State of the Art Tips for Fixing Hooded Eyes

Many patients seek consultation at Metrolina Eye Associates to fix the appearance of their drooping or “hooded eyes” where the eyelids look heavy and the upper eyelid skin is folding over or obscuring the lashes. Some patients are searching for surgical options, others are wondering about alternatives.  Here, Dr. Christine Annunziata discusses the current best practices for addressing hooded eyes.

Dr. Annunziata specializes in facial reconstructive and cosmetic surgery as well as non-surgical procedures including laser skin treatments and injectables for wrinkle and fat reduction.  She is board certified by the American Academy of Ophthalmology and the American Society of Ophthalmic Plastic and Reconstructive Surgeons and has been practicing medicine for 20 years.  She has focused exclusively on oculoplastic surgery for 16 years and has performed thousands of cosmetic and reconstructive eyelid and facial surgeries.  To learn more about your options and all of the services Dr. Annunziata provides, call our office at (704-234-1930) to schedule a consultation.

When Injectables Can Help

Injectable neuromodulators like Botox®, Dysport® or Xeomin® are commonly used to relax specific facial muscles, which has the effect of smoothing wrinkles in the treated area. In mild cases of hooded eyelids caused by low eyebrow position or slight brow drooping, these injectables can be helpful.  In these cases, neuromodulators can be used to lift the outer tail of the eyebrow and reveal a small amount of the underlying eyelid skin. However, this nuanced approach requires an experienced doctor who is careful not to over-correct the area and produce an artificial-looking result.  Dr. Annunziata injects small amounts of the medicines into the lower forehead and outer tail of the eyebrows to weaken the depressor muscles responsible for the eyebrow drooping (while keeping the elevator muscles, which raise the brow, intact). Raising the brow even just a few millimeters helps the eyes look more open and awake. 

Injectable dermal fillers like Juvéderm® or Restylane® are an excellent complementary treatment to Botox®, as they are able to address age-related volume loss at and surrounding the injection site.  Dermal fillers work to restore the plumpness to your skin, which then results in a lifting effect in the applied area.  When used alone or especially in combination with Botox®, these fillers can restore a natural-looking fullness and youthful contour to the brow without the need for brow lift surgery.

When Injectables Cannot Help

If the eyes look hooded because of pronounced brow droop or a considerable amount of excess eyelid skin, Botox® and other injectables are often ineffective, and in some cases they can worsen the appearance of drooping. No injectable product can reduce or tighten the skin — the only solution is to have it surgically lifted or excised through surgery.

During Upper Eyelid Surgery or Blepharoplasty, Dr. Annunziata removes excess eyelid skin and contours the deep structures of the upper eyelid to give the eyes a rested, pleasant appearance. The operation involves removing excess eyelid skin and repositioning fat and muscles as needed to flatten and firm the lids. 

Upper Eyelid Blepharoplasty

For many patients, the hooded eye appearance is not simply the result of excess skin, but a combination of gravitational forces and volume loss on the brow and upper face.  The brows must be in an appropriate position to attain beautiful, youthful and natural appearing eyelids.  In appropriate cases, blepharoplasty can be combined with different brow lifting techniques to achieve the best results.

Dr. Annunziata is an expert in Surgical Eyebrow Lifting, and she performs many different types of techniques that are individually tailored to a particular patient’s needs.  Her artful and delicate surgical techniques can contour the eyebrow specifically to the patient’s desires while providing soft, natural results.

Endoscopic Brow Lift is the most current and state-of-the-art method of forehead and eyebrow lifting.  An endoscopic brow lift is a minimally invasive approach to lifting the brow. Small, hidden incisions will be made in the hairline and a tiny specialized lighting system, camera (endoscope) and surgical instruments will be used to lift and reposition the brow tissue to a more youthful and secure position.  Because it is minimally invasive, recovery is much quicker compared to a traditional brow lift which involves making a larger incision along the hairline and more aggressive maneuvering.  This less-invasive technique allows for a relatively pain-free recovery with less swelling and bruising and minimal complication risk when compared to more traditional techniques while still retaining durability and effectiveness.  Patients are often back to normal after just 1-2 weeks!

Upper Eyelid Blepharoplasty with Endoscopic Brow Lift

Browpexy vs. Brow Lift

A Browpexy (or brow tack) is very different from an endoscopic or traditional brow lift. A browpexy is a procedure Dr. Annunziata performs in conjunction with eyelid surgery in order to slightly elevate or stabilize the brow so it doesn’t droop. For patients who have a natural low brow position or early brow drooping, when an eyelid lift is performed the brow will be pulled down. The browpexy is a stabilizing procedure to prevent the brow from falling as a result of eyelid skin removal.  The brow is elevated and stays suspended in a youthful position.
There are two techniques Dr. Annunziata uses to perform a browpexy :
Internal Browpexy – performed from within the eyelid (no additional visible scarring)
External Browpexy – performed through a small incision above the brow

Upper Eyelid Blepharoplasty with Internal Brow Pexy

Brow position is an important consideration when undergoing an upper blepharoplasty to ensure the results are optimal. It is also important to see an expert oculoplastic surgeon to make sure you get the correct procedure. Many people get the need for brow lift and eyelid lifting confused and it is Dr. Annunziata’s goal to help her patients understand the differences. While endoscopic brow lift procedures are relatively common, it is important to find an oculoplastic surgeon with specific endoscopic surgical training to ensure you have safe and successful results.  Dr. Annunziata has performed thousands of eyelid and brow procedures (of all techniques) and is an expert in these procedures.  To learn more about your options and all of the services Dr. Annunziata provides, call our office at (704-234-1930) to schedule a consultation.