Sagging eyelids are usually associated with advancing age, but the truth is, many different underlying conditions may affect the appearance of the eyes. As Dr. Gaborieau has mentioned, getting plenty of sleep, adequate hydration, and avoidance of salt may help some of the common causes of sagging eyelids. Other important ones are allergies, and chronic edema or swelling that is non-allergic in nature.
In the case of the upper eyelids, BOTOX injections placed correctly can result in a slight elevation of the brow, and consequently raise the skin of the upper eyelid to "open up" the upper eyelid area. These results are not consistent, and may vary between patients. Certain amounts of droop in the brow, or excessive skin in the upper lids, may have to be corrected surgically.
In the lower lids, several other factors come into play. Some of the first signs of aging are seen in the lower eyelid area resulting from a decrease of fat under the skin of the lower eyelid. This exposes not only the bone of the eyesocket, creating a "tear trough deformity", but in some cases may expose the normal fat of the lower eyelid, resulting in the appearance of lower lid "bags".
It is essential for the treating physician to recognize this condition prior to recommending removal of fat. Such surgical treatment can lead to hollowing and a gaunt appearance postoperatively.
While surgery and fat removal certainly have a place in lower eyelid bag treatment, younger patients with loss of fat in the lower lids benefit most from addition of volume in this area. Volume can be added with fat grafting, or simpler procedures such as Restylane injections. This is a treatment we call "Thirties Eyelift" in my practice. Restylane injections can be done with mild discomfort in the office, and some of my patients have had their results last up to one year with a small touch up.
