Am I a candidate for a Botox eyelid/brow lift? Or is eyelid surgery my best option for my hooded eyes? (photos)

Hello I am 25 years old and have dreaded hooded eyes and low brows. Hooded eyes do run in the family I also have had some weight gain in the past and now have lost of about 65lbs. I now weigh 135lbs. I describe my eyelids as almost webbed in between where corner meets nose area. I have heard of botox brow and eyelid lifts to help this problem can this work for me? Or is major surgery my only option. Any information would be helpful. Thanks, Bree

Doctor Answers 12

Am I a candidate for a Botox eyelid/brow lift? Or is eyelid surgery my best option for my hooded eyes?

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You have very beautiful eyes & I think surgery at your age would be a mistake.  I think you could get very good results with botox if injected with the right practitioner who is experienced with this technique.  This could help raise the brows a bit giving you less hooding, but it will not completely eliminate the hooding.  Good luck!

Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Botox versus surgery

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this woman is very difficult to answer on line even with your photos and thank you for providing those.  In general I would say this is your natural anatomy and you can raise your brow with Botox but the somewhat sleepy or "bedroom eyes" your eyes themselves have I do not think would change with Botox.  That being said I feel like it is a little early for U for surgical intervention for your brow or your eyes.

sorry I could not be more helpful

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Botox brow lifting

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Thank you for your question. Shaping the brows is one my favorite parts of using Botox. It requires a very detailed understanding of the underlying anatomy as well as assessing each individual while they are animating their brows. By carefully placing Botox in the muscles that depress the brow, you can cause the brow to rest and relax in a lifted position. There are limits to how much you can lift, and for some surgery is better option. Incorrect assessment or placement can also lead to the reverse effect, so overall technique is critical. You can also shape the brow different. For example, you can raise the tail of the brow vs creating a raised arched brow vs creating a raised horizontal brow. It depends on the individual's desired brow aesthetic goals. I would consider this a very advanced technique so I would query your injector on their experience in this area.
As far as how many units may be needed, this also depends on which part of the brow you want to correct. For the inner brows, you may consider ~20 units (same as the frown line treatment). For the middle or outer brow, I generally use up to 5 units on each side.
You may also want to consider adding fillers to shape and raise the brow. Combining the two products can work synergistically together.

Botox or Surgery for Hooded Eyelids

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With your anatomy, I would recommend against a browlift.  Your brows appear to be in a desirable shape and location.  Botox is a great option for a subtle non-invasive way to lift the brow.  Plus, if you don't like the effect, it will wear off.  The outer eyelid fold (commonly referred to as hooding) will change with well-placed Botox.  More severe hooding requires surgery (blepharoplasty), but the photos do not indicate you would need that yet.  However, Botox is not likely to change the inner fold of the eyelid (epicanthal fold), and that would require a different procedure to change the shape (epicanthoplasty).

Christopher R. Hove, MD
Paoli Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Botox Candidate?

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Botox will give a subtle change for your lid fold but may raise your eye brows moderately and the  result will be temporary. If you are looking for optimum result just for your eyelid folds, the best solution will be upper blepharoplasty with or without epicanthoplasty, but if you want both lid folds and brows top be raised, then the solution will be endoscopic forehead lift.

Somyos Kunachak, MD
Thailand Facial Plastic Surgeon
4.7 out of 5 stars 17 reviews

Repair of upper lids

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The primary goal upper blepharoplasty is to remove the "hooding" of the upper lids. This tends to give  a tired look. An upper blepharoplasty can remove the extra skin and a small amount of fat can give more of a refreshed appearance. The  epicanthal fold should be left alone. For examples of what can be accomplished with an upper blepharoplasty, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Two issues....

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You have mentioned two concerns here and I'll address each separately: 
1. You mention that you have hooded eyes and low brows. I agree with you that you have a low eyelid crease which extends medially into the "webbed" area [called epicanthal folds]. This does not allow your eyelid platform to be very visible. I do not necessarily agree that you have low brows however. You do not have an overly high, arched, eyebrow, but this is quite a normal variation. If you aesthetically prefer a higher arch to your brows, then botox would give you that subtle improvement.
If you would like get more of your eyelid platform to be visible, and the botox does not seem to give you enough of that, then a very conservative skin only blepharoplasty would improve the eyelid platform show.
This however, may make your webbing, slightly more pronounced.
I have attached a photo of a young patient [21 years old] for whom I performed a conservative blepharoplasty to improve her eyelid platform show

2. Webbing- as I mentioned above, this is technically called an epicanthal fold and is often present in the Asian or Native American ethnicity. It can be surgically improved, but as mentioned by others, it will leave a scar. I do not recommend surgery for this.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Do not consider eyelid surgery

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At  your age do not consider surgery for your eyes as you have nice proportions and symmetry.  If you want a 1 - 2 mm elevation of the eyebrows then consider botox.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Botox or surgery?

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I think it would be unwise to go for surgery before at least seeing what Botox can do first. For a relatively low cost and low risk procedure, you will have your answer, without committing straightaway to a relatively high cost and higher risk surgical procedure.

Roy Ng, FRCS(Plast)
London Plastic Surgeon

Look into microdroplet botulinum toxin.

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This method creates a forehead lift while preserving forehead movement.  Rena Wong, M.D. a plastic surgeon in practice in Normandy Park near SeaTac performs Microdroplet BOTOX in the Seattle area.  

I actually think you might benefit from being assessed for upper eyelid ptosis which is upper eyelid heaviness.  Typically when this is corrected, it is appropriate to also remove a small amount of upper eyelid skin.  Regarding the inner web, this is called an inside fold.  The web could be removed by this can leave visible scars on the face.  For this reason, removal of the medial epicanthal fold is not recommended.

Remember what you are looking for really is about aesthetics not about age.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.