scar that hides in the crease.
What is checked first: dry eye, because removing skin can worsen it and someone with significant existing dryness needs that managed before surgery; thyroid eye disease, which changes both the assessment and the plan; previous eyelid surgery; and any history of facial nerve weakness or difficulty closing the eye, which is a reason for caution because the eyelid must still shut properly afterwards.
Smoking delays healing, and anyone on blood thinners needs a plan agreed with whoever prescribes them, because bruising around the eye is the main early complaint and bleeding behind the eye, though rare, is the serious one.
Dry Eyes Come First
Removing eyelid skin can worsen dry eye. If your eyes are already gritty or watery, that is assessed and managed before surgery rather than discovered afterwards.
Check the Brow
Eyelid surgery on someone whose real problem is a descended brow produces a crowded result and a disappointed patient. The brow is assessed as part of every upper lid consultation.
What Upper Eyelid Surgery Will Not Do
Setting expectations honestly
It removes surplus skin from the upper lid and uncovers the eye. That is a genuine and often dramatic change, and satisfaction with it is consistently high.
It does not lift the brow, soften crow’s feet, or change dark circles and hollows under the eyes. It does not alter the shape of your eye or make a round eye almond, and requests to change eye shape rather than remove excess skin are a different conversation with a different answer. It does not stop ageing — skin continues to lose elasticity, and while most people never need the operation again, some do after ten or fifteen years.
It also does not correct a drooping lid. If your MRD1 is low, skin removal alone leaves you with a tidier eyelid that is still half shut — which is the single commonest reason people seek revision after eyelid surgery done elsewhere.
What Treatment Costs
From £2,500
Upper blepharoplasty at Deansgate Hospital starts from £2,500 under local anaesthetic, or £5,000 under general anaesthetic. Upper and lower lids together start from £6,500, and lower lid surgery alone from £5,500. Brow lift starts from £8,000. Ptosis repair is quoted individually at consultation.
The fee covers your surgeon, the procedure, the hospital, dressings and all routine follow-up. Assessment is a free consultation with a £25 booking deposit, redeemable against treatment.
Where your hooding is heavy enough to obstruct vision, ask your GP about NHS funding before booking privately. We will raise it at assessment if it looks likely to apply.
Assessment and Surgery, Step by Step
From first appointment to twelve-month review
An upper eyelid assessment is mostly measurement, and the measurements are what decide the operation. Here is what each stage involves.
Your surgeon examines you sitting upright looking straight ahead. MRD1 is measured on each side — pupil centre to upper lid margin — which distinguishes excess skin from a genuinely drooping lid. Levator function is measured by asking you to look up and down with the brow held still. The amount of surplus skin is assessed by pinch, and the brow position is checked with the forehead relaxed.
Your eyes are checked for dryness, and you will be asked about grittiness, watering, contact lens use and any thyroid problems. Where the hood is heavy enough to obstruct vision, formal visual field testing is arranged.
You are then told which finding you actually have — skin, muscle, brow, or a combination — and what each would involve. Photographs are taken and you leave with a written plan and quotation.
Excess skin with a normal MRD1 is a blepharoplasty. A low MRD1 is a ptosis repair. A descended brow is a brow lift. Where two findings coexist, both are addressed — commonly a blepharoplasty with a ptosis repair in the same sitting.
Getting this right is the whole value of the appointment. Removing skin from an eye with unrecognised ptosis is the classic error, and the patient goes away with a neater lid that is still half shut. Likewise, operating on the eyelid of someone whose brow has descended pulls the brow lower still and produces a crowded, heavy look.
Where the answer is that you would be better served by a brow lift than the eyelid surgery you came in asking about, that is what we will tell you.
You are marked sitting upright, because eyelid skin falls differently lying down. Most upper blepharoplasty is done under local anaesthetic with you awake and comfortable, taking thirty to forty-five minutes for both sides.
A crescent of surplus skin is marked and excised, with a strip of orbicularis muscle and a small amount of fat removed where indicated. The incision sits in the natural eyelid crease, which is where the scar becomes almost invisible once healed. Closure is with fine sutures, usually removed at five to seven days.
Deansgate Hospital is a day-case facility and you go home the same day. Where a ptosis repair or brow lift is combined, the operation is longer and may be done under general anaesthetic.
First 48 hours. Swelling and bruising, at their worst around day two to three. Sleep propped up, cold compresses, and no bending or straining. Discomfort is usually mild and managed with paracetamol.
Week 1. Sutures out at five to seven days. Bruising turns yellow and starts to fade. Most people prefer not to be seen socially this week. Reading and screens are fine in short bursts; eyes tire quickly.
Week 2 to 3. Most bruising gone or concealable with makeup, which can usually restart once the wounds are fully sealed. Back to work typically at seven to ten days for a desk job.
Weeks 3 to 6. Light walking only — nothing strenuous, nothing that raises your heart rate or blood pressure, because raised blood pressure around fresh eyelid wounds risks bleeding. No swimming until fully healed.
Six weeks onwards. Exercise resumes. The scar remains slightly pink in the crease for a few months then fades to a fine line that is difficult to see with the eye open.
Upper blepharoplasty is well tolerated but it is surgery on the eyelid. Common and expected: bruising, swelling, temporary blurred vision from ointment, watering, and a period of dryness or grittiness.
