Can Botox be used to maintain natural eyelid hooding?

Question

I have always had hooded eyelids, like Kathleen Turner. Since getting glabella Botox, my eyelids have lost the hooding. My injector has tried the trick of putting a unit over the peak of my brows, which only helps a little. I'm in my 60s. Is there a way to get Botox and maintain natural eyelid hooding?

Ella Fedonenko, MD · Answer

I recommend trying to inject more Botox into orbicularis oculi muscles. I would try 2-2.5 units on each side.

Anil R. Shah, MD · Answer

When Botox is injected into the glabella complex (procerus + corrugators), it not only softens frown lines  it also reduces the downward pull on the inner brows.

In some people, this creates a lift in the medial brow.

That lift can make hooded eyelids look less hooded, or even slightly expose more lid than before.

Erik Peterson, MD · Answer

Hi! Dr. Peterson here &mdash;
What you’re describing happens because Botox in the glabella (the frown lines between the brows) can subtly change how the forehead and brow muscles interact, leading to less brow depression and a more “open” upper eyelid look. Some patients love that lift, but if you’ve always had a natural hooding and prefer to maintain it, dosing and placement become very important.
A few options: • Lower dosing in the glabella can sometimes minimize that lifting effect. • Strategic placement (avoiding too much lateral spread) can preserve some of your natural brow position and hooding. • In certain cases, leaving small muscles active helps maintain your natural look while still softening lines.
At your age, eyelid and brow changes can also be related to skin and tissue laxity, so it’s not only about Botox. A board-certified dermatologist or dermatologic surgeon can individualize the treatment so you keep the look you want while still treating wrinkles safely.

Lexie Wang, MD · Answer

It's interesting you want hooding bc most people don't... however, if you do want that, then you want to make sure you get some botox to the frontalis muscle (forehead) because that will partially paralyze your brow lifting muscles, and if you are getting glabella botox that does 'lift' your brows.

Anna Chacon, MD, FAAD · Answer

Botox can sometimes alter the appearance of the eyelids and brows by changing how the muscles pull in the area. In patients with naturally hooded eyelids, Botox placed in the glabella or forehead can lift the brows slightly, which may reduce or change the natural hooding. While small adjustments in technique—such as adding units to the lateral brow—can help, there is no guaranteed way to preserve the exact natural hooding effect with Botox. If maintaining your natural eyelid appearance is a priority, careful dose adjustments and precise placement are key. In some cases, alternatives to Botox or different injection patterns may be more suitable.

Behnoush Zarrini, MD · Answer

Botox can create subtle changes around the brows and eyelids, but it cannot truly “maintain” natural eyelid hooding. What’s happening in your case is that Botox in the glabella or forehead relaxes muscles that normally pull the brows downward. When those muscles are weakened, the brows can sit slightly higher, which makes the eyelids appear less hooded.
For patients who want to preserve or even emphasize a hooded eyelid appearance, it’s important for the injector to be conservative and very precise with dosing in the brow and forehead region. In some cases, avoiding Botox in the lateral forehead altogether may help, since this area contributes to brow lift when relaxed.
Ultimately, Botox is best at softening lines and balancing brow position, but not at restoring or preserving natural eyelid hooding. If maintaining a certain eyelid look is the priority, careful technique or alternative treatments may be a better fit. An in-person consultation allows us to customize placement to your exact goals.

Michael Chung, MD · Answer

It is difficult to give a precise answer without an in-person examination, but your question raises an important point about the balance between the brows and the upper eyelids. Botox in the upper third of the face typically relaxes muscles that elevate the brows, which can slightly lower them. In patients with preexisting excess skin of the upper eyelids, called dermatochalasis, even small changes in brow position can alter how the eyelid hooding appears.
At your age, you may be a candidate for procedures such as upper eyelid surgery (blepharoplasty) or, in some cases, repositioning of the brow. These procedures can restore a more natural balance between the eyelids and brows and give a longer-lasting improvement than Botox adjustments alone.
The best next step is to consult in person with a board-certified plastic surgeon who can assess your anatomy and advise you on whether surgical or non-surgical approaches will give you the most natural and satisfying result.
Sincerely,Michael Chung, MDPlastic and Reconstructive Surgery

Camille Cash, MD · Answer

Botox can help with brow positioning.  While Botox can provide a conservative brow lift, it can also create more of a "heavy" brow if desired.  Make sure to visit with an experienced injector to discuss your desired look.

Can Botox be used to maintain natural eyelid hooding?

Answers (8)

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