Upper eyelid skin sagging or redundancy produces what people call “hooded eyes.” The condition is common, with mild to moderate cases creating merely cosmetic concerns. However, severe eye hooding may affect vision and cause chronic headaches, thus becoming a medical problem.
The idea of getting a wrinkle treatment like Botox for hooded eyes may sound outlandish, but we encourage you to read on. Here, we talk about how the drug can remedy sagging eyelids to open your eyes and make them look younger. We also explain what you can expect throughout the treatment process.
But first, you might want to know…
What Causes Hooded Eyes?
The eyelid skin covers the area between the eyebrow bone and the eyelash. The factors creating a sagging eyelid are plenty, but for simplicity, we classify them as either structural or neuromuscular.
- Structural causes include changes in the skin, bones, ligaments and tendons surrounding the eyes, making the upper eyelids look redundant or overhanging.
For example, genetic factors give rise to inborn excess skin and fat in the eyelids. Aging and too much sun exposure lead to the loss of eyelid skin elasticity, making it droop. Trauma, scarring, tumors, connective tissue disease and age-related bone loss may also produce hooded eyes.
- Neuromuscular causes refer to those nerve and muscle conditions pulling the eyelid skin down.
Facial muscles control the movement of the eyebrows and eyelids by pulling them in different directions, as shown in the picture above. A balance exists when these muscles are intact and at rest.
The frontalis muscle—the primary forehead muscle—raises the eyebrows and upper eyelids. The orbicularis oculi open and close the eyes and pull the upper eyelids down. Other muscles that can lower the upper eyelids are the corrugator supercilii, procerus and depressor supercilii.
Downturned eyes due to predominant downward muscular forces are not always abnormal. However, some nerve or muscle disorders result in abnormal eyelid drooping. Examples are stroke and inborn nerve or muscular conditions.
“Iatrogenic” or medical procedure-related dysfunction of the nerve and muscles may also produce an abnormally droopy eye. For example, complete relaxation of the outer sides of the frontalis results in eyebrow and eyelid drooping, as happens after a botched Botox forehead injection.
The above conditions result in varying degrees of eye hooding. There are currently no specific guidelines for classifying the condition according to severity. But we will use the following for this discussion:
- Mildly hooded eyes have the eyelid skin sagging without reaching the eyelashes
- Moderately hooded eyes have the eyelid skin drooping down to the level of the eyelashes
- Severely hooded eyes have the eyelid skin reaching below the level of the eyelashes, partly covering the corneas
Doctors treat each case based on cause, problem severity and other patient factors.
Are Hooded Eyes the Same as Ptosis?
The medical term “blepharoptosis” or simply “ptosis” refers to abnormal upper eyelid drooping. The eyelids normally cover the upper 1-2 millimeters of the corneas. Patients who have ptosis have at least one eyelid drooping below this level.
Ptosis may develop from the same conditions that can cause eye hooding. So the difference between the two is one of degree or scope. The word “ptosis” is typically used to describe a pathological condition, whereas the term “hooded eyes” is not always associated with disease.
If a neuromuscular disorder is the cause of ptosis, other symptoms are usually present, such as visual blurring, crossed eyes, dry eye, speech problems, etc.
How Does Botox Fix Hooded Eyelids?
Botox is a drug derived from the bacteria-produced botulinum toxin type A. It blocks the nerve impulses controlling muscle movement. In a Botox brow lift, your dermatologist gives the eyebrows and eyelids a nonsurgical lift by relaxing the upper facial muscles in strategic areas.
You may check out our detailed Botox treatment guide for further information on how botulinum toxin injection works.
What Can You Expect During Your Consultation for Hooded Eye Treatment?
Our BHSkin Dermatology specialists treat all patients with utmost professionalism and care. They shall start the consultation by taking your problem’s history, asking about when it began and if it is progressing rapidly. They may also inquire about your medical and family history to find the most likely cause of the condition.
Afterward, they will examine your eyes closely. Mild to moderate eye hooding has symptoms affecting only the upper eyelids. But more serious cases may be accompanied by visual impairment, uneven facial expressions and other abnormal signs, so your doctor may ask permission to inspect other parts of your body. They will protect your privacy as they go through their physical examination.
Once they complete their evaluation, your doctor will tell you if your problem can be corrected by a dermatologic procedure. They will work with you to help you decide whether a surgical or nonsurgical brow lift is best for you.
How Should You Prepare for Your Botox Brow Lift?
This part of the treatment process is easy, yet it saves you from a lot of potential hassles.
