Maybe you observed the change in a photograph. Perhaps you realized you had less real estate to apply eyeshadow than you once did. Whatever led you to the conclusion that you have droopy eyelids, we understand that once you see them in the mirror, saggy lids can be hard to unsee, which may have led you to search for options to lift them.
There’s a good chance you came across surgical options, like blepharoplasty (aka eyelid lift), as well as noninvasive treatments in your search. However, before you book a consultation for any eye lift procedure, it’s important to understand the true cause of your drooping lids. If you’re under 35 and noticing super-saggy lids, it could be due to excess skin. But for most people, “the problem is really a drop in the brow, or a bit of a combination,” says Dr. Ava Shamban, a board-certified dermatologist in Beverly Hills, California.
A study of aging and changes in eyebrow position and movement published in the Archives of Plastic Surgery shows that the majority of the brow drops with age, mostly due to changes in the face’s skin condition, musculature, and fat. However, it’s the tail of the brow, or lateral endpoint, that drops the most. It also happens to be the part of the eyebrow that tends to drop first. “That’s what you really start to notice in your late 40s and 50s,” adds Dr. Shamban. By raising the height of the eyebrow tail, regardless of the method, the eye appears more open and the skin of the lid looks lifted. (Go ahead and give it a test in the mirror!)
Before we dive in, let’s get one thing straight: If the actual skin of your eyelid is so lax that it’s obstructing your vision, a nonsurgical eye lift may not deliver the results you’re looking for. In that case, you should consider setting up a consultation with a board-certified oculofacial plastic surgeon, ophthalmologist, or other qualified practitioner to discuss surgical options. (Bonus: If it’s deemed medically necessary, health insurance may cover the cost.) But if you’re actually dealing with a droopy brow, volume loss, and some skin crepiness, a nonsurgical eye lift could make a difference—and you have plenty of options for treatment. Here, doctors share their eight favorite ways to achieve an eyelid lift without surgery.
Treatment #1: Neurotoxins (Botox, Dysport, Xeomin, and Jeuveau)
Best for: lifting the brow
How many treatments needed to see results: one
How long treatment lasts: about three to six months
What you need to know: To best understand how neurotoxins can create a brow lifting effect, we recommend you take a look in the mirror again and make a look of shock. The frontalis muscle in your forehead is known as a levator muscle, as its “only job is to lift your brow up,” explains Dr. Shamban. Conversely, there are depressor muscles around the eyes—the orbicularis oculi, which are responsible for crow’s feet—that pull your brow down. (Squint, and you’ll see how these muscles drop your arches.)
When treated with what many call a Botox brow lift, “you’re relaxing the muscles that pull the brow and eyelid down,” says Dr. Shamban. “If you put a little bit of neurotoxin in the middle of the frontalis, then you can use the sides of the frontalis to lift up the brow, which will help the lid.” She usually injects about four units of Botox at the tail of the brow, to release the depressor orbicularis oculi, letting the frontalis lift the tail and open the eye.
As is the case with booking any injectable treatment, it’s essential to seek out an experienced, certified provider. “If it’s not done properly, [it] can drop the eyelid or the eyebrow, and you’ll walk around like this for a few months,” warns New York City board-certified dermatologist Dr. Bruce Katz. This is known as ptosis, and we’ll be coming back to it later.
Treatment #2: Fillers
Best for: adding volume around the eye
How many treatments needed to see results: one
How long treatment lasts: about a year
What you need to know: “Filler is actually outstanding,” gushes Dr. Shamban about the treatment’s ability to mimic an eyelid lift. There are a few ways to achieve this look, but Dr. Shamban’s preferred method is to target a fat pad under the brow. (This area thins out with time, leading to eventual sagging.) “The cannula is threaded into this fat pad, and it lifts the brow, giving the brow a really pleasing shape,” she says.
Another way to help lift this area with filler could also be to treat the temples. If you have particularly strong masseter or jaw muscles due to bruxism, your clenching can, over time, cause the fat in your temples to deteriorate. The loss of that fat can cause the tail of your brow to drop. “It’s shocking,” says Dr. Shamban, “but putting filler out there does lift the brow too.”
If it’s your lower lids that are bugging you, Dr. Katz notes that tear trough filler can help address their appearance. “Over time, people get hollow there—and when they’re losing volume below the eyelid, the eyelid looks puffy,” he explains. When you restore that volume with a hyaluronic acid filler, the under-eye area can look smoother.
