Low Lying Lids or Ptosis

May 28, 2022

Ode to our bright eyed youth. As we age, our upper eye lids get heavier and our eyes get smaller. Bigger eyes are a sign of beauty and youth. As you can see in right side of the photo above, the almond shape and visible white of sclera is youthful, alert and desirable.

I am a conservative by nature and like to avoid the knife. We have quite a few options in dermatology to non-invasively rejuvenate the upper lids.

Let’s start at the notorious Botox: Botulinum toxin. Botulinum toxin is a neurotoxin that prevents transmission of chemical pulses thus paralyzing muscles. Our body is able to replenish receptors on nerve endings thus it effects last for just 3 months.

A little bit of Botox or the like (ie Dysport, Juveau, Xeomin) in the lateral tail of the brow can give a little lift. Add a standard dose to glabella between the brow and you really release the pull down on brow. Botulinum toxin’s cosmetic benefits were discovered over 30 years ago by ophthalmologists who had been using it to ease eye spasms for years. The safety profile and efficacy is long and evidence based.

Another gift from ophthalmology is a simple eye drop called oxymetazoline. It is a selective stimulator of a muscle of the upper lid called the Mueller muscle. By stimulating the otherwise age fatigued Mueller muscle, oxymetazoline contracts and elevates the upper lid, exposing more white of eye and the upper portion of the colored iris. It also vasoconstricts blood vessels which whitens the eye. This medicine too has been used safely and effectively for years in medical patients with acquired ptosis and dermtochalasis (excess eyelid skin) that interferes with vision. Most recently it has been approved for cosmetic use as Upneeq.

Finally lasers have entered the eye opening field. There are many out there that can help. I am going to highlight my favorite called the Opus. Opus is a hybrid laser. Hybrid meaning it combines 2 modalities: plasma and radiofrequency. This resurfaces the texture and also tightens. The focus tip has shown reliable results to lift upper lid with virtually no down time. A new more targeted handpiece called Colibri gives even better tightening results with about a week of downtime and no surgery.

Hooding and heavy eyelids are a sign of aging. Just as wide bright eyes are a sign of youth. Here I have listed just 3 of my favorite methods but there are many options and modalities that all work better together than any one method alone to give natural long term results. Visit us or a board certified dermatologist to discuss your options.

Happy Summer and See you soon,

Saryna Young, MD, FAAD