Best approach for chronically/genetically heavy eyes? (Photo)

I feel like my eye bags are so prominent, am airline might charge me a fee. Since I was a young kid, people ask if I'm tired or sad. They LOOK and FEEL heavy 100% of the time. I don't want a crazy overhaul, just to look awake and young - while I still can! Is Botox/fillers enough or do I need to take it a step further? This is all I see when I look at the mirror. It's definitely more pronounced than the photos let on.

Doctor Answers 8

Tired and sad appearance of eyes.

A lower blepharoplasty and removal of fat with repositioning is what you need for your lower eyelids. Your upper eyelids may need a mini brow lift. I would advise against an upper lid blepharoplasty. Very often this changes the persons look when they need a mini four head left instead. That will not change your look and will make your upper lids look less 

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews


The best way to determine what is best for you is to see a physician in person. You should see a board certified plastic surgeon in your area to discuss your options.


Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Heavy eyelids and best treatment

Thank you for posting your photo.  I have a great deal of patients who come to my office for fillers or Botox for this area.  In your case I would refer you to an excellent oculoplastic surgeon to help remove some of the excess skin.  After the procedure you would be an excellent candidate for some "baby" Botox to remove the fine lines and Belotero under the eyes for the tear trough area if that area was still of concern.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 74 reviews

Treatment of Heavy Eyes

The bags of your lower eyelids are a common inherited characteristic, especially in females. It is difficult for me to clearly see the contour of your eyelids but this is treated by removing the protruding fat through an incision on the posterior surface of the lids or combining this with placement of some this fat in depressions at the lower margin of the lid if a groove is present.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Heavy eyes - best treatment approah

For heavy eyes due to excessive lower eyelid fat herniation there are a couple of choice. One approach would be to camouflage the herniated fat with filling the tear trough. A dermal filler like restylane or juvederm is good. A more permanent solution is a lower eyelid blepharoplasty with transposition and superficial laser resurfacing. 

Jose E. Barrera, MD, FACS
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Best approach for chronically/genetically heavy eyes

Your upper eyelids have some redundant skin.  Do not use Botox or fillers.  You should consider an upper eyelid blepharoplasty.  Leave your lower eyelids alone.

Kenneth D. Christman, MD
Dayton Plastic Surgeon
5.0 out of 5 stars 1 review

Best approach for chronically/genetically heavy eyes?

You have two options. Non surgical like fillers & Botox vs surgical as in blepharoplasty. Only in person opinions count... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Heavy eyes, lids, brows

Dear KikiBaker:

Thank you for sharing your photos.

Eyelid surgery is a common request for today’s patients. Depending on whether the problem is attributed to the Upper Eyelid, the Lower Eyelid or the Brow and Forehead, the options are different.

Some points to consider include:

Upper eyelid skin excess causing visual obstruction to surrounding features or simply to look better could require a upper eyelid lift or blepharoplasty (with or without removal of the fat bags) to create a more open and appealing eye and return to a more youthful appearance.

In our practice, 50% of patients show concern for the upper eyelid excess particularly along the outer sides of the eye brow. This is called “hooding” and may also obstruct vision but is attributed to “drooping” of the brow and forehead.

If the one or both upper eyelids themselves droop to the point of covering the pupil (black spot in the middle of the eye; it is called “ptosis”. This is a functional problem from trauma, tumor or disease will need an evaluation for proper repair.

Usually, lower eyelid surgery is performed cosmetically to reduce the fat bags which develop under the eyes and / or for the overlying loose or crepey skin.

Lower eyelids which are rounded or loose from the eye itself may contribute to an open but unnatural appearance of the eye region and contribute to irritation, dryness and irritability.

It is best to undergo an evaluation and correct diagnosis of your eyelid concerns with a Board Certified and well experienced Plastic Surgeon or Ophthalmologist. Your desires can be addressed with cosmetic and / or reconstructive surgical and sometimes non-surgical (for example, botox or filler) options.

I hope this was helpful! Good luck and Happy New Year!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 82 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.