Recognised risks: asymmetry between the two sides, which is the commonest reason for a small adjustment; over-correction or under-correction of the amount of skin removed; a scar that is visible for longer than hoped; and difficulty fully closing the eye, which is usually temporary but is the reason your surgeon is conservative about how much skin to take.
Dry eye can be worsened, sometimes persistently, which is why existing dryness is assessed and managed beforehand.
The rare but serious complication is a retrobulbar haematoma — bleeding behind the eye — which can threaten vision and requires immediate treatment. It is why straining, bending and raised blood pressure are restricted after surgery, and why anyone on blood thinners needs a plan agreed in advance. You will be told what to look for and how to reach us.
Deansgate Hospital is a registered independent hospital in central Manchester with its own theatres and its own team. Your consultant plastic surgeon is on the GMC specialist register, you meet them at assessment, and they perform the operation themselves.
For eyelids in particular, what matters is the measurement. MRD1, levator function and brow position take two minutes to assess and they determine whether the operation you are about to have is the right one. Aftercare, follow-up and any revision required for a surgical complication are included in the quoted fee.
Hooded Eyes
Frequently Asked Questions
What causes hooded eyes?
Loss of elasticity in the upper eyelid skin, so surplus skin folds down over the crease. Age is the main driver, helped along by sun exposure, smoking and genetics — some families hood in their thirties. The medical term is dermatochalasis. A descended brow often contributes by pushing the tissue down from above.
Is hooding the same as a droopy eyelid?
No, and the distinction decides the operation. Hooding (dermatochalasis) is excess skin over a normally positioned lid — lift the fold and the eye underneath looks normal. Ptosis is a drooping lid, where the muscle that lifts it is weak or detached, so the lid margin itself sits low over the pupil. Removing skin does not fix ptosis.
What is MRD1?
Margin reflex distance 1 — the distance from the centre of the pupil to the upper lid margin when you look straight ahead. Normal is around 4 to 4.5mm. A lower figure indicates true ptosis rather than simple hooding. It takes seconds to measure and it is the single most useful number in an upper eyelid assessment.
How do I know if my brow is the problem?
Look straight ahead, relaxed, then hold your brow down firmly at its natural resting position so you cannot lift it with your forehead. If the lid still looks heavy, the problem is eyelid skin. If holding the brow down makes things dramatically worse, a descended brow is contributing and eyelid surgery alone will disappoint you. It is a rough guide, not a substitute for examination.
Can hooded eyes be treated without surgery?
Not meaningfully, once there is an established fold. Nothing applied to the surface removes skin, and non-surgical eyelid-tightening devices produce little in genuine dermatochalasis. Anti-wrinkle injections can give a small brow lift in some people, which helps at the margins, but it does not address surplus eyelid skin.
Where is the scar?
In the natural crease of the upper eyelid, which is one of the best places on the body to hide a scar. It is pink for a few months and then fades to a fine line that is difficult to see with the eye open. Most people find it undetectable at conversational distance within a few months.
Is it done awake?
Usually, yes. Most upper blepharoplasty is performed under local anaesthetic with the patient awake and comfortable, taking thirty to forty-five minutes for both sides. General anaesthetic is available and is used where the procedure is combined with a brow lift or ptosis repair, or simply where you would prefer it.
How long is the recovery?
Sutures out at five to seven days. Bruising is worst around day two to three and mostly gone or concealable by week two. Back to a desk job typically at seven to ten days. Exercise waits until six weeks — raised blood pressure around fresh eyelid wounds carries a bleeding risk, so light walking only before then.
Will it make me look different, or just less tired?
For most people it uncovers the eye they already had rather than changing it — the usual comment from friends is that you look rested rather than that you have had something done. It does not change eye shape, and a request to alter shape rather than remove excess skin is a different and more complex conversation.
Can I get it on the NHS?
Sometimes, where the hood is heavy enough to obstruct your upper visual field. It generally requires formal visual field testing demonstrating obstruction, and thresholds vary by commissioning area. If you find yourself lifting your brows to see, it is worth asking your GP before going private — and we will raise it at assessment if it looks likely to apply.
I have dry eyes — can I still have it?
Often, but it needs assessing first. Removing eyelid skin can worsen dry eye, sometimes persistently. Existing dryness is evaluated and managed before surgery, and in some cases the sensible answer is to treat the dry eye first and be more conservative with how much skin is removed.
How much does upper eyelid surgery cost in Manchester?
At Deansgate Hospital, upper blepharoplasty starts from £2,500 under local anaesthetic or £5,000 under general. Upper and lower together from £6,500; lower lids alone from £5,500; brow lift from £8,000. Ptosis repair is quoted individually. The fee covers your surgeon, the procedure, the hospital, dressings and routine follow-up.
Not sure if it is skin or a droopy lid?
Hooded Eyes Assessment, Manchester
Hooding and drooping look similar in the mirror and need different operations. Getting that wrong is the commonest reason someone comes out of eyelid surgery with an eye no more open than before — and it takes two minutes of measurement to avoid.
Book an assessment with one of our consultant plastic surgeons in Manchester. MRD1 and levator function are measured, brow position assessed, and you will be told which of the three problems you actually have. Call 0161 470 9280 or enquire online.