First up, Botox injection traumatizes the skin a bit. So days to weeks before your session, your doctor may advise you to avoid exposures that can delay healing, such as:
- Blood-thinning medications and supplements
Second, the eye area has a rich blood supply, making it prone to bruising. So your dermatologist may also recommend starting anti-bruising supplements like arnica and bromelain a few days before your appointment.
Third, exercise may cause facial flushing, ruining Botox’s effects if done within the first few hours after treatment. So you may want to fit an extra workout into your schedule shortly before your Botox appointment.
Fourth, you must cleanse your face and keep it makeup-free right before your session to lessen your infection risk.
You may read our full Botox before-and-after injection guide for other preparation tips that can help ensure the safety and effectiveness of the procedure.
What Can You Expect During Your Botox Eyebrow Lift Session?
Your Botox specialist will start the procedure by cleaning up the treatment areas. They will ask you to move certain facial muscles to help them mark their targets. Then the actual injection. The session usually takes only a few minutes, though it may be a bit longer for patients requiring topical painkillers.
What Is the Timeline of the Effects of a Botox Eyelid Lift?
The timeline is essentially the same as in other Botox procedures. In the first 1-3 days, the treated areas will begin to weaken. You will observe the maximal effects by the end of the second week. Three to four months after injection, the treated muscles will gradually recover their strength. Your eyelids will go back to their pretreatment condition by the fifth or sixth month.
How Long Does Botox Last for Hooded Eyes?
As stated above, the muscles slowly regain their strength three to four months after Botox treatment. The procedure’s cosmetic effects are completely gone after that. One of the ways to keep the treated muscles relaxed is to get maintenance injections two to three times a year or as recommended by your Botox specialist.
To learn more about making Botox last longer, you may read our article on the subject.
How Do You Take Care of Your Face After a Botox Brow Lift Procedure?
The Botox post-treatment regimen is also straightforward.
What Should You Avoid After Botox Injections?
Your dermatologist may recommend refraining from the following activities until four hours after your session:
- Lying on your back
- Scratching the injection sites
- Applying heat or heavy pressure on the treated areas
- Activities that can increase the blood flow to your face, such as sauna-bathing, exercising and suntanning
Avoiding them reduces the likelihood of spreading the toxin to distant muscles and causing complications. It also increases Botox absorption in the nerve endings, helping to prolong its effects.
What Should You Do After Botox Injections?
Many people recover quickly from Botox treatment and resume their usual four hours after their session. But some stay sore and bruised for days, making it necessary to avoid vigorous activities until the inflammation subsides. You may do the same if it happens to you. Additionally, apply makeup only if your skin is not irritated.
As previously mentioned, the eye areas are prone to bruising. Icing the injection sites repeatedly during the first 24 hours after the procedure helps relieve bruising and inflammation. To help clear those blood traces faster, you may take bruise-busting supplements, sleep upright and take it easy for a few days.
And remember, sticking to your dermatologist’s prescribed post-treatment skin care regimen enhances the effects of your Botox brow lift.
As in proper pretreatment preparation, following these aftercare recommendations helps ensure the safety and effectiveness of your procedure. If you want to know more about Botox recovery and aftercare, you may check out our detailed guide on this topic.
What Are the Risks of Getting Botox for Hooded Eyes?
The most common side effects of Botox injections are redness, discomfort, swelling and bruising. They are normal inflammatory reactions, and they will disappear after a few days, even without treatment. Sensitive patients may take acetaminophen or ice the injected areas for symptom relief.
Rare, unwanted side effects may result from having an inexperienced provider perform the procedure. They include the following:
- Severe headache
- Injection site infection
- Excessive bleeding
- Altered sensation or numbness on the treated areas
- Botulinum toxicity
Moreover, compared to other treatments, the following potential complications are more likely after Botox injection for hooded eyes:
- Brow elevation asymmetry or unevenness
- Feminized look if done improperly in male patients
- Worsening of eyelid drooping
- “Spock brows” or “Spocking,” named after the famous Star Trek character
You can avoid these problems by entrusting your procedure to no less than a Botox expert, which all highly experienced board-certified dermatologists are.
How Much Does a Botox Brow Lift Cost?
The procedure’s price depends on various factors, the most important being your provider’s expertise, the Botox dose used and the clinic’s geographic location. But it typically ranges from $500-1,000 per session.
Health insurance can pay for treatments that help relieve severe hooded eye complications like visual changes, chronic headaches and other head and neck problems.
How Effective Is Botox in Treating Hooded Eyes?
Botox injection can raise sagging eyelids by a few millimeters. So it is best for mild and moderate eye hooding, which are more common among younger than older patients. If you want more oomph to those eyes, you may talk to your dermatologist about combining Botox with other treatments.
