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.