The Best Options for Droopy Eyelids, Circles and Sags

Injections or surgeries can give older eyes a lift
older woman closeup of her eyelids and wrinkles

If you’re bothered by drooping eyelids and sagging, wrinkled skin around your eyes, injections or restorative surgical options could help make your eyes look more youthful.

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As you age, your skin gradually loses its elasticity and begins to droop all over, but the effect is most obvious on your face — especially around the eyes.

“Treatment for aging eyelids focuses on the particular anatomical change that’s causing the problem,” says ophthalmologist and oculoplastic surgeon Julian Perry, MD. Although droopy eyelids usually result in purely cosmetic issues for people, they can also cause vision problems in certain cases, he says.

Age-related changes that cause circles, bags and sags

Dr. Perry points to several factors that contribute to the undesirable look of the area around your eyes as you age:

  • Extra skin causes wrinkles and bags under the eyes.
  • Fatty tissue deposits may cause the upper or lower lid to appear puffy.
  • Periorbital hollows show up as dark circles around the eyes.
  • Ptosis occurs, which is a weakness of the muscle that opens the eye.
  • Tear trough indentations become more marked as you age.

Women and, increasingly, men are investigating cosmetic fixes for drooping skin around aging eyes. Doctors divide the options for correcting these issues into non-surgical and surgical approaches.

Non-surgical options to boost droopy lids

Injection of products that contain botulinum toxins (such as Botox® or Dysport® and hyaluronic acid fillers, which include products such as Juvéderm® and Sculptra®), can help tighten sagging skin and smooth out wrinkles.

It’s important to note that these products work in completely different ways to correct eyelid issues associated with aging, Dr. Perry says. Botox® and Dysport® work to weaken muscles in the crow’s feet area around the eye, giving you a more youthful look when you smile.

Injectable fillers provide extra volume to fill in deeper crevices on the cheeks and around the lower lid areas.

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“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 says. “It’s not perfect, though, and can sometimes leave the area looking slightly gray or bluish.”

“Both products have their pros and cons but do work well to provide a more youthful appearance.”

He says it’s often a good idea to use both types of products, since they treat different problems, thus further enhancing the overall benefit.

Surgery goes deeper to rejuvenate the eye area

“The surgical options are designed to treat structural issues around the eyelids, such as crow’s feet or deeper crevices due to aging,” Dr. Perry explains.

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

If a patient has excess skin, the surgeon can remove a small amount in the 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 the eye. This skin removal only treats part of the problem.

Patients who want a more dramatic, rejuvenating effect from surgery will need to undergo deeper restructuring that treats the problem of excess fat and bags.

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“Older surgeries involved simply removing this excess fat, which improves the under-eye bag, but do nothing to improve the hollow area that forms beneath the bag,” Dr. Perry explains. Fat removal can help a patient appear less tired and more alert, but doesn’t necessarily have a rejuvenating effect, he says.

For the hollow underneath the eye bags, oculoplastic surgeons reposition the fat rather than removing it completely. Taking fat from one area and repositioning it addresses both the bag and the hollow area underneath it. In fact, he 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.

The best thing to do if you feel bothered by the way your eyes look as you age is to pay a visit to your ophthalmologist, especially one who has experience in oculoplastic surgeries.

He or she will carefully assess your individual situation and discuss the best options for you.

“We choose between these options after a careful assessment of the patient’s individual anatomy and desires,” Dr. Perry says.

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