Years ago, those with hooded eyelids who were looking to lift them had few options beyond surgery. But technology has come a long way in the last several years. Now hooded eyes can be corrected by several non-invasive options: Botox, eyebrow thread lifts, and plasma fibroblast treatments among them.
As Lindsey Zubritsky, MD, explains, it's a problem that most often affects older people—but even some younger people are starting to request treatment that can help fix hooded eyes. "The majority of my patients are older women between the ages of 40 and 70, but many men and even young adults are coming into the office seeking treatment" for hooded eyelids, says Zubritsky.
With the help of Zubritsky, Azadeh Shirazi, MD, and Dr. Michael Horn, we explored how to fix hooded eyes.
Meet the Expert
- Azadeh Shirazi, MD, is a board-certified cosmetic dermatologist at the La Jolla Dermatology & Laser Surgery Center in La Jolla, California.
- Lindsey Zubritsky, MD, is a board-certified cosmetic dermatologist at Advanced Dermatology and Cosmetic Surgery in the greater Pittsburgh area.
- Dr. Michael Horn is a board-certified plastic surgeon based at Lakeshore Plastic Surgery in Chicago.
The Causes of Hooded Eyes
From an aging perspective, hooded eyelids are when the skin above the eye sags and hangs over the eye. The excess skin occurs between the brow and the upper lash line. They're caused by a variety of factors, including age and genetics. Dr. Michael Horn explains that as we age, we lose bone, facial volume, collagen, elastin, and fat.
"Various factors such as genetics, aging, and underlying fat contribute to hooded eyelids. As we age, our muscles begin to lose elasticity and sag," Horn says. "This is typically first evident around the eye area where the skin is the thinnest."
While these are some of the most common reasons for hooded eyelids, many people are born with a naturally hooded eyelid due to their facial structure and the skin dropping down and folding over the crease of their lid.
"When eyes are hooded, the sagging skin may cover all or part of the eyelid, causing a crease and making the eyelid/eyes appear smaller," explains Horn. "While it does not usually lead to medical issues, some find it can obscure their vision besides cosmetic ones."
Treatments for Hooded Eyes
Botox
Zubritsky says that Botox is an easy, relatively low-risk procedure with minimal downtime used to lift hooded eyelids and droopy brows; this is often referred to as a "Botox brow lift."
This procedure is best used in mild cases of hooded eyelids or for younger patients. Botox for hooded eyes works by relaxing the muscles around the eyes and between the brows, which then lifts the eyebrow to a higher position. Shirazi says that when Botox is strategically placed, it can lift and open up the eyes quite significantly, resulting in a brighter look to the eyes.
Price: The cost of Botox cost depends on the number of units used by your provider, but in 2019, the national average was around $379.
Temple and Brow Filler
Shirazi explains that the loss of structure around the eyes can cause the eyebrows to droop. Adding a dermal filler to the area can provide a lift to the eyebrows and decrease the look of hooded eyelids.
Price: The cost of dermal fillers depends on the brand used (Juvederm Ultra, Ultra Plus, Voluma, Restylane Lyft, Restylane, Belotero, Sculptra, etc.), ranging from $625 to $850 in 2019.
Laser Resurfacing
Laser resurfacing can provide "substantial results," says Horn, as it works by tightening the skin while promoting collagen production. This helps the area heal in a smoother, more even appearance while ablating loose skin around the eyes for a non-surgical eyelift.
"It works by heating the layers of the eyelid skin to enhance collagen production, which we lose with age," Horn says. "It is typically performed with a fractional Co2 laser. This is performed on an outpatient basis."
Price: Ablative laser resurfacing will cost a pretty penny—in 2019, the procedure came in at around $2,200.
Eyebrow Thread Lift
An eyebrow thread lift is a minimally invasive procedure. Dissolvable threads are strategically placed in the appropriate layer of skin with a needle (no incision needed) and lifted upward; they essentially act as an anchor. The excess threads are then cut off. This creates an instant lift to the eyebrow area and adds support for the upper eyelid. In addition, it helps the region to produce new collagen over time. It's a pretty quick procedure performed under local anesthetic—it can even be done on your lunch break. Keep in mind that it does come with a little bit of bruising, soreness, or swelling for a few days post-treatment.