When Is a Botox Brow Lift Better than Other Hooded Eye Remedies?
A slightly droopy eyelid does not usually cause health problems, and you can easily conceal it with makeup. But patients who get eyelid lift procedures generally want makeup-free eye reshaping or rejuvenation. Besides the Botox brow lift, other treatments you can get for hooded eyes include the following:
- Upper blepharoplasty, a type of upper eyelid cosmetic surgery
- Laser skin resurfacing, which removes excess skin from the eyelids and enhances collagen production
- Dermal filler injection in eye areas needing volume
- Thread lifting, which stitches and pulls the upper eyelid skin upward
- Radiofrequency (RF) microneedling, which stimulates collagen formation, tightening sagging eyelid skin
There are many others. However, a Botox eyelid lift has distinct advantages in certain instances
Lower Side Effect Risk
Botox does not destroy tissues, unlike blepharoplasty and laser eyelid surgery. The risk of infection, scarring, etc. is less, making it a good option for mild to moderate eye hooding.
If you don’t like the result of your Botox treatment, you can just let it wear off and try a different hooded eyelid remedy next. Meanwhile, the effects of a surgical brow lift are irreversible unless another costly surgery is done.
Different Botox injection techniques result in varying eyelid lift levels. Injecting a small dose at the outer edges of your eyebrows produces subtle changes. But your dermatologist can inject the drug in other areas for a more dramatic lift.
Will Not Significantly Disrupt Your Routine
Botox cosmetic treatments are quick, and their downtime is minimal to none. They are perfect for busy individuals.
Fast Onset of Effects
It may take several weeks to months before you see marked changes after hooded eye surgery. The same goes for skin-rejuvenating procedures like laser treatment and RF microneedling. Dermal fillers work instantly but tend to create or worsen eye bags in young patients.
Meanwhile, Botox takes effect in a few short days, peaking in the second week. It will not cause significant eye swelling when injected properly.
The Botox Aftercare Regimen Is Easy
There is no postop wound to care for after a Botox brow lift, unlike when you have cosmetic eyelid surgery. Besides one or two days of slight activity restriction and remedying mild inflammation, not much is required by way of aftercare.
A Botox procedure is much cheaper than blepharoplasty or laser treatment. It is the more cost-effective option for mildly hooded eyelids.
You May Start Young
The Botox brow lift is a good initial remedy for hooded eyes. It is generally not contraindicated in healthy young adults, so you may begin maintenance treatments as early as your 20s.
If these benefits appeal to you, you should seriously consider talking to your doctor about having a Botox brow lift.
Why Should You Entrust Your Botox Eyelid Treatment to a Board-Certified Dermatologist?
Correcting hooded eyes is an off-label application of Botox injection. That means that the treatment is not yet FDA-approved for this condition.
Off-label therapies are inherently risky. Few or no large-scale clinical trials support their safety and effectiveness in remedying specific problems. They are not illegal, but it is best to entrust them to a medical professional with years of experience using the treatment.
That said, board-certified dermatologists are the top choice for performing Botox brow lift procedures. They have extensive experience giving Botox cosmetic injections. Entrusting the procedure to them helps you ensure the best esthetic outcomes while avoiding unwanted side effects. Their deep knowledge of skin care can also help you enhance and prolong the results of your Botox treatment.
Overall, you get the most bang for your buck from a nonsurgical brow lift procedure when you leave it in the hands of these specialists.
Things to Remember When Getting Botox for Hooded Eyes
Eye hooding is a common condition resulting from eyelid sagging. It has a myriad of causes, ranging from excess skin to neuromuscular dysfunction, though it does not always pose serious health risks.
Botox facial injection is a nonsurgical way of reducing mild to moderate eyelid drooping. It works by relaxing the muscles pulling the eyelids down, reinforcing those tugging them up. It is safe and cost-effective, so many consider it a good initial treatment for mild to moderate eyelid sagging.
However, Botox eyelid lifts are not FDA-approved for treating hooded eyes. In inexperienced hands, they may not produce the results you want. To ensure the safety and effectiveness of these procedures, entrust them only to a reputable board-certified dermatologist.
Want to Rejuvenate Your Eyes Without Eyelid Surgery? Let LA’s Top Botox Experts Help
Botox injections can open up hooded eyes. But a misstep in their performance can lead to unpleasant results that your friends can never unsee.
At BHSkin Dermatology, our doctors have performed thousands of Botox cosmetic procedures, including eyelid lifts. Visit us at our Glendale or Encino office or use our telederm portal for your initial consultation.
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