What's causing drooping? What can I have done to fix this?

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment- especially since there are no pictures included here. There are both surgical and non-surgical options to correct excess upper eyelid skin, depending on the situation.

For less significant upper eyelid skin excess or more mild improvement, there are nonsurgical treatments: Radiofrequency (Thermage or Venus Legacy/Viva), injectable fillers, and a Botox brow lift can help contour the eyebrows and lift the eyelid skin.

Surgery (browlift and/or upper blepharoplasty) is a great option for more significant improvement- for example if the hooded eyelids have more excess skin present.

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

Your photographs apparently did not come through on your post. The skin of everybody’s upper eyelid can appear to become more prominent after weight loss and aging, However, the issue is actually not an increased amount of skin, it’s deflation of the volume underneath the skin of the upper eyelid that makes the skin look loose and hang. For most people a skin only blepharoplasty, maintaining all the volume underneath the skin, rejuvenates the upper eyelid by maintaining the full, plush volume that is the hallmark of youth. You’re asymmetry is not surprising as virtually everybody is asymmetric in their appearance. I doubt Botox of your crows feet would worsen this, as usually this elevates the lateral portion of the brow and reduces the appearance of excess skin in the upper lids. A skin only blepharoplasty of your upper eyelids can be done in the office, under locally anesthesia and has a very rapid easy recovery. Speak to your plastic surgeon about this option. Best wishes.

Hello,

Thank you for your question and for sharing your concerns.

Regarding the excess upper eyelid skin that is more noticeable on one side, it is important to consider whether you also received Botox treatment to the forehead. Treatment to the forehead can weaken the frontalis muscles, which are responsible for raising the eyebrows. This weakening can result in a lower position of the eyebrows, making the excess upper eyelid skin more noticeable, even if you only had Botox treatment to the crow’s feet area.

If you did receive Botox to the forehead, this could explain the asymmetry and the increased visibility of the upper eyelid skin. As the effects of Botox wear off, the position of your eyebrows should return to their normal state. In the future, it might be advisable to either avoid Botox treatment to the forehead or use a lower dosage to prevent this issue.

I recommend waiting for the Botox to completely wear off to see if the excess upper eyelid skin becomes less noticeable. If the asymmetry persists or you have further concerns, consider consulting with your practitioner to discuss alternative treatment options or adjustments to the dosage.

Unfortunately the photos you submitted did not post. Depending on the location of your Botox injections, a droopy eyelid could result. This effect is temporary and will improve over time. If it is unrelated to Botox there are several treatments to refresh the eyes depending on the cause. See a board certified plastic surgeon near you to learn more.

Droopy eyelids are almost always genetic. If you have Botox in your forehead, it can make the drooping look much worse. I do I do laser blepharoplasty to treat this with great success using the type of treatment in 1000's of patients over the past 20+ years.

Unfortunately, there are no pictures so we can’t begin to make an assessment.
Botox can potentially lower the eyelid if it’s inappropriately injected, causing weakness to the levator muscle.
This usually causes a fairly dramatic response which becomes obvious within a short amount of time.
Botox treatment of the frontalis muscle can also lower the brow position which can in turn cause fullness in the upper eyelids.
I suggest having a few in person consultations with either plastic surgeons or oculoplastic surgeons in your community.
For unilateral upper eyelid, position issues an oculoplastic surgeon may be the preferred provider.
If you have concerns about the outcome of your Botox treatment, then follow up with your provider.
Best,
Mats Hagstrom MD