Price: The cost of an eyebrow thread lift can range from $1,500 to $6,000. Results lasts between one to three years, depending on how quickly your body dissolves the threads.
Plasma Fibroblast Skin Tightening
Plasma fibroblast skin tightening treatments work by creating hundreds of tiny holes or controlled micro-injuries on the upper eyelid with a high-frequency electric current. Instantly, the little holes shrink up, resulting in a retraction of the skin and a tightening and lifting effect. This may sound a bit frightening, but it's considered to be a low-risk procedure. Since the eyelid area is thin and delicate, a bit of swelling may occur.
It usually takes two to three weeks for the tiny holes to heal, and you will see the final result within six to eight weeks, depending on your skin's healing time. Results can last up to three years.
Price: Plasma fibroblast skin tightening treatment costs vary, but are typically in the upper hundreds of dollars.
Microcurrent Devices
Microcurrent devices are popular because they are relatively easy to use, can be performed at home, and are not as expensive as in-office procedures. Microcurrent devices like NuFace Trinity with the ELE attachment (a smaller attachment for the eye and lip areas) work by stimulating muscles, resulting in a temporarily lifted effect to the skin.
Before undergoing even a minor cosmetic procedure, though, it's best to speak to an expert, says Horn. "If you are uncertain about the cause of your saggy eyelids, visit an ophthalmologist for an eye exam to rule out non-cosmetic and medical conditions," he says.
Price: Microcurrent devices will, on average, range from $200 to $400 and should last thousands of uses.
Surgery
Eyelid surgery, known as upper lid blepharoplasty, is recommended for people with moderate to severe eyelid sagging. Out of all the treatments for hooded and sagging eyes it will be the most invasive and expensive, and comes with the most downtime. However, the results often last around a decade, which is significantly longer than most other treatment options.
Blepharoplasty is a surgical procedure that requires anesthesia, but can be performed on an outpatient basis. Horn explains: "It takes approximately one hour, or less, depending on whether a patient is having upper and lower eyelids corrected."
"With upper lid blepharoplasty, a plastic surgeon typically makes an incision along the eyelid's natural crease," Horn continues. "After the incisions have been completed and excess skin and fat deposits removed, this will tighten the eyelid area and restore the eyes to a more youthful, symmetrical, less puffy, wide-eyed and more rested appearance."
Horn says most patients can return to work or regular activity in two to three days, with full recovery in about a week to 10 days in terms of physical appearance."
The treatment is a high-priced option but as Horn notes, it is the gold standard for droopy or hooded eyelids. "It requires only one surgery, and its benefits last for many years."
Price: Blepharoplasty costs upwards of $4,000, according to recent statistics from the American Society of Plastic Surgeons.
Eye Drops
As Horn explains, UPNEEQ is a new FDA-approved eye-lifting drop available by prescription that offers "a temporary fix for droopy eyelids and requires a single dose daily."
"It will not provide the permanent or dramatic results one gets from surgery; however, it can give about 1mm of lift in the upper eyelid following the first use, which can be enough for some people to see an improvement," Horn adds.
Price: UPNEEQ ranges from $200 to $300 for a 30-day supply.
Radiofrequency Treatment
Radiofrequency treatment offers a non-invasive way to stimulate collagen production "by permeating the dermis in a high-density dot pattern," Horn explains.
"Fast healing occurs because stem cells in the untreated areas advance new collagen growth in the treated area. This is approximately a 15-minute procedure and ideal candidates are those with mild to moderate eyelid skin laxity but are not ready for surgery."
Several treatments may be required to achieve the desired outcome and radiofrequency can be used on the upper or lower eyelids.
Price: Radiofrequency treatment costs vary from $500 to $5,000 depending on the device used.
The treatment you ultimately end up choosing—if you choose any at all—is a personal decision, based on factors including your desired results, downtime, and budget. It's a good idea to speak with a board-certified dermatologist about your options to obtain your goals.