Treatment #3: Upneeq
Best for: treating acquired ptosis, or droopy eyelids
How many treatments needed to see results: one
How long treatment lasts: about eight hours
What you need to know: This recently launched prescription eye drop is the first of its kind and treats a very specific type of droopy eyelid called ptosis, “an abnormal drooping of the upper eyelid margin when looking straight ahead,” explains board-certified ophthalmologist Dr. Diane Hilal-Campo in Oakland, New Jersey. In addition to potentially obstructing vision, this condition can make someone’s eyes appear asymmetrical when only one lid is affected, or if someone has ptosis in both lids, make them look sleepy. As previously mentioned, ptosis can also be an unfortunate side effect of an errant neurotoxin injection.
Historically, ptosis has been addressed by operating on one of the muscles that lifts the eyelid. Upneeq works similarly but in a noninvasive way. The formula’s active ingredient, oxymetazoline 0.1%, “stimulates the Müller’s muscle of the eyelid, which is responsible for two to three millimeters of lid elevation,” says Dr. Hilal-Campo. “The average elevation seen [from this product] is one millimeter.” Each dose of Upneeq contains enough to treat both eyes once daily, and the treatment takes anywhere from five minutes to two hours to kick in before providing about eight hours of relief from ptosis symptoms—including those of neurotoxin-induced ptosis.
While this is a game-changing treatment for ptosis sufferers, Dr. Hilal-Campo highly recommends getting a full checkup from an ophthalmologist before taking the plunge. This is because ptosis could be an indication of a significant health issue. “Serious deadly diseases may not be diagnosed if this drug is prescribed by doctors who are not trained to look for them,” she warns. While acquired ptosis can be caused by things like prolonged contact lens use and injury, it can also be a symptom of brain aneurysm, myasthenia gravis, Graves’ thyroid eye disease, or Horner’s syndrome. A qualified ophthalmologist can both rule out serious causes of ptosis and write your Upneeq prescription, which includes a month’s worth of treatment for both eyes.
Treatment #4: PDO Thread Lift
Best for: physically lifting the brow
How many treatments needed to see results: one
How long treatment lasts: six to eight months
What you need to know: After being a well-kept secret for decades throughout Europe, the popularity of this minimally invasive procedure has spiked stateside in recent years. Early iterations of this treatment used permanent thread, but today, providers use a medical-grade, ultrafine thread made of a dissolvable polymer known as polydioxanone or PDO. (This material is FDA-approved and has historically been used for dissolvable sutures.) “I anchor the upper eyebrow and insert the thread under the skin and have it taken out in the scalp area, where it’s hidden, and the thread pulls up the eyebrow,” explains Dr. Katz. By lifting the tissues of the brow, you’ll inherently be lifting the lid as well.
There’s also a subtle long-term benefit to a thread lift—it can kick-start new collagen production. “Installing” PDO threads creates micro injuries below the skin’s surface, triggering its healing response and subsequently, new collagen growth. (Though that new collagen is not likely to give you dramatic, long-lasting results, it can give you a bit of oomph.)
PDO thread brow lifts require great precision and an intimate knowledge of facial anatomy. “You can’t treat the middle of the brow, because of the nerves and the vessels there,” says Dr. Shamban, who likes to treat the tail of the brow, for the most prominent lid lift effect. “You don’t end up looking like Spock or anything, and you can get a couple of millimeters [of lift]—it’s actually pretty significant,” she says. You can expect to get only around eight months of wear from your threads before they dissolve entirely, “but for immediate improvement that you want for short-term effect, like a big social event or a wedding, this treatment can work very nicely,” adds Dr. Katz.
Treatment #5: Fractional CO2 laser
Best for: resurfacing, stimulating new collagen
How many treatments needed to see results: two to six, depending on depth of treatment and severity of concern
How long treatment lasts: three to five years
What you need to know: While CO2 lasers have long been used for overall wrinkle reduction and for skin retexturizing from head to toe, Dr. Katz likes to use this technology specifically to target and correct the delicate skin around the eye. “Fractional CO2 lasers create zones of ablation—columns of tissue that the device vaporizes—to destroy damaged collagen so new collagen can replace it,” he explains. He places protective metal shields in his patients’ eyes, then treats the entirety of both eyelids, “right down to the lashes.”
When it comes to laser procedures, the more severe your concern, the more treatments you’ll need in order to see significant results. If you’re just starting to see a few fine lines and a little laxity, Dr. Katz recommends two or three treatments, spaced two weeks apart, while those with deeper wrinkles and more significant sagging would benefit from four to six treatments. Ordinarily, laser skin resurfacing using CO2 comes with some downtime, which is why Dr. Katz opts for “very, very light” treatment so all the patient sees is some redness and puffiness that can easily be covered with makeup.
Because this laser is triggering new collagen production, it’ll take a bit of time to observe the results of the treatment. You can expect to start to see some smoothing and firming around your second treatment, but you’ll continue to see results taking shape up to several months after your last session. However, if you have a deeper complexion, you should consult with a board-certified dermatologist before booking a skin resurfacing laser treatment; CO2 laser could result in permanent hyperpigmentation in skin of color.
Treatment #6: Plasma Pen
Best for: tightening, resurfacing, stimulating new collagen
How many treatments needed to see results: one or more, depending on severity of concern
How long treatment lasts: up to a year
What you need to know: While the name may be confusing, don’t mix up platelet-rich plasma treatment with a plasma pen—this treatment is more like a fractional laser resurfacing. However, while laser treatments harness light energy, a plasma pen converts electricity into electrostatic energy, to create nitrogen plasma gas from the air around you. Flashes of the plasma pen create microtrauma to the skin, which triggers new collagen production. The entirety of the eye area can be treated, including the upper and lower eyelids.
According to Dr. Shamban, this is an ideal option for someone who’s dealing with a bit of excess skin around their eyes but not to the point that they need surgery. “You can use a fractional laser, but the plasma pen seems to give more tightening,” she opines. One treatment should suffice for those with earlier signs of damage, typically in the 30- to 40-year-old range, while someone in their 60s might benefit from a few sessions. She also notes that plasma pen treatment works best when paired with other modalities. “If you follow it with something that tightens tissue, like radiofrequency, you’ll improve your results,” she says.
Treatment #7: Radiofrequency (ideally, paired with microneedling)
Best for: tightening, stimulating new collagen
How many treatments needed to see results: one or more, depending on depth of treatment and severity of concern
How long treatment lasts: about a year
What you need to know: This category of treatments uses radiofrequency energy (RF) to gently but powerfully heat the skin all the way down to the dermis, triggering new collagen production while providing an instant tightening effect. Today’s most popular modalities often pair RF with microneedling, for even more potent skin-firming results. “Because the skin around the eyes is the thinnest on the body, it responds really well to these technologies,” says Dr. Shamban.
One such RF microneedling device is Morpheus8, which has small, precise tips with varying needle lengths that can be used around the eyes. “Not only does it go deeper than any other device—it goes down to seven millimeters—but it also has burst technology, which is comparable to doing multiple passes [of the device] at one time,” says Dr. Katz. Say your provider is treating you with the greatest depth, seven millimeters. Burst technology allows the radiofrequency to pulse as the needle penetrates your skin at three, five, and seven millimeters, so the device can target multiple layers of the dermis simultaneously.
Unlike laser treatment, microneedling/radiofrequency hybrids are safe to use on dark skin tones. And because both the needle depth and the heat of the RF can be customized to each patient’s needs, you may need only one or two treatments. You’ll see results within a few days to a few weeks after treatment, and they’ll continue to develop (as new collagen forms) for the next six months.
Treatment #8: Ultrasound (ideally, paired with radiofrequency)
Best for: tightening, stimulating new collagen
How many treatments needed to see results: at least two, spaced up to a month apart
How long treatment lasts: up to a year
What you need to know: This form of treatment uses focused ultrasound energy to heat deep layers of the skin for new collagen production and a tauter look. By treating the forehead and upper lid with this technology, you’ll get a “pretty high tightening,” according to Dr. Shamban. Yes, traditional forms of ultrasound can be incredibly effective—if they work on you; about “20–30% of people don’t really see results at all,” says Dr. Katz. Plus “it hurts, because it’s right on the bone,” says Dr. Shamban.
If you’d rather pass on pain that comes with the risk of zero reward, you’ll be happy to know that you still have ultrasonic options. Many providers are opting for new types of technology that combine two forms of energy, usually ultrasound with radiofrequency, as seen in Exilis Ultra. “We can use Exilis to elevate the eyebrows [and] tighten the skin on the temples, the forehead, and the malar areas—the upper cheeks,” says Dr. Katz. (Even better: Exilis is practically painless in comparison to the older technology and, because it’s not breaking the skin, has minimal to no downtime.) As is the case with RF, it’ll take several months for the full results of your ultrasound treatment to be visible as your new collagen forms.
You may be curious whether at-home energy devices can provide comparable results to in-office treatments. It’s important to remember that these tools are, in Dr. Katz’s words, “dumbed-down” versions of the real thing. “Manufacturers don’t want lawsuits,” he points out. But while they are much weaker than professional devices, “they’re nice tools to add if you’re really good about taking care of your face,” says Dr. Shamban. “Will they solve your eyelid problems? Doubtful. But they’ll help a little bit.”
