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Dr. Dennis Bucko was recently asked to compare Botox, Dysport, Xeomin, and other neurotoxins versus eyelid surgery to treat hooding or drooping upper eyelids. His patient wanted to know whether periodic Botox or other neurotoxin injections would provide sufficient rejuvenating results or if they should consider having eyelid surgery or brow lift. Since Dr. Bucko thinks other patients may have the same question, he decided to address the answer in its own blog post.

Understanding What Botox Can Accomplish

Botox and all neurotoxins are designed to relax the facial muscles to reduce prominent wrinkles and sometimes to raise the lateral brow. In many cases, a drooping brow is responsible for causing the eyelid skin to droop and look heavy. Botox can be used to elevate the eyebrows by a few millimeters by relaxing the eyelid closure muscle (orbicularis), thereby lifting the sagging brow and eyelid skin, and making more of the upper eyelid crease visible. This helps the eyes look more awake and rested.

Small amounts of Botox are injected into the lower portion of the forehead, or “frown muscles,” and the outer tail of the eyebrow to relax the depressor muscle responsible for the eyebrow drooping (while keeping the elevator muscles responsible for raising the brow intact).

Keep in mind that Botox helps only when the eyelid drooping is due to a sagging brow (which is not always the case). In addition, the amount of upper lid drooping must be minimal. If a sagging brow is not responsible for the eyelid drooping, or the eyelid drooping is more pronounced, Botox cannot provide sufficient improvement.

Botox cannot treat puffiness due to excess fat or fine wrinkles in the eyelid skin. Furthermore, Botox can make the upper lid hooding worse if injected into the mid-forehead muscles allowing the forehead to sag even more. Botox does not stimulate or tighten muscles.

Also, Botox results are temporary, making it a short-term solution. Ultimately, upper eyelid and/or brow lift surgery are necessary to correct the drooping and provide long-term results.

Understanding What Eyelid Surgery Can Accomplish

Eyelid surgery offers deeper and more comprehensive restructuring to remove loose upper eyelid skin and improve the look of the lids. During the operation, excess skin is removed, the remaining skin is tightened and fat is often removed to deepen the eyelid fold. The muscles may be altered only if the lid is actually droopy. Making these anatomical changes leads to longer-lasting results.

Eyelid surgery can also address cosmetic concerns in the lower lids, such as excess fat, puffiness and loose skin, using similar techniques. In addition, eyelid surgery can be combined with other facial rejuvenation procedure such as Belladerma face or neck lift if skin in other parts of the face has started to sag or droop. Botox is not usually used in the lower lids.

Contact Dr. Dennis Bucko

If you feel bothered by the way your eyes look, the best thing to do is schedule a personal consultation with Dr. Bucko. With over 30 years of experience in facial rejuvenation, he can assess your case and recommend your best treatment option. Call (858) 453-8484 today to request an appointment.