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How to fix droopy eyelids

If you’re bothered by drooping eyelids and sagging skin, you’re not alone. More and more people are investigating cosmetic fixes to smooth out the wrinkled skin around your eyes. “Treatment for aging eyelids focuses on the particular anatomical change that’s causing the problem,” says Dr. Perry.

Doctors divide the options for correcting these issues into nonsurgical and surgical approaches.

How to fix droopy eyelids without surgery

Nonsurgical treatments — including hyaluronic acid fillers, or injections like Botox® or Dysport® — can help you look more youthful. These treatments can smooth out wrinkles around your eyes, fill in hollows or tighten sagging eyelids. An oculoplastic surgeon or oculofacial plastic surgeon can assess the best treatment for your needs.

Injections

Injection of products that contain botulinum toxins (such as Botox or Dysport) can help tighten sagging skin and reduce wrinkles around your eyes.

These products work to correct eyelid issues associated with aging by weakening muscles in the crow’s feet area around your eye, giving you a more youthful look when you smile, Dr. Perry says. “Interestingly, by weakening the muscles that pull the brows down, it can actually lift the brows,” says Dr. Perry. “We can achieve a Botox brow lift that can take some of those folds and heaviness of the upper lids and lift it out of the way.”

Fillers

Hyaluronic acid gel fillers, which include products such as Juvéderm® and Sculptra®, provide extra volume to fill in deeper crevices on your cheeks and around your lower lid areas.

“I’ve used fillers in the lower eyelids for a decade, and it often improves the hollowness that can form beneath the bag within the eyelid,” Dr. Perry notes. “It’s not perfect, though. Fillers can cause a bluish hue in those hollow areas, which can contribute to the appearance of dark circles.”

Plus, fillers are also temporary, require reinjections over time and can cause fluid buildup in the eyelids. “We call this fluid buildup festoons or malar mounds,” says Dr. Perry. “Those are also unsightly because they lead to shadows and contours in the junction between the eyelid and the cheek.”

In more serious cases, fillers in the tear trough periorbital hollow can even cause blindness. “The risk of that is incredibly low — but it is not zero,” Dr. Perry says. “If the filler gets into a blood vessel that tracks behind the eye, bad things can happen to the vision. And it can be permanent.”

Dr. Perry adds that it’s often a good idea to use both fillers and injections. Because each option treats different problems, you experience greater overall benefit. “Both products have their pros and cons but do work well to provide a more youthful appearance.”

However, fillers aren’t right for everybody. “If you have fluid blisters, inflammation, allergies, Graves’ disease — anything that causes a tendency for fluid buildup in the eyelids — you may not be a good candidate,” he notes.

Chamomile tea bags

You can use chamomile tea bags to improve the tear film, the layers that keep your eyes moist. Chamomile tea bags can also improve blepharitis, which is “basically dandruff, thick oils and inflammation around the eyelashes,” says Dr. Perry. However, these tea bags are not helpful at improving dark circles.

Surgical options

“Surgical options offer a more permanent solution that can treat more of the components that contribute to the aging process,” says Dr. Perry. “The surgical options are designed to treat structural issues around the eyelids, such as crow’s feet or deeper crevices due to aging.”

Eyelid surgery

Eyelid surgery — blepharoplasty and other procedures — can remove excess skin and fat, reposition fat and tighten your skin.

If you have excess skin, the surgeon can remove a small amount in your lower lids, but Dr. Perry says it’s important to realize that removing this skin doesn’t really treat the underlying problem of laxity and bags under your eye. This skin removal only treats part of the problem.

Fat removal

If you want a more dramatic, rejuvenating effect from surgery, you’ll need to undergo a deeper restructuring that treats the problem of excess fat and bags.

“Older surgeries involved simply removing this excess fat, which improves the undereye bag, but do nothing to improve the hollow area that forms beneath the bag,” Dr. Perry explains.

Fat removal can help you appear less tired and more alert, but can have a downside, he says. “You might think that removing the fat is the key to rejuvenation. In reality, removing the fat can sometimes add to aging changes and add to the hollows.”

Fat repositioning

For the hollow underneath eye bags, oculoplastic surgeons reposition the fat rather than removing it completely.

“Part of what we do with our cosmetic surgeries is use fat to our advantage to improve the shadows, hollows and the contours, rather than simply throwing it away,” Dr. Perry says. “Yes, those eyelid bags are made up of herniated fat. But it does not mean that we necessarily want to simply discard that fat.”

Taking fat from one area and repositioning it addresses both the bag and the hollow area underneath it. In fact, Dr. Perry says, this procedure treats dark circles and hollows better than hyaluronic acid fillers — but it requires a bigger commitment to surgery.

“When we move eye socket fat into the cheek, we’re crossing anatomic boundaries, which can result in longer healing time and little lumps and bumps that take some time to improve,” he says.

Do droopy eyelid exercises exist?

Unfortunately, no. Exercises don’t exist to prevent droopy eyelids or the effects of aging on your eyes.

“If you think about it, our eyelids are exercising all day long,” Dr. Perry says. “They blink 30,000 times a day. Our eyes are constantly moving. Our eyes are already getting a workout. There’s nothing extra we can do to prevent or delay or improve these aging changes.”

However, preventing inflammation near your eyes is important. “Rubbing your eyes can lead to skin stressing, which is maybe why long-term contact lens wear can cause droopy eyelids,” Dr. Perry says. “Anything that causes inflammation is going to hasten or aggravate aging changes.” That’s why it’s important to treat allergies, dry eye and blepharitis, and avoid the sun. “All of those are inflammatory and those participate in the aging process.”

Are droopy eyelids serious?

Although droopy eyelids usually result in purely cosmetic issues, Dr. Perry says they can also sometimes cause vision problems. “Generally, it’s going to cause limited ability to see up above,” he explains. “Some people notice a shadow on the upper part of their vision. Some people notice that they’re needing to lift their brows up in order to see better, or even lift their eyelids up to see better.”

Other people might feel symptoms like fatigue, heaviness or weightiness, he adds. “And when the lower lid sags, that it can sometimes lead to tearing. That can affect vision as well.”

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