Eyes are one of the first features people notice when they interact with you, so if your eyelids have begun to droop, you may be sending a message you don’t necessarily feel (tired, sad, old). So why do lids sag and pouches form as you age — and what solutions exist to help you look rested and refreshed?
First things first: Eyelid skin is the thinnest of all skin — and that has consequences. “Due to the thin layer of collagen and elastic tissue (which give the skin its strength and resiliency, respectively), gravity can stretch the skin over time,” says Dr. Arielle Kauvar, board-certified dermatologist, laser surgeon, MOHS surgeon, and founding director of New York Laser & Skin Care. She notes that this is a function of normal aging and can be more pronounced in some people than others.
In addition to gravity, droopy eyelids can result from repeated exposure to UV rays and pollution. “Chronic skin inflammation such as eczema and use of corticosteroid preparations in or around the eye can thin the skin further and promote eyelid droop,” Dr. Kauvar says.
But let’s return to that forever-problematic combo of gravity and aging: It causes a weakening of the levator muscles that elevate the lid, which in turn can create the rather unsightly protrusion of upper or lower eyelid fat pads — the latter commonly referred to as “bags.”
Yes, “the bags under the eyes are commonly caused by a protrusion of fat from within the eyelids — and this is fat we have our entire lives,” says Dr. Jacob D. Steiger, double-board-certified facial plastic surgeon at Steiger Facial Plastic Surgery in Boca Raton, Florida. “But, as we age, two major things happen to cause the lower eyelid fat to protrude: One, the ligament that holds this fat within our eyelids weakens, and, two, we lose volume (think: fat, bone, muscle) from around our eyes and cheeks.”
Correcting droopy eyelids for cosmetic reasons is perfectly understandable, but Dr. Kauvar notes other reasons beyond the desire to put your freshest face forward exist for seeking treatment. “The sudden development of a lid droop can be worrisome. Causes include damage to the muscle or nerves from disease or injury, diabetes, tumor, stroke, or autoimmune disease (myasthenia gravis),” she says. If you notice a sudden droop rather than one that develops over time (likely caused by aging), see a doctor immediately.
Solution #1: Topical Care
If sagging is minimal, using an over-the-counter cream could help firm up droopy eyelids. Dr. Kauvar recommends applying products that work to fend off free-radical damage and/or build up the skin’s elastin and/or collagen. Here are a few suggestions:
SkinCeuticals Serum 20 AOX+: The serum’s antioxidants — vitamin C, phloretin, and ferric acid — neutralize free-radical reactions from environmental damage, including UV exposure. Available at skinceuticals.com, $120.
Eau Thermale Avène YsthéAl Eye and Lip Contour Care: This cream contains retinaldehyde to help build depleted collagen. Available at aveneusa.com, $40.
SkinCeuticals A.G.E. Eye Complex: Blueberry extract aids in reducing advanced glycation end products that weaken existing collagen and elastin. Available at skinceuticals.com, $97.
Alastin Skincare Restorative Eye Treatment with TriHex Technology: The formula’s blend of peptides works to remove damaged proteins in the dermis; niacinamide reduces inflammation and peptides help stimulate collagen formation. Available at alastin.com, $85.
Solution #2: In-Office Treatments
If the droop of your eyelids is more advanced, an in-office treatment could help alleviate the issue. Dr. Kauvar points to Botox injections as a way to lift sagging eyebrow skin and eliminate crow’s feet at the same time, helping improve the appearance of the eye region.
If Botox isn’t your chosen path to less sag, she says, “Injections of the tear troughs (the under-eye hollows) with hyaluronic acid fillers can fill out areas that have lost fat and hide bulging fat pads under the eyes. Or injections of fillers in the temple will elevate the brows and decrease the appearance of sagging.”
Another treatment to pursue: CO2 Fractional Laser Resurfacing. “Used on the eyelid skin, it can build collagen and elastic tissue to tighten and rejuvenate the eye region,” she explains.
Solution #3: Surgery
However, if you seek impressive — and more permanent (more than 20 years!) — change, eyelid surgery (blepharoplasty) may be in the cards for you. Dr. Steiger notes that blepharoplasty has become one of the most common cosmetic surgical procedures — and for good reason: “It’s one of the most rewarding because the recovery is usually very easy, the downtime minimal, the results dramatic, and the effects long lasting,” he says.
Traditional blepharoplasty involves removing excess skin, muscle, and fat, and it is often performed on an outpatient basis. Small incisions (hidden in the eyelid crease and the crow’s feet for the upper eyelids, and inside the eyelid and occasionally under the lash line for the lower eyelid) allow a surgeon to augment the upper eyelid and reposition or remove fatty pouches on the lower eyelid. However, Dr. Steiger warns that removing too much fat can make the eyelid appear hollow.
“In most cases, instead of removing the fat, I reposition or place the fat back into the lower eyelid where it came from,” he says. From there, a surgeon may elect to fill in lost volume by injecting small amounts of fat taken from your own body, through a process called fat grafting. Possible risks of blepharoplasty include temporary blurred vision, dry eyes, noticeable scarring, and difficulty closing your eyes, so you should weigh the benefits and risks with a board-certified facial plastic surgeon during your consultation to decide whether the surgery is right for you.