If extra skin is folding down over your upper eyelid, Botox can’t remove it. Only eyelid surgery takes skin away. Botox relaxes muscles, so it’s good for lines around the eyes and can sometimes lift a low brow a little, which can make mild hooding look better for a few months. The cause of your hooding decides which one will help.
We hear this question a lot, usually from someone who has noticed eyeshadow disappearing into a crease by lunchtime, or who looks tired in photos when they don’t feel tired. It’s a fair question. One option is a ten-minute appointment and the other is surgery, so it makes sense to want to know whether the quick one will do.
What causes hooded eyelids?
There are three usual reasons, and many people have more than one.
The first is extra skin on the upper lid. Skin loses elasticity as we get older, and the thin skin of the eyelid shows it early. The extra skin settles into a fold that sits on the lashes or covers the crease.
The second is fat. The fat that cushions the eye can push forward with age, giving a puffy upper lid or bags underneath.
The third is the brow. When the eyebrow sits lower than it used to, it pushes the skin beneath it down onto the lid. Some people are simply born with a fuller, heavier lid, too.
A quick way to see this for yourself: look in a mirror and gently lift your eyebrow with a fingertip. If the hooding mostly disappears, the brow is a big part of it. If there’s still a fold of skin sitting on the lid, extra skin is part of it as well.
What can Botox do for the eye area?
Botox works by relaxing specific muscles for a few months. Around the eyes, it’s used for crow’s feet at the outer corners, the frown lines between the brows, and horizontal forehead lines. You can read more on our Botox page.
Because some muscles pull the brow down and others pull it up, an experienced injector can sometimes relax the downward pull so the outer brow sits slightly higher. For someone whose hooding is mostly a low brow, and only mild, that small change can open the eye a bit.
What Botox can’t do is shrink or remove skin, or move fat. If the fold is made of extra skin, relaxing a muscle won’t make it go away.
The appointment itself takes about ten to fifteen minutes, with no downtime. You’ll start to see the effect in three to ten days and the full result in about two weeks. It lasts about three to four months, and then you’d need to repeat it to keep the look.
What does eyelid surgery do?
Eyelid surgery, or blepharoplasty, removes extra skin and fat and tightens the muscle around the eye. It can be done on the upper lids, the lower lids, or both. For the upper lid, the incision is placed in the natural crease, so once it has healed it tends to sit in the fold where it’s hard to see.
At Bellava, Dr. Chang Soo Kim, a plastic surgeon certified by the American Board of Plastic Surgery, performs it in our accredited surgical suite in Bedford Hills. It’s outpatient, so you go home the same day. More detail is on our eyelid surgery page.
What is recovery from eyelid surgery like?
Expect bruising and swelling for about seven to ten days. Most people plan to stay home and keep things quiet for that stretch, and save social plans and important photos for later. Dr. Kim will give you specific instructions for your eyes, and it’s worth following them closely, because the skin there is thin and heals best when it’s left alone.
The result is longer lasting than Botox, because tissue has actually been removed. Your face keeps ageing afterwards, of course, so good skin care still matters.
So which one should I choose?
Botox is worth trying first if your hooding is mild, the brow is the main reason, and you’re mostly bothered by lines around the eyes. It’s quick, needs no recovery, and you can stop if you don’t like it.
Eyelid surgery makes more sense if there’s a visible fold of extra skin on the lid, if the lid feels heavy, or if puffiness and bags are part of the picture. No injection can reach those.
They also work together. Some patients have eyelid surgery and then keep up Botox for crow’s feet and frown lines, because the surgery doesn’t change how those muscles move.
Frequently asked questions
Can Botox fix droopy eyelids?
Botox can lift a low brow slightly, which can help mild hooding. It can’t remove extra eyelid skin. If the eyelid itself is drooping, rather than the skin above it, see a doctor, because that can have other causes.
Is upper eyelid surgery painful?
You’ll have anesthesia during the operation. Afterwards, most people describe the eyes as tight, swollen and sore rather than very painful. Dr. Kim will go over what to expect and how to manage it at your consultation.
How long does Botox around the eyes last?
Usually three to four months. After that the muscles start moving again and the lines come back, so it’s repeated if you want to keep the effect.
Can I have upper and lower eyelid surgery at the same time?
Yes, the upper lids, the lower lids or both can be treated. Dr. Kim decides at your consultation which areas would actually help.
How much does eyelid surgery cost?
There’s no set price, because it depends on which lids are treated. Dr. Kim gives you a quote at a free consultation, and it covers the surgeon, anesthesia and the facility together.
Book a consultation in Bedford Hills
If you’re not sure whether your hooding needs surgery or an injection, come in and let us look. At Bellava MedAesthetics & Plastic Surgery Center in Bedford Hills, Dr. Chang Soo Kim offers a free consultation for eyelid surgery, and our injectors can talk you through Botox. Call or text (914) 809-9693 to book.