How Botox can Help With Slightly Hooded Eyes, and When Eyelid Surgery is More Appropriate

How Botox can Help With Slightly Hooded Eyes, and When Eyelid Surgery is More Appropriate

Thank you for your question. You submitted photos of your eyes and you
are asking can Botox® help one eyelid in terms of hooding because one eyelid has more
hooding compared to the other. Well, I can certainly share with you my thoughts
about your photos and how I counsel my patients about the different strategies to help hooded
eyes. A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained
oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long
Island for over 20 years. I have been treating patients with Botox® since 1993. And I also
perform a lot of cosmetic surgery for hooded upper eyelids. So it’s very important, when
I meet a patient like yourself who comes with very similar types of concerns to help guide
them on what is the potential benefit and what are the limits. So to begin with, when I look at a person
like yourself, I can see that there is a difference in the facial volume between the two eye sockets
or skeletal structure and that’s perfectly normal. The human body is naturally asymmetric.
And so the right side, the brow is a little bit lower. The left side of the brow is a
little bit higher. And it appears that the right eye, the hooding, is a little greater
than the left. So there are certainly ways to try to enhance the balance. And you can
begin with by first understanding how does Botox® actually lift eyebrows. Now Botox® is a neurotoxin. Botox®, Dysport,
Xeomin are all neurotoxins, different types of botulinum toxins. And what they do is relax
the muscle strategically so that there is unopposed action of other muscles that can
occur so at least in the principle as it applies to brow lifting. So when you think of the
eyebrow position, there is a brow elevator called the frontalis muscle and then there’s
a brow depressor set of muscles and those muscles are the corrugator, procerus muscle
and the orbicularis oculi muscle. So you can strategically inject the depressors to get
the eyebrow to lift. Now the question is can that eyebrow lift
enough to make an impact on your upper eyelid hooding? Well an argument for trying it is
that Botox® is fairly safe. It works for a temporary period of time which is about
4 months. And you can see, if you get a little bit of elevation, if however, the amount of
hooding in your upper eyelid is so significant that even with Botox®, the eyelid doesn’t
come up or the eyebrow doesn’t come up to open up the eyelid, then you might want to
consider upper eyelid blepharoplasty. Now a lot of people who are afraid of surgery
will not even entertain the idea because when they think of surgery, they think of general
anesthesia. In our practice, we have overcome that obstacle
decades ago by developing systems and processes to do the procedures under local anesthesia.
And it’s very important to also help people deal with any types of anxiety and anticipation
so we also give a very light sedation. So that combination has been really successful. Another fear that patients will have is about
being overdone. Thanks to certain actors and certain people in media, people are very afraid
of looking surprised. And so that’s where we talk about the art of the procedure. And
even though I’m just going further developing the idea about hooding, it’s just important
to at least understand the options because my general perception from your photo is that
Botox® will not likely be enough. Going back to the revisional point of the
surgery, basically when I do my procedures, before I do them, I actually sit with the
patient and I do the drawings and planning with the patient. So they understand and we
decide together. Are we going to be conservative or are we going to be more aggressive? And
what are the desired outcomes? And the patients understand exactly what I’m going to do
by drawing them, we take photos, we have them sign the photos so that we know that we’re
all working with the same map and then we proceed with the surgery. I’m mentioning that because again, this
is often the case for many patients who come to me for cosmetic eyelid surgery is that
they often would try a lot of non-invasive things before they end up having eyelid surgery.
And what I think, what I perceive in modern times is that a lot of people are probably
over promising non-invasive procedures that don’t come close to achieving what needs
to be accomplished with eyelid surgery. It doesn’t stop them from trying. People try
different heating devices. People tried different types of lifting threads of various kinds
and ultimately, if there’s extra skin, there’s no getting around it, there’s extra skin.
But there is always a role for a combination of approach. As far as your question is concerned, you
can selectively reduce the activity of your depressor muscles on the side where the brow
is lower and see if that brow comes up enough to give you at least better symmetry. You
might find it a little bit strange because the muscles on the other side are going to
be working differently but that is not always an issue. Like I said, it’s worthwhile trying
because it is a drug that goes away. So if it doesn’t work or you don’t like the
way it affects you, well, just wait a few months and it’s gone. So learn of course about the option of the
Botox® brow lift approach as well as explore further the idea of limited cosmetic upper
eyelid blepharoplasty under local anesthesia with LITE™ sedation. I didn’t mention
to you that also, our procedures are done in our office under local anesthesia, LITE™
sedation, in our Joint Commission approved facilities. So for many patients who have
another hesitation about surgery is they don’t want to go to a hospital or major surgery
center where they may feel like they’re going to be treated like cattle. And so, in
an office setting, it’s a lot more private and you know the staff members. But to maintain
the same level of safety as a hospital or surgery center, we are certified by the Joint
Commission and we go through processes and protocols to ensure that there’s no difference
between how a patient is treated in our office facility compared to a typical ambulatory
surgery facility. So I hope that was helpful, I wish you the
best of luck and thank you for your question.


  • KathysBeautyCareChats says:

    Could you do a video on WHERE you inject the Botox for the brow lift? Thank you so much! Love your videos! xoxo!

  • KathysBeautyCareChats says:

    Thank you so much!!

  • Vi Haze says:

    "I've been in practice in Manhattan and Long Island for over twenty years" What the hell? You look like you're in your twenties.

  • audrey pistor says:

    If I knew someone to stay with in Manhattan I would differently come see you and have a procedure done by you. Can you help would you know anyone I can stay with? I know it sounds a little much however I feel from your videos I trust you…..Audrey new port richey florida

  • Maisy says:

    I would love for you to do my eyes…

  • Zara G says:

    Hello doctor I would like to know if have complications after Botox injections like drooping eyebrow Where I need inject Botox to improve complications. This area is good for inject Botox for lift eyebrow . Thanks .

  • Bee Bop says:

    I had Botox last week and now my eyes seem funny looking to me but I can’t put my finger on it what is different. Just my eyes look different…smaller, less vibrant. I guess I’ll have to suck this up as a mistake while the effects wear off. In the meantime, I’ll have to figure out if I’d rather smooth out my frown and forehead areas or have my eyes normal. 😔

  • Hannah G. Wiley says:

    Your videos are super helpful, and you are super cute!

  • Hannah G. Wiley says:

    I've been running into your videos for a year now. They are always super helpful, and you are super cute! I think I have a YouTube crush on you now.

  • sl dp says:

    Is the age of 20 okay for a upper eyelid surgery? What is the age where it’s usually okay.

  • Elizabeth Milhans says:

    I am 38 and have hooded eyes being half asian. Have you done surgeries for eyes like mine?

  • Meg Ro says:

    I have this issue and was considering surgery but I fixed it with the Botox brow lift as suggested and the plasma pen on my lid to tighten the excess bagging ❤️

  • Kat Shanks says:

    I have hooded eyes. 😞 Side Note: Can you bottle up whatever you are taking and/or doing? You look amazing! 🔥👌🏻

  • Cwsing 7 says:

    Lovely hair sir but not a great haircut

  • Susan Chavez says:

    Dr. Prysad, can you help me? I'm from and still reside in Colorado.

  • srbija_xDD says:

    instead of botox that just last temporary, can you graft fat instead ? for lift the eyebrow ?

  • Luiz says:

    Shame he’s not in the UK

  • FloridaLovin69 says:

    I have hooded eyes now because of my age..How much is this procedure?

  • Nejun14 Nejun_14 says:

    Is health care covered or do u have to pay for it ?

  • Dorian Smith says:

    I have hooded eyes and other things I'd like to fix that come with aging… However, I have Ehlers Danlos Syndrome, therefore; my skin acts up and I scar differently. I'd be absolutely horrified if I develop unusual scaring in place of my hooded eyes. 😔 Adding Insult to injury…
    I want to try Botox, however; EDS likes to be accompanied by multiple obscure allergies. With my luck I'll be allergic and my forehead will become necrotic. (I know, dramatic… but my luck works like that. )
    I'm still going to have a consultation though. Maybe I'll get lucky and find a practitioner familiar with EDS. 🤷🏽‍♀️

  • Shulagna Roy